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1 Feeling the Heat ?- Drink but Don't Exercise Advice
Updated: 21 Jul 2014

the Telegraph reports that many public sector workers will be wearing shorts to work today, following an appeal from

unions including Unite to let workers ‘dress down for summer’.

The appeal was made in recognition of the heatwave that yesterday saw some parts of the UK become warmer than

Barbados. Today temperatures are expected to reach up to 32C in sheltered areas.

Public health officials have warned that Muslims fasting for Ramadan should be particularly careful. Public Health England

has also advised people to avoid venturing outside and to ‘eat salad, drink plenty of water and avoid extreme physical


2 The Causes of being Overweight
Updated: 16 Jul 2014

What Causes Overweight and Obesity?

Lack of Energy Balance

A lack of energy balance most often causes overweight and obesity. Energy balance means that your energy IN equals your energy OUT.

Energy IN is the amount of energy or calories you get from food and drinks. Energy OUT is the amount of energy your body uses for things like breathing, digesting, and being physically active.

To maintain a healthy weight, your energy IN and OUT don't have to balance exactly every day. It's the balance over time that helps you maintain a healthy weight.

  • The same amount of energy IN and energy OUT over time = weight stays the same
  • More energy IN than energy OUT over time = weight gain
  • More energy OUT than energy IN over time = weight loss

Overweight and obesity happen over time when you take in more calories than you use.

Other Causes

An Inactive Lifestyle

Many Americans aren't very physically active. One reason for this is that many people spend hours in front of TVs and computers doing work, schoolwork, and leisure activities. In fact, more than 2 hours a day of regular TV viewing time has been linked to overweight and obesity.

Other reasons for not being active include: relying on cars instead of walking, fewer physical demands at work or at home because of modern technology and conveniences, and lack of physical education classes in schools.

People who are inactive are more likely to gain weight because they don't burn the calories that they take in from food and drinks. An inactive lifestyle also raises your risk for coronary heart disease, high blood pressure, diabetes, colon cancer, and other health problems.


Our environment doesn't support healthy lifestyle habits; in fact, it encourages obesity. Some reasons include:

  • Lack of neighborhood sidewalks and safe places for recreation. Not having area parks, trails, sidewalks, and affordable gyms makes it hard for people to be physically active.
  • Work schedules. People often say that they don't have time to be physically active because of long work hours and time spent commuting.
  • Oversized food portions. Americans are exposed to huge food portions in restaurants, fast food places, gas stations, movie theaters, supermarkets, and even at home. Some of these meals and snacks can feed two or more people. Eating large portions means too much energy IN. Over time, this will cause weight gain if it isn't balanced with physical activity.
  • Lack of access to healthy foods. Some people don't live in neighborhoods that have supermarkets that sell healthy foods, such as fresh fruits and vegetables. Or, for some people, these healthy foods are too costly.
  • Food advertising. Americans are surrounded by ads from food companies. Often children are the targets of advertising for high-calorie, high-fat snacks and sugary drinks. The goal of these ads is to sway people to buy these high-calorie foods, and often they do.

Genes and Family History

Studies of identical twins who have been raised apart show that genes have a strong influence on a person's weight. Overweight and obesity tend to run in families. Your chances of being overweight are greater if one or both of your parents are overweight or obese.

Your genes also may affect the amount of fat you store in your body and where on your body you carry the extra fat. Because families also share food and physical activity habits, a link exists between genes and the environment.

Children adopt the habits of their parents. A child who has overweight parents who eat high-calorie foods and are inactive will likely become overweight too. However, if the family adopts healthy food and physical activity habits, the child's chance of being overweight or obese is reduced.

Health Conditions

Some hormone problems may cause overweight and obesity, such as underactive thyroid (hypothyroidism), Cushing's syndrome, and polycystic ovarian syndrome (PCOS).

Underactive thyroid is a condition in which the thyroid gland doesn't make enough thyroid hormone. Lack of thyroid hormone will slow down your metabolism and cause weight gain. You'll also feel tired and weak.

Cushing's syndrome is a condition in which the body's adrenal glands make too much of the hormone cortisol. Cushing's syndrome also can develop if a person takes high doses of certain medicines, such as prednisone, for long periods.

People who have Cushing's syndrome gain weight, have upper-body obesity, a rounded face, fat around the neck, and thin arms and legs.

PCOS is a condition that affects about 5–10 percent of women of childbearing age. Women who have PCOS often are obese, have excess hair growth, and have reproductive problems and other health issues. These problems are caused by high levels of hormones called androgens.


Certain medicines may cause you to gain weight. These medicines include some corticosteroids, antidepressants, and seizure medicines.

These medicines can slow the rate at which your body burns calories, increase your appetite, or cause your body to hold on to extra water. All of these factors can lead to weight gain.

Emotional Factors

Some people eat more than usual when they're bored, angry, or stressed. Over time, overeating will lead to weight gain and may cause overweight or obesity.


Some people gain weight when they stop smoking. One reason is that food often tastes and smells better after quitting smoking.

Another reason is because nicotine raises the rate at which your body burns calories, so you burn fewer calories when you stop smoking. However, smoking is a serious health risk, and quitting is more important than possible weight gain.


As you get older, you tend to lose muscle, especially if you're less active. Muscle loss can slow down the rate at which your body burns calories. If you don't reduce your calorie intake as you get older, you may gain weight.

Midlife weight gain in women is mainly due to aging and lifestyle, but menopause also plays a role. Many women gain about 5 pounds during menopause and have more fat around the waist than they did before.


During pregnancy, women gain weight to support their babies’ growth and development. After giving birth, some women find it hard to lose the weight. This may lead to overweight or obesity, especially after a few pregnancies.

Lack of Sleep

Research shows that lack of sleep increases the risk of obesity. For example, one study of teenagers showed that with each hour of sleep lost, the odds of becoming obese went up. Lack of sleep increases the risk of obesity in other age groups as well.

People who sleep fewer hours also seem to prefer eating foods that are higher in calories and carbohydrates, which can lead to overeating, weight gain, and obesity.

Sleep helps maintain a healthy balance of the hormones that make you feel hungry (ghrelin) or full (leptin). When you don't get enough sleep, your level of ghrelin goes up and your level of leptin goes down. This makes you feel hungrier than when you're well-rested.

Sleep also affects how your body reacts to insulin, the hormone that controls your blood glucose (sugar) level. Lack of sleep results in a higher than normal blood sugar level, which may increase your risk for diabetes.

For more information, go to the Health Topics Sleep Deprivation and Deficiency article.

3 Alzheimers Cases could be Reduced by Healthier Lifestyles
Updated: 15 Jul 2014

As many as a third of Alzheimers cases could be prevented by leading a healthier lifestyle, meaning 200,000 fewer cases in

the UK by 2050, according to a new study in the Lancet Neurology.

The BBC reports that a Cambridge based team used population data to identify the seven greatest risk factors, including:

diabetes, mid-life hypertension, mid-life obesity, physical inactivity, depression, smoking and low-educational attainment.

 Professor Carol Brayne, from the Institute of Public Health at the University of Cambridge, said: ‘Although there is no single

way to treat dementia, we may be able to take steps to reduce our risk of developing dementia at older ages.’

4 Six Health Myths
Updated: 13 Jul 2014

Don't swallow it: Six health myths you should ignore

(Image: Peter Dazeley/Getty)

We are constantly being bombarded with health advice, but not all of it is based on rigorous evidence.

New Scientist debunks six common myths


Drink eight glasses of water per day

Too much of a good thing? <i>(Image: Macie J. Toporowicz/Getty)</i>

This myth just won't go away, but the truth is no one even knows where it came from.

And why pure water, not tea or juice?
Read more


Sugar makes children hyperactive

Rocket fuel? <i>(Image: JoKMedia/Getty)</i>

Many parents are utterly convinced that eating sugary foods makes their kids bounce off the walls.

They're wrong
Read more


Our bodies can and should be 'detoxed'

Cleaning fluid? <i>(Image: Matej Pribelsky/Getty)</i>

There are all kinds of programmes and products designed to help us "detox".

Do we need them and do they work?
Read more


Antioxidant pills help you live longer

Radical therapy <i>(Image: Matej Pribelsky/Getty)</i>

The evidence is in: popping pills containing antioxidants such as vitamin A and E doesn't help you and may be harmful
Read more


Being a bit overweight shortens life

When should you start worrying? <i>(Image: Bryan Mullennix/Getty)</i>

Carrying just a few extra pounds, far from being a one-way ticket to an early grave, seems to deter the grim reaper
Read more


We should live and eat like cavemen

The most searched-for diet earlier this year was (Image: Adri Berger)" />

Our bodies evolved for eating the food our ancestors could catch or gather, not stuff grown on farms.

So the "paleo diet" has got to better for us, hasn't it?
Read more

5 No Out of Hours GP ? -Dial 111 or Funeral Parlour for Last ? Rights
Updated: 11 Jul 2014

Recruitment crisis leaves 60% of out-of-hours providers unable to fill gaps in GP rotas


The GP recruitment crisis is hitting out-of-hours providers who are struggling to fill shifts and meet national quality requirements because GPs are too ‘punch-drunk’ exhausted to work beyond their regular hours.

The Out-of-hours GP services in England report by the National Audit Office – released today – found that 59% of OOH providers had unfilled rotas from September to December last year, while one in four providers were unable to meet quality targets around responding to urgent cases.

The NAO said that these problems ‘often related to staffing’, as recruiting out-of-hours GPs had become ‘more difficult’ due to increased in-hours workloads and the rising costs of indemnity insurance.

Out-of-hours leaders told Pulse that even attracting agency staff is becoming more difficult, while the GPC said that GPs are too ‘punch drunk’ to work out-of-hours shifts.

It comes after Pulse has reported that some CCG leaders have had to inject extra cash to support out-of-hours services due to major problems with filling out-of-hours shifts.

The NAO, which is the Government’s official auditing body, looked into out-of-hours services between September and December last year.

It found that generally the quality of provision remained high, but 26% of providers failed to comply with the target to triage 90% of urgent cases within 20 minutes.

The report states that missed responsiveness targets were ‘often related to staffing.’

It says: ‘Sometimes providers failed to roster enough clinicians during peak periods, for instance over bank holiday weekends. More generally, providers told us that recruiting and retaining enough GPs was difficult.’

The report adds: ‘The providers we interviewed preferred to employ local GPs who were familiar with local health services. But not all local GPs want to work out-of-hours. Some providers said it was getting harder to attract GPs for a number of reasons.’

These included a ‘general rise in in-hours’ workload for GPs, as well as the increased cost to of indemnity insurance which ‘providers reported has markedly increased in the last two years’ and has led to some health bodies having to support GPs to obtain indemnity.

The report explains that despite the large number of providers reporting gaps, 98% of rota hours are filled.

But Dr Emma Rowley-Conwy, chair of the SELDOC out-of-hours provider in south-east London, said they are increasingly dependent on agency workers to cover gaps.

She told Pulse: ‘Generally, yes it is difficult to recruit, yes we have gaps in our rota. Yes, we are now actually even struggling to achieve our [National Quality Requirements] and this is impacting on our NQR performance.’

‘Sometimes [we can’t even get agency cover] and we’re just not able to fill the shifts at all. We’re using agencies a lot more, but then on Friday nights somebody might ring and say “I’ve cancelled I’m sick” and then it does actually fall apart.’

‘We’re making use of text a lot to try and get GPs, but they are exhausted. If they’ve already done a lot of work in their practice, then they don’t want to come and work out of hours.’

She said that the problem in the long term is a shortage of doctors overall.

Dr Peter Holden, GPC lead on urgent and emergency care and a GP in Matlock, Derbyshire told Pulse that the spiralling cost of indemnity fees meant that out-of-hours work financially unviable for many GPs.

Dr Holden told Pulse: ‘The bottom line is, it’s not surprising. This is the market at work, once you get to about 30 sessions a year; if you work anymore you’ve got to work to about 50, for nothing, just to pay the indemnity premium. It’s a huge problem.’

‘The other problem is that out-of-hours services are struggling because… [they] are actually punch drunk from a day’s work.’

‘We’re just knackered from a day’s work. We can’t then go and work out of hours. So therefore there are fewer of us working for it and the price has gone up.’

An NHS England spokesperson said: ‘NHS England welcomes the report and will consider it carefully and respond fully in due course.  We are confident that the new out-of-hours assurance process brought in earlier this year (March 2014) is robust and has addressed many of the issues outlined by the National Audit Office.’

‘We will however carry on developing processes to ensure patients continue to receive high quality care and access to a GP outside of surgery hours.’

6 Breaking- NHA party on BBC Radio 4 -8pm tonight 9th July
Updated: 09 Jul 2014
NHA Party news
The Moral Maze on BBC Radio 4 tonight at 8pm will be discussing 'The Future of the NHS'.

Dr Louise Irvine, NHA Executive member and Chair of the Save Lewisham Hospital Campaign will be on the panel.

Don't miss it!

The NHA Campaign Team

7 NHS Waiting Times Are Depressing - And The Coalition Is Incompetent
Updated: 06 Jul 2014

Waiting times for common operations have risen steeply under the Coalition, despite a pledge by David Cameron to bring

them down, The Guardian reports.

Hernia patients now wait 10 days longer than in 2010, patients wait 14 days longer to get their adenoids removed, and 15

days longer to have their tonsils removed, NHS data reveals.

Katherine Murphy, chief executive of the Patients Association, said: ‘While we appreciate the financial squeeze in the NHS, it

cannot be at the cost of patient care and should not mean that patients are suffering, as these figures suggest that they are.’

8 The NHS Parasites
Updated: 06 Jul 2014

The competition watchdog Monitor has come under fire by ministers for spending too much on senior managers and

management consultants, and for just 21 out of its 337 staff having ever worked in the NHS.

The Telegraph reports a Commons Public Accounts Committee report has damned the regulator for having more than 30

managers on £100,000 or more, and for spending a fifth of its budget on management consultancy services.

PAC Chair Margaret Hodge said: “[Monitor’s] effectiveness is undermined by a lack of frontline NHS experience. It is

currently spending £9 million a year out of its £48 million budget on consultants to fill gaps in expertise.’

9 NHS Bosses put Cancer Services Out to Private Tender
Updated: 03 Jul 2014

The Guardian’s front page today leads with the news that four Staffordshire CCGs are putting cancer services worth more almost £700m out to tender.

It said that a ‘host’ of private healthcare firms have already expressed interest in securing the ten-year contract.

The CCGs itself said it was not about ‘privatising’ services

10 Unite Union Fighting to Save the NHS
Updated: 02 Jul 2014

A fight we can’t afford to lose

Wednesday 2nd
posted by Morning Star in Features

Unite will be doing its utmost to ensure our NHS is saved from those who want to sell it off, writes SHARON GRAHAM

THE NHS matters to all Unite members. We take free, publicly provided healthcare for granted — we pay tax and the

government provides a universal health service. 

We rely on the NHS, for ourselves and our families. We expect everyone to be treated equally, regardless of how much

money they have. We don’t pay to see a doctor or go to the hospital. 

If we have a problem, we get treated. We don’t worry about whether we can afford it or whether the nurses, doctors or

consultants are doing anything other than trying to make us better. 

This is changing and fast. Our NHS is under attack like never before. This government has an agenda — cuts, privatisation

and making patients pay for treatment. 

Soon the size of your wallet could determine the treatment you get. 

It is not exaggerating to say that if we do nothing, in 10 years our health service in England will be like the energy market —

expensive, profit-driven and in the grip of a handful of private companies and their shareholders. 

Already government cuts are biting. Over 7,000 NHS clinical staff have been made redundant and more than half of the

maternity units in the UK are being forced to put lives at risk due to inadequate cover. 

But it is the NHS sell-off, driven by the 2012 Health and Social Care Act, that is changing the face of our health service


Wholesale privatisation beckons, with over 70 per cent of contracts for NHS services being won by private companies and

the first NHS hospital being privatised at Hinchingbrooke. 

Unsurprisingly, private companies driven by the profit motive have not all delivered services in the interest of patients. 

Harmoni, which was awarded the contract to operate the NHS urgent advice telephone service 111, has been heavily

criticised and reports suggested at least three people may have died due to flaws with the service. 

Serco was bailed out of a contract for supplying out-of-hours GP services in Cornwall following sustained criticism, failure

to meet national standards and accusations of falsifying data. 

With a further £20 billion contract bonanza predicted, it is perhaps unsurprising that private interests are busy buying

political favour. 

Six Cabinet ministers, 17 other government ministers, the current Health Secretary and two former health secretaries — as

well as dozens of MPs and lords — all have financial links to private healthcare. They can all vote on health legislation —


The influence of private companies does not stop there. The new head of NHS England, Simon Stevens, was executive vice-

president of giant US healthcare company UnitedHealth, which has been awarded contracts with the NHS. 

The head of NHS competition enforcer Monitor, David Bennett, is a former partner of management consultancy McKinsey, a

company with NHS contracts. There are many more besides. 

Private companies are also using their power to influence international trade agreements. 

US healthcare corporations, including UnitedHealth, want the EU-US Transatlantic Trade and Investment Partnership to

include public healthcare and make it impossible for any future government to roll back privatisation of the NHS.

A movement for change is required and our union is best placed to deliver. Our team of 100 trained organisers will use their

expertise to help mobilise people and expose what is happening to our NHS. 

We will make decision-makers accountable and campaign to prevent privatisation or cuts to local services. 

We have already made our mark, joining with local campaigners to help save the George Eliot Hospital in Nuneaton from


Now, in London, we are supporting our GP members working at the Jubilee Street practice in Tower Hamlets, who are

fighting cuts and the closure of one of the top-ranked surgeries in the country. 

But we can’t do it on our own — to win, we need you, from bus drivers to airport workers, to cleaners in the City of London. 

 This is a fight for us all and one that we can’t afford to lose. We will contact our activists whenever there is a relevant local

campaign, so please join with us and together let’s stand up for our NHS.

Sharon Graham is Unite executive officer.

11 The Tories Want Your NHS Money for Their Private Health Care
Updated: 30 Jun 2014

  Growing calls from senior Coalition MPs -including former health minister Paul Burstow, and former health select

committee chair, Stephen Dorrell - to boost funding for the NHS.

The BBC reports that the new chair of the of the House of Commons Health Committee, Dr Sarah Wollaston, said the NHS

was facing ‘crunch time’ and that funding must increase to match rising inflation in the health sector.

Dr Wollaston told the BBC: ‘We have protected spending on health. It is rising in line - just above - background inflation, but

inflation in the health sector is much higher because we have got an ageing population.’

‘Personally, I’d like to see services continue to improve, so I think in order to achieve that we are going to need an increase

in funding

12 NHS- Government has Lied and Broken Promises
Updated: 25 Jun 2014

Hunt calls for more openness and honesty

yet his own Government has lied and broken promises

Posted by: Giselle Green June 24, 2014 

Reaction of NHA co-leader Dr Clive Peedell to Jeremy Hunt’s announcement of a new patient safety website to ‘encourage
an open and honest culture in the NHS’.(story here: http://www.theguardian.com/politics/2014/jun/24/jeremy-hunt-

“Jeremy Hunt’s hypocrisy in calling for more openness and honesty in the NHS beggars belief. His own Government has

lied, obfuscated and repeatedly broken public promises with it’s NHS reforms. It even refused to publish the NHS Risk

Register which warned of the risks of its disastrous Health & Social Care Act, the impact of which is now being felt by

patients and staff. s policies will

actually reduce openness & transparency because private companies are protected by commercial confidentiality.”

13 NHS Mental Health Service a Crisis caused by Jeremy Hunt
Updated: 25 Jun 2014


Mental health services 'a car crash',

Jeremy Hunt driving 'naming and shaming' culture,

and 'arrogant and uninformed' assumptions basis for cuts

24 June 2014

Mental health services in the UK have been labelled a ‘car crash’ by the outgoing president of the Royal College of

Psychiatrists, Professor Sue Bailey, who said the health secretary had failed to make them a ‘priority’.

Professor Bailey told the BBC: ‘It’s a car crash, the system is in crisis and we need people to listen.’ She said Jeremy Hunt

had visited several hospitals but only a handful of mental health trusts while in power.

Professor Bailey said: ‘He has a basic understanding of [mental health] but whether he takes it seriously, the proof of which

would be making it a priority, then sadly not.’

Jeremy Hunt has been accused of driving a ‘naming and shaming’ culture in the NHS after plans for a new ‘disclosure drive’

- to boost error reporting in hospitals – were reported by the Guardian today.

A recent assessment of English hospital trusts found that 21% of trusts were rated poor, indicating they were under

reporting incidents, or that staff felt responses to reported incidents weren’t adequate.

Speaking on the BBC’s Today programme, Mr Hunt said: ‘We certainly do not want to humiliate anyone. If you have a group

of hospitals that do not have the right reporting culture how are you going to change that unless you identity that?’

BMA chair Dr Mark Porter has accused the Government of using the ‘uninformed and arrogant’ assumption that the NHS is

inefficient to make cuts and drive privatisation, the Independent reports.

Speaking at the BMA’s annual representatives meeting in Harrogate this week, Dr Porter said that new competition

regulations had created a ‘bizarre market culture’ in the NHS and added it had been ‘a bumper year for multinationals’.

Dr Porter said: ‘Do we really want an NHS that is so obsessed with private companies tendering for the work? Or do we want

an NHS that is passionate about tending to the weak? It doesn’t have time to be both.

14 NHS Safe Staffing Levels have been established-but are flaunted
Updated: 24 Jun 2014

Safe staffing levels at heart of patient safety

 24th June 2014

UNISON, the UK’s largest health union, today backed calls for greater transparency and reporting in the NHS but warned

that we have to constantly make data easier for patients & staff to understand on websites,  so that they can have trust and

confidence in them.

UNISON Head of Nursing, Gail Adams, said:

 “The Government is deflecting attention away from underfunding which is the central problem facing the NHS today.  The

key to driving up standards is safe staff to patient ratios and that means investing in those staff.  The NHS is under

enormous strain and the fact that Government still seems to believe that the service can improve and save money at the

same time is placing too much pressure on staff and the NHS.

“What patients need to know now & be confident in is that they are being cared for in an organisation which is putting

patient care first.  That means not constantly trying to juggle the ever more difficult job of – do we focus on patients or

balance the books?  They need to be cared for in a timely manner and the service needs to respect and value its workforce.  

Time and time again research tells us that well-motivated staff with high morale deliver good patient care.   Government

interference in their pay award this year will do nothing to improve staff morale across the NHS.  UNISON believes that

setting minimum nurse to patient ratios is needed now.

“Asking Robert Francis to head up an Inquiry into whistleblowing is one way of tackling a culture of fear that still exists in

some parts of the NHS, but urgent action is needed now.   UNISON is already running a Be Safe campaign working with

employers. It involves training staff on how to report concerns when they have them and be confident in doing so.  We need

action to ensure that staff know how to raise concerns about patient safety so they can be dealt with urgently.  Again,

whistleblowers need help and support, but if we need whistleblowers, something has already gone wrong.  Prevention is

better than cure.”

15 BMA demand £2bn for the NHS or Will Accuse Osborne of Economic Illiteracy
Updated: 23 Jun 2014

The BMA’s demands of an extra £2bn for the NHS makes the papers this morning, including the front page of The Times which says the funding ‘black hole’ will ‘cause a care crisis’.

BMA chair Dr Mark Porter warned George Osbourne it would be ‘economic illiteracy’ not to announce extra money for healthcare before next year’s general election.

He said: ‘The NHS does work very efficiently, but you can’t carry on doing everything with less resources. That’s the basic fundamental contradiction in this,” he said. “The national health service is by objective measurement the most efficient health service on the planet

16 Stay Cool This Summer
Updated: 23 Jun 2014

AC-Free Ways to Stay Cool This Summer

– Wed, Jun 18, 2014 6:17 PM EDT

Want to save on air-conditioning? You can still keep cool when the weather heats up. Stephanie Sisco, associate home editor at Real Simple magazine, talks about the best ways to cool yourself and your home.

It's all about the windows. When it comes to cooling the home, start with the windows. "Close your curtains and blinds, ideally with a sun-deflecting white on the window side," Stephanie explains. "That will actually help reduce the amount of heat that passes through your home by up to 45 percent." Another great tip comes from rangers in Death Valley, Calif. "Hang a damp sheet across an open window, so that when the breeze comes in, it will cool you and your entire home," she adds.

Air-dry everything. "Machines use so much heat, and during the summer, you just don't want to add that to your house." Stephanie says. Instead, let dishes air-dry after running a wash cycle, and hang your clothes on the line after doing a load of laundry to avoid the excess heat from the dryer.

Beware of unexpected sources of heat. You're probably not thinking about the fireplace in the summer, but, Stephanie says, " make sure that you close the damper before the summer starts." Leaving the damper open can suck hot air into your home as opposed to pushing it out.

Put your computer to sleep. Laptops are always warm, so if you're going to be away from your computer for more than 10 minutes, set a timer for sleep mode. "If you're going to be away for any more than 10 minutes, just power it down completely," Stephanie says.

Water is your friend. Keep hydrated and "stay away from beverages that include alcohol, excess sugar, and caffeine," she says. Another great tip? Keep a spray bottle of water in the refrigerator, and spray the inside of your wrists when you get warm. It cools the blood running through your veins and encourages thermal regulation.

Dress the part. Sweat-wicking clothes worn by athletes and other clothes made of lighter fabrics can help you avoid feeling sticky in the summer. "Choose something that's thin, lighter-colored, and more loose and flowy," Stephanie says. "That allows the air to kind of flow next to your skin and evaporate that moisture to keep you cool." Lose the shoes to cool your body from the bottom up.

Eat right. There's a reason why people gravitate toward salads and lighter foods in the summer. "Look for items that contain a lot of water like fruits and vegetables," Stephanie says. Hydrating foods will help cool you from the inside out.

17 Ebola Virus rife in West Africa
Updated: 20 Jun 2014

Ebola virus

From Wikipedia, the free encyclopedia

Ebola virus (EBOV)



Ebola virus (abbreviated EBOV) was first described in 1976.[1]HYPERLINK \l "cite_note-Bowen1977-2"[2]HYPERLINK \l "cite_note-Johnson1977-3"[3] Today, the virus is the single member of the species Zaire ebolavirus, which is included into the genus Ebolavirus, family Filoviridae, order Mononegavirales. The name Ebola virus is derived from the Ebola River (a river that was at first thought to be in close proximity to the area in Democratic Republic of Congo, previously called Zaire, where the first recorded Ebola virus disease outbreak occurred) and the taxonomic suffix virus.[4]

According to the rules for taxon naming established by the International Committee on Taxonomy of Viruses (ICTV), the name Ebola virus is always to be capitalized, but is never italicized, and may be abbreviated (with EBOV being the official abbreviation).

Previous designations

Ebola virus was first introduced as a possible new "strain" of Marburg virus in 1977 by two different research teams.[1]HYPERLINK \l "cite_note-Bowen1977-2"[2] At the same time, a third team introduced the name Ebola virus.[3] In 2000, the virus name was changed to Zaire Ebola virus,[5]HYPERLINK \l "cite_note-6"[6] and in 2005 to Zaire ebolavirus.[7]HYPERLINK \l "cite_note-8"[8] However, most scientific articles continued to refer to Ebola virus or used the terms Ebola virus and Zaire ebolavirus in parallel. Consequently, in 2010, the name Ebola virus was reinstated.[4] Previous abbreviations for the virus were EBOV-Z (for Ebola virus Zaire) and most recently ZEBOV (for Zaire Ebola virus or Zaire ebolavirus). In 2010, EBOV was reinstated as the abbreviation for the virus.[4]

Diagnostic criteria

A virus of the species Zaire ebolavirus is an Ebola virus if it has the properties of Zaire ebolaviruses and if its genome diverges from that of the prototype Zaire ebolavirus, Ebola virus variant Mayinga (EBOV/May), by ≤10% at the nucleotide level.[4]


EBOV is one of four ebolaviruses that causes Ebola virus disease (EVD) in humans (in the literature also often referred to as Ebola hemorrhagic fever, EHF). In the past, EBOV has caused the following EVD outbreaks:

Ebola virus disease (EVD) outbreaks due to Ebola virus (EBOV) infection


Geographic location

Human cases/deaths (case-fatality rate)


Yambuku, Zaire

318/280 (88%)


Bonduni, Zaire

1/1 (100%)


Porton Down, United Kingdom

1/0 (0%) [laboratory accident]


Woleu-Ntem and Ogooué-Ivindo Provinces, Gabon

52/32 (62%)


Kikwit, Zaire

317/245 (77%)


Mayibout 2, Gabon

31/21 (68%)


Sergiyev Posad, Russia

1/1 (100%) [laboratory accident]


Ogooué-Ivindo Province, Gabon; Cuvette-Ouest Department, Republic of the Congo

62/46 (74%)


Ogooué-Ivindo Province, Gabon; Cuvette-Ouest Department, Republic of the Congo

124/97 (78%)


Ogooué-Ivindo Province, Gabon; Cuvette-Ouest Department, Republic of the Congo

11/10 (91%)


Cuvette-Ouest Department, Republic of the Congo; Ogooué-Ivindo Province, Gabon

143/128 (90%)


Cuvette-Ouest Department, Republic of the Congo

35/29 (83%)


Koltsovo, Russia

1/1 (100%) [laboratory accident]


Cuvette-Ouest Department, Republic of the Congo

11/9 (82%)


Kasai Occidental Province, Democratic Republic of the Congo

264/186 (71%)


Kasai Occidental Province, Democratic Republic of the Congo

32/15 (47%)


Kibaale District, Western Uganda

24/17 (71%)


Isoro, Viadana, Dungu districts of Orientale Province Democratic Republic of the Congo

62/34 (54%)


Guinea, Sierra Leone, Liberia (2014 West Africa Ebola outbreak)

528/337 (64%)

18 Labour -Save the NHS or Lose the Election ?
Updated: 19 Jun 2014

Eleven months to save the health service

Thursday 19th
posted by Morning Star in Features

Labour needs to boldly declare its intention to rescue the NHS from the profit hunters, says JOHN LISTER

IT’S NOW less than a year to the general election in which we have the first chance to get rid of the coalition government led by the nasty party that has made Britain so much nastier since 2010.

This right-wing government of millionaires has taken a brutal toll of public services, welfare rights and benefit payments, targeting the poorest and most vulnerable.

Its attitude to healthcare and the NHS has followed similar lines. The biggest-ever funding squeeze on the NHS has seen funding flatline since 2010 while pressures and demands increase costs by up to 4 per cent each year. The squeeze is set to continue to 2021 — a full decade of frozen funding leaving a potential cash gap of £50 billion.

So far the brunt of this has fallen on NHS staff, whose pay has been frozen or kept below inflation year after year, slashing the value of NHS pay by upwards of 10 per cent since 2010. 

Health unions have now started to reflect the anger of their members — promising a fight on pay. But even before this, hard-bitten management consultants such as McKinsey were warning ministers that a further prolonged period of effective pay cuts could not be sustained without damaging recruitment and staffing in vital services.

Already waiting lists are back to record levels, cancer patients and others are once again facing the kind of delays that 10 years of investment in the NHS under Labour effectively wiped out — until the Tories came back.

Desperate NHS trust managers are wheeling out cynical plans to “reconfigure” (ie cut) hospital services, knowing that there is no cash available to invest in alternative services in the community. 

Mental health budgets are being squeezed to leave desperate shortages of community-based services and hospital beds for those needing more intensive treatment and support. 

GPs are complaining that they can’t cope with the growing workload while spending on primary care has been squeezed downwards.

But in the midst of this massive cash famine, countless millions are being squandered on the costly and wasteful Health and Social Care Act, which splits and fragments services to create bite-size chunks for private sector and so-called third sector organisations to compete for. 

The NHS Confederation (trust bosses and commissioners) conference in Liverpool showed clearly who has been benefiting from the new legislation — exhibition stands from law firms and management consultants doled out lavish quantities of free champagne as they celebrated their new, expanding empire in what was a public service, publicly provided. 

McKinsey is apparently so busy they can no longer accept any more NHS contracts.

The Act is compelling many clinical commissioning groups (CCGs) throughout England to put a wide range of services out to competitive tender — at enormous cost. 

A survey by the Health Service Journal shows that fear of infringing the legislation and incurring legal action is the main factor behind almost a third of the CCGs that have opened up tenders. 

So far only one, the largest CCG in England, the North, East and West Devon CCG, has been bold enough to announce that it will reshape its community health services without opening up to competition. 

This CCG decided that to ensure “a more seamless service” its contracts are to go to NHS trusts and the Royal Devon & Exeter Foundation Trust. Other CCGs appear willing to fragment local services in order to comply with timid legal advice. 

Yet the NHS regulator Monitor’s guidance on Section 75 of the Act explains that CCGs can avoid tendering services if they can show this would not be in the best interests of patients. 

It never could be in the best interests of patients to waste money that could be spent on front-line care on legal advice and dense contracts drawn up by overpaid management consultants, much of which in the end is unenforceable.

Only today one of the three private sector-led bidders on a shortlist of four has dropped its bid for a share of the £800 million contract to commission older people’s services in Cambridgeshire and Peterborough — the day after public consultation ended. 

A company like this could just as easily up sticks and walk away part way through a contract — as Serco has done recently on its contract
to manage Braintree Hospital — leaving the public sector to pick up the pieces. 

Other private contractors are trying to screw down staff pay and conditions to create a margin of profit, or reducing numbers of better qualified staff — regardless of the impact on quality of care.

The competitive market in healthcare has for many years been a costly failure, delivering no benefits to patients, but undermining existing health services and healthcare providers. 

The Tories, promoting this at the same time as throttling the life out of the NHS through frozen budgets, now want ministers to keep quiet about health — they know they’re vulnerable to a determined campaign on this.

Sadly up to now there has been as little sign of vim or vigour from Labour on the NHS as there has been political savvy advising the hapless Ed Miliband to prevent him making an idiot of himself clutching a copy of the Sun or wrestling with an unaccustomed bacon sandwich.

But in recent weeks there have been limited signs that at least some elements in Labour’s leadership are waking up to the need to toughen up the line and offer a more radical and convincing alternative to the Tories on the NHS. 

Some timid anti-market rhetoric has crept in, alongside repeated vague pledges to repeal the Health & Social Care Act.

But without a much stronger critique of the Tories’ marketisation of the NHS and a clear commitment not to go back down the dire path mapped out by Tony Blair and Alan Milburn, of welcoming private, profit-seeking companies into the NHS “family,” Labour’s message will remain unconvincing.

Only a full-blooded break from the market system can stop the haemorrhage of vital NHS budgets into the coffers of lawyers, accountants, management consultants and private companies, and redirect it to expand patient care.

As long as Eds Balls and Miliband remain locked into acceptance of George Osborne’s plans for freezing NHS spending to 2021 rather than committing to make wealthy scroungers pay their tax — and collecting the £120 billion unpaid taxes each year — Labour will need to warn of similar “tough choices” and brace itself to implement unpopular cuts and closures.

If it continues to sit silent on the issue of NHS pay and tacitly accepts the Tory lie that any pay rise for NHS staff must come at the expense of patient care, Labour will fail to convince a million health workers that they represent a real alternative.

Rather than shilly-shally around with weasel words that avoid any clear commitment, Labour’s leadership should come out loud and proud as the party that will — once again — rescue the NHS and public services from the Tories.

They should sign up for the new short emergency Bill to restore the NHS that is being drawn up by Allyson Pollock and colleagues to complete work started in Lord Owen’s previous short Bill. 

The health unions could help in this by endorsing the Bill and helping to campaign for its adoption as a commitment to be implemented immediately after the next election.

If health unions go out now into local communities and the wider Labour and trade union movement campaigning for support to this short bill and for a break from the spending freeze on NHS spending and health workers’ pay, they could help to build an unstoppable pressure on Labour’s leaders to up their game — and give the electorate something to vote for.

From this weekend’s People’s Assembly demonstration let’s have a growing campaign for an NHS publicly provided and properly funded to meet the rising needs of the population. 

If Labour is bold, the money could be there without increasing taxes on working people. And, as the Unison slogan insists: “We’re worth it.”

John Lister is director of London Health Emergency

19 NHS is No 1 in Europe - Psst-Don't Tell the Nasty Pasty Party
Updated: 18 Jun 2014

The two surprising NHS surveys the government hopes you don’t see

17TuesdayJun 2014

(not satire – it’s the UK today!)

There has been a concerted campaign in the mainstream press over the last few years to smear the NHS.

Here’s a recent example:

Daily Telegraph uses death of baby and outright lies to smear NHS

This is all part of the government’s misinformation campaign to discredit the NHS so it can turn over as much of it as possible to private healthcare companies.

Which is why you probably won’t have seen much in the mainstream press of a recent international survey which has ranked the UK’s NHS number 1 in the world for healthcare – above countries like Sweden, Switzerland, Germany and Norway:


But there’s another shocking recent survey you probably won’t have heard much about either.

The latest NHS staff survey shows over 70% of NHS workers think there are no longer enough staff to enable them to do their jobs properly:

20 Wake Up to the TORY NHS extinction of YOUR District and Community Nurses
Updated: 17 Jun 2014

District nurses: Crippling government cuts

threaten foundation of community healthcare with extinction

Tuesday 17th
posted by Morning Star in Britain

  1. of the foundations of England’s community healthcare faces extinction with district nurses’ numbers slashed by almost half in crippling government cuts. 

The nurses, who enable patients to stay in their homes and communities, could disappear unless drastic action is taken,

their professional body the Royal College of Nursing (RCN) warned yesterday.

A survey commissioned by the RCN as the union meets for their annual conference found that district and community nurse numbers have fallen by 47 per cent in the last decade.

A third of those remaining are over 50 and nearing retirement.

At current rates the system will collapse by 2025 and a vital tier of NHS care will have been removed by government inaction.

The survey said at least 10,000 more qualified district nurses are needed.

RCN chief executive and general secretary Peter Carter said: “The district nurse role is the foundation of a system which should be able to manage conditions and keep sick and frail people at home. Remove those foundations and the whole edifice could come crashing down.

“The NHS and the people who run it have long paid lip-service to the ideal of moving care closer to home. But many people up and down the country are still in need of expert care from district nurses.

“By 2025, there will be many thousands of families with frail older relatives who may well have survived a number of illnesses — and when they look for help to manage at home, it simply won’t be there.”

21 Social Isolation-No 1 Disease in Britain
Updated: 16 Jun 2014

Problems living alone can predict development of depression in CHD patients


Posted by: Clinical Blog Mon, 16 Jun 2014

Problems living alone, chest pain and disability are important predictors of depression in patients with coronary heart

disease, suggests a recent UK study.

803 patients, with a mean age of 71 years, with coronary heart disease were recruited from general practice registers and

assessed for cardiac symptoms, depression, quality of life and social problems over a two-year period. Depression was

measured using the Clinical Interview Schedule-Revised, which yielded an International Classification of Diseases-10 (ICD-

10). Quality of life was measured using the EQ-5D and current social problems using the Social Problem Questionnaire


42% of the participants had a documented history of myocardial infarction, and 54% had a diagnosis of ischaemic heart

disease or angina. 44% of the participants still experienced chest pain. 7% of participants had an ICD-10 defined depressive

disorder. Factors independently associated with this diagnosis were problems living alone (3.71), experiencing chest pain

(3.27) and other pains or discomfort (3.39). The social problems at baseline that affected the risk for a depressive disorder

were problems with usual activity (5.96), problems with pain or discomfort (5.96), problems living alone (8.73) and lack of

social contacts (4.13)

The researchers noted that the ‘coronary heart disease register was shown to be an effective means to assess a community

population with documented coronary heart disease’ and advised that ‘the follow-up of these study participants will allow

associations to be tested in a more substantial way’.

22 NHS Privatisation-In Inside Job for Tory Man
Updated: 13 Jun 2014

Privatisation: Health privateer's man on the inside

Friday 13th

SOLOMON HUGHES looks at the role of a top Tory in Alliance Medical’s NHS landgrab

Senior Tory MP Malcolm Rifkind has a new £60k-a- year job as a director of Alliance Medical, an NHS privatisation firm

currently under investigation by the Competition Commission for a deal which might hurt the National Health Service.

Rifkind announced the new job as a part-time director of Alliance Medical in the latest register of MPs’ interests. Rifkind

says he is being paid over £1,500 an hour by the firm.

Alliance Medical sells scanning services to the NHS in competition with existing NHS radiology and medical imaging


The Office of Fair Trading referred Alliance Medical’s takeover of another imaging firm, IBA Molecular, to the Competition

Commission this March just before Rifkind’s appointment.

It looks like Rifkind has been hired at just the point Alliance Medical needs help dealing with government regulators.

 IBA Molecular, the company Alliance Medical has purchased, produces FDG-18, a chemical which is injected into patients to

help scanning machines locate cancers.

Regulators are worried that the takeover will give Alliance Medical over 45 per cent of the FDG-18 supply business, giving

the firm too much power over the NHS.

The OFT’s chief economist Chris Walters said the merger “could lead to an increase in cost to the NHS and a reduction in

the reliability of supply” of the vital chemical.

When Alliance Medical first expanded in the NHS in 2005, critics, including the Royal College of Radiologists, said contracts

with the firm were “interfering” in NHS budgets for MRI scans and diverting NHS money away from training and investment.

Alliance Medical was heavily criticised for taking money for scans that never happened and for the quality of the scans it did

undertake. Poor-quality reports meant the NHS had to duplicate its work.

Rifkind is one of the most senior Tory backbenchers. He first became an MP in the 1980s and has served as defence and

foreign secretary.

David Cameron made him chairman of the powerful intelligence and security committee in 2010, showing that Rifkind is still

very influential in top Tory circles.

Rifkind was chairman of Alliance Medical around eight years ago but left the firm in 2006 when the company was sold on by

its then owner, Bridgepoint Capital.

Alliance Medical built up a strong NHS business under Bridgepoint, but since the sale the firm has been in financial


It had so many debts that in 2010 Alliance’s Dubai-based owners lost control of the firm to their creditors.

 Alliance is now owned in part by Lloyds Bank — which is in turn partly publicly owned thanks to the 2008 bailout.

Bringing Rifkind back on to the board is part of Alliance Medical’s strategy to get the business back into profit, as a

struggling NHS privatiser obviously sees having a Tory MP on board as a valuable asset.

IN the wake of the “Trojan horse” letter affair, Michael Gove wants schools to teach more “British values.”

 But what are British values? Gove himself pushed the academy plan that invited religiously minded governors to run state


Then he used a fake letter to declare any Muslims who took advantage of his offer were part of a terrorist plot.

So there we have one set of British values — hypocrisy and bigotry. An urge to have the vicar preach in front of everyone. A

fear that any non-Christians who reject his preaching are part of a plot that will kill us all in our own beds.

Gove thinks the values that suffused the British empire, the golf club and the commuter-belt market town are British values.

But other British values are available. You can get some from the Sleaford Mods.

This duo, whose latest LP Divide And Exit came out in April, started with the British value of confusing naming systems —

they are not from Sleaford and they aren’t mods.

Instead the band have a brutal minimalist electro beat powering angry and often mordantly funny lyrics.

The songs are filled with the “British values” of bitterness and dark wit. They are very abrasive, but with a bit of elliptical

poetry about them which has led to comparisons with The Fall.

They also bear a certain similarity to the Streets’ first album in that these are everyday tales set against simple electronic


It’s a stream of consciousness between a drag of a roll-up and a drink of cheap high-strength cider set against a digital


The songs can be harsh enough to take the skin off your ears and are peppered with profanity.

They aren’t sloganeering but they are casually political, complaining about “The prime minister’s face hanging in the clouds

like Gary Oldman’s Dracula.”

Perhaps more politically, they  describe ordinary life in hard times, about having “crap ideas about clearing arrears” through

“selling booze from the back of a van,” with “cheap midget gems” for a treat.

They are sometimes described as a “voice from the underclass.” You can see why with, for example, Jobseeker, one of their

standout tracks describing the delights of signing on with a biting sarcasm.

But they are describing the life of everyday people — from managers of high-street shops and supervisors in fast-food

outlets to any number of people in low-paid regular employment where “the wage don’t fit” (although a “free cream cake on

a Friday” is available). It’s a caustic view of working-class life, not an “underclass.”

The band have been running in one form or other since 2007, so along with Divide And Exit, which is in record shops now,

I’d recommend their back catalogue.

If you have a taste for their entertaining, incisive, elliptical rant, previous LPs including Chubbed Up and Austerity Dogs are

available as low-cost MP3s through the Bandcamp website.

23 Tomato Pill to Save Your Life
Updated: 10 Jun 2014

A tomato pill to save your life? Scientists have proved that constricted blood vessels, a risk factor for heart disease, are

widened by a prescription-free food supplement containing an antioxidant found in tomatoes. The good news story is is

picked up by several newspapers and even makes the front-page splash of the Daily Express.

Aterenon, which includes concentrated version of an antioxidant called Lycopene, apparently reproduces some of the

effects of keeping a Mediterranean diet, a proven method to boost heart health. Alternatively, according to the Telegraph

you could just ‘have ketchup with everything’.

24 One in Three UK Adults has Borderline Diabetes
Updated: 10 Jun 2014

One in three adults in England has ‘borderline’ diabetes, warns the Telegraph, after an ‘extremely rapid rise’ in the condition

in recent years.

The authors wrote: ‘This rapid rise in such a short period of time is particularly disturbing because it suggests that large

changes on a population level can occur in a relatively short period of time.’

25 Hope for Arthritis Sufferers ?
Updated: 05 Jun 2014

More "fresh hope" for arthritis sufferers from the Daily Express which runs a front page story on how scientists have found

out more about how the disease develops.

Apparently scientists have identified two proteins that promote abnormal development of blood vessels in the joints of

people with rheumatoid arthritis and contribute to progression of the disease.

Natalie Carter, head of research liaison and evaluation at Arthritis Research UK, said: ‘We welcome this study into

identifying factors that may play a role in the development of rheumatoid arthritis and while this is early laboratory research,

it builds on our existing knowledge of the condition and how rheumatoid arthritis develops.’

She added: ‘We hope that this information can be built upon in the near future to develop treatments.’

26 Lifestyle - To Change or Not To Change ?
Updated: 02 Jun 2014

Small changes to your lifestyle

Keeping fit and healthy can be a challenge if you are living with a long-term condition, but it will make a big difference to

your wellbeing. If you’ve been thinking about making changes to your lifestyle, such as stopping smoking, losing weight,

eating healthily, drinking a little less alcohol, or doing more exercise, there’s plenty of help and support available.

Talking to your GP and other healthcare workers, including pharmacists, is the first step. They’ll help you look at your

lifestyle and suggest changes that are suitable for your condition and any treatment you’re having. Your health or care

worker can also let you know about local services that can help you.

For example, if you want to start exercising but you're unsure how to, your GP can put you on the Exercise on Referral

scheme. These schemes are run with local gyms and fitness centres and can include swimming. Ask at your GP practice for

more information.

Your GP can also help you if you want to stop smoking, for instance by enrolling you in a clinic where you’ll get support

from other people who are also trying to stop. Nicotine replacement therapy and other stop smoking treatments provided by

your GP can also help you resist cravings and boost your chances of quitting successfully.

Use our collection of interactive lifestyle tools to find out where and how you could make simple and easy healthy living

improvements to your lifestyle.

Read more about how the NHS can help you to:

eat healthily

lose weight

stop smoking

get fit

27 Kidney Function Blood Test
Updated: 24 May 2014

Kidney Function Blood Test

Routine kidney function is one of the most commonly performed blood tests.

The kidneys

The kidneys regulate the amount of water and salts that we have in our bodies. They do this by filtering the blood through

millions of structures called nephrons. The kidneys also pass out certain waste products from the body. Urine is made up of

the excess water, salts and waste products passed out by the kidneys down to the bladder.

Routine blood test of kidney function

The usual blood test which checks that the kidneys are working properly measures the level of urea, creatinine, and certain dissolved salts.

Urea is a waste product formed from the breakdown of proteins. Urea is usually passed out in the urine. A high blood level

of urea ('uraemia') indicates that the kidneys may not be working properly, or that you are dehydrated (have a low body

water content).

Creatinine is a waste product made by the muscles. Creatinine passes into the bloodstream, and is usually passed out in

urine. A high blood level of creatinine indicates that the kidneys may not be working properly. Creatinine is usually a more

accurate marker of kidney function than urea.

Estimated glomerular filtration rate (eGFR) provides a guide to kidney function. Although the level of creatinine in the blood

is a useful guide to kidney function, the eGFR is a more accurate measure. Blood creatinine can be used to estimate the

eGFR using age, sex, and race. This is often calculated by computer and reported with the creatinine blood test. The normal

value for eGFR is 90-120 ml/min. An eGFR below 60 ml/min suggests that some kidney damage has occurred. The value

becomes lower with increasing severity of kidney damage.

Dissolved salts that are routinely measured are sodium, potassium, chloride and bicarbonate. They are sometimes referred

to as 'electrolytes'. Abnormal blood levels of any of these may be due to a kidney problem. (Some other conditions may also

alter the salt balance in the blood.)

Who has a blood test of kidney function?

 Routine kidney function is one of the most commonly performed blood tests. It may be done:

As part of a general health assessment.

If you have suspected dehydration (when the urea level increases).

If you have suspected kidney failure. The higher the blood levels of urea and creatinine, the less well the kidneys are

working. The level of creatinine is usually used as a marker as to the severity of kidney failure. (Creatinine in itself is not

harmful, but a high level indicates that the kidneys are not working properly. So, many other waste products will not be

cleared out of the bloodstream.) You normally need treatment with dialysis if the level of creatinine goes higher than a

certain value.

Before and after starting treatment with certain medicines. Some medicines occasionally cause kidney damage as a side-

effect. Therefore, kidney function is often checked before and after starting treatment with certain medicines.

Other tests of kidney function

The routine kidney blood test is a general marker of kidney function. If the blood test is abnormal it cannot say what is

causing the kidney problem. Therefore, if you have an abnormal result you may need further tests to find the cause of a

kidney problem. For example: urine tests, other blood tests, scans, X-rays, kidney biopsy, etc.

28 The 5+1 Top Killers of Men - Maladies or Ladies
Updated: 22 May 2014

The top 5 killers of men

How to dodge the handful of maladies most likely to stop you clocking up a century

man killers

First, the good news. In 2012 the Office for National Statistics announced that over a third of babies born that year would live to over 100. Now, the bad. Since you're reading this, we can safely assume you weren't born yesterday – which means your odds aren't quite so appealing. We're not talking National Lottery. More Vegas. Keep reading, though, and we can help you beat the house. Almost half of all male deaths are attributed to just five diseases. Fortify your body against them with simple lifestyle, nutrition and exercise tweaks and your likelihood of reaching three figures will skyrocket. (Tip one: avoid skyrockets.)

1. Heart disease (kills 15.6% of UK men)

Take heart. There's innumerable habits you can adopt to lower the chances of a sputtering ticker sabotaging your centenarian ambitions. Start by eating more almonds (daily handful = risk cut 12.5%), garlic (two cloves a week = risk cut 25%), and fish (four servings a week = risk cut 14%). Red wine and dark chocolate (in moderation) and fruit and veg (in bulk) will also improve your cardiac prospects – as will these 15 quick tips.

You'll also want to keep your arteries supplecombat high blood pressure and exercise a minimum of three times a week. This heart-strenghtening 25-minute circuit is an ideal place to start. Reward yourself with a glass of champagne. Reading University research shows its polyphenols will improve your circulation. No, really.

2. Lung cancer (7%)

If you're among the fifth of men in the UK who smoke, you don't need us to tell you that you're significantly increasing your chances of lung cancer. But if you are readying yourself for an attempt at ditching the cigs, our guide to the strategies scientifically-proven to work may be of use. To further buttress your body against the big C, load up on the cancer cell-stunting flavonoid quercetin – red onion, watercress and kale are among the richest sources – and go Brazilian. University of Surrey research found selenium can cut your risk of lung cancer by up to 46%; four Brazil nuts are all you need to meet your RDA.

If you do find yourself with a cough you can't shift, sharp chest pains or persistent shortness of breath, book an appointment with a doctor immediately. If tumours are discovered within the first three months of inception, your chance of making it through the next 10 years is 92%, according to the New England Journal of Medicine. After diagnosis, the latest stats show just 29.4% of men will survive the year. Make sure you catch it early.

3. Empysema/bronchitis (6%)

Stop smoking. We said that already. Just three days after quitting your bronchial tubes begin to relax and you'll start to breathe easier; after three months your lung function will have improved by a massive 10%. To combat your chronic cough further, sign up for some yoga. A study by scientists at the All India Institute of Medical Sciences found 12 weeks of practising breathing techniques, postures and meditation led to improved lung function and reduced shortness of breath and inflammation.

Finish every session with a long, scalding shower. Research published in the American Journal of Medicine found steam helps to clear mucus from your lungs. Finally, try to avoid the emphysema-encouraging nitrates in processed meats like bacon as much as possible. Don't panic. You don't need to swear off your full English for good; simply spend a little more on nitrate-free rashers and build a better BLT.

4. Stroke (5.9%)

Besides the obvious – exercise regularly, cut down your salt intake and, you guessed it, don't smoke – there's a variety of everyday habits you can adopt to lower your likelihood of succumbing to a stroke. Start by snacking on a banana every afternoon – the fruit's substantial hit of potassium relaxes your blood vessels and flushes sodium from your system. Then start incorporating the following foods into your diet: grapes, avocados, honey and tuna. All will soup up your testosterone levels, which will further stymie your stroke risk. As will hitting the gym for a good ol' fashioned compound move workout.

Bookened each day with a forensic two-minute assault on your teeth and don't forget to floss; a glut of studies have linked poor oral health with stiffening arteries. And halitotic breath will also seriously dent your chances of getting married – another way to shrink your stroke risk.

5. Dementia and Alzheimer's (5.8%)

To keep your grey matter in the pink, you need to train it harder than any muscle. Thankfully, the cognitive equivalent of concentration curls is significantly less agonising. Your mantra is simple: do something different every single day. Each time you brush your teeth with your weaker hand, change up your route to work or expand your culinary repertoire you force your brain to spawn new circuitry. Of course, long hours at work can make it tricky to ensure every day's a school day. But don't stress about your stress levels. Research published in the Journal of Occupational Health and Psychology has found demanding jobs help to bolster your mental functioning for years after retirement. Boredom, not pressure, is your brain's worst enemy.

Safeguard your chances of a cerebrally-sound dotage further by filling up on beetroot (unparalleled in its abilities to improve blood flow and oxygen delivery) and B vitamins – which break down the amino acids responsible for cognitive decline. One of the best sources? Steak. Cook it right and serve up twice a week to ensure you don't sacrifice your heart to save your mind.

29 Cameron's NHS Re-Organisation has led to a Decline in Standards
Updated: 15 May 2014

Wednesday, 30 April 2014

Sharp Decline in standards in England's hospitals

Reports disclosed to me by the official care standards regulator in England suggests a sharp decline in standards in England’s hospitals over the last 12 months.

In the last year, inspectors observed examples of unacceptably poor care at one in five hospitals. By March this year, the care regulator listed 45 hospitals not providing safe care following 215 inspections – close to three times the 16 hospitals failing on this measure in the same month in 2013.

In the same period, Care Quality Commission inspectors found 32 hospitals without adequate numbers of staff – more than one in six - after inspecting 175, up from 14 only a year earlier.

The inspectors’ official reports catalogue the failings witnessed, including:


  • a trebling of bed sores put down to under-staffing;
  • patients on the wrong wards not visited by doctors over the weekend;
  • patients transferred from other hospitals without any medical notes;
  • diabetic patient left without insulin;
  • unstaffed ambulance triage area, leaving patients and paramedics waiting;
  • unanswered call-bells;
  • patient needing fall assessment every 48 hours not seen for 3 weeks;
  • inexperienced A&E receptionist told patients with chest pains to take a seat, against hospital policy on suspected heart attacks;
  • patients at risk of malnutrition or dehydration not given assistance to eat and drink;
  • backlog of X-rays and CT scans reports caused by lack of staff;
  • an overreliance on locum and agency staff.

This provides indisputable proof that the NHS is heading seriously downhill on this Government’s watch. Hospitals across England are operating way beyond safe bed occupancy levels and without enough staff.

It is simply not good enough for the Government to blame the NHS, as they always trying to do. Hospitals are having to pick up the pieces from their botched policies. Severe strains on general practice, mental health and social care are piling pressure on hospitals. There is a limit to what hospitals can safely do and these reports show that many have now reached and even gone beyond it.

What we are now seeing are the consequences of David Cameron’s disastrous decision to destabilise the NHS with an unwanted and unnecessary re-organisation. Hospitals are struggling, NHS waiting lists are at a six-year high and it has got harder for millions to get a GP appointment.

But, as the NHS in England goes downhill, Ministers have spent the last year pointing the finger at the NHS in Wales. Self-serving spin like that is of no use to patients. People will rightly ask: why wasn’t their attention focused where it should have been - on services in England?

This explains why people have reached the conclusion the NHS is simply not safe in David Cameron’s hands. He must cut the spin and bring forward a credible plan to ensure hospitals are safe and properly staffed.

30 Reduced Couple Fertility -Is Population Decline due to this Rotten World System ?
Updated: 13 May 2014

The Independent has front page news warning that supposedly ‘non-toxic’ chemicals in household products may be a cause

of rising male infertility.

Scientists found one in three chemicals in everyday products such as soap, sun screens and plastic toys directly impair the

swimming behaviour of human sperm and cause them to prematurely release enzymes needed to penetrate and fertilise the

egg cell, the paper reports.

Lead author Professor Niels Skakkebaek, from Copenhagen University Hospital, told The Independent: ‘In my opinion, our

findings are clearly of concern as some endocrine-disrupting chemicals are possibly more dangerous than previously


However, it remains to be seen from forthcoming clinical studies whether our findings may explain reduced couple

fertility which is very common in modern societies.

31 UK NHS to move to India ? Don't Stomach Foreign Parts
Updated: 12 May 2014

GP support services could be 'offshored' to India

9 May 2014 | By  

Exclusive Administrative support services for GPs could be outsourced to India under proposals to be considered by NHS England to slash costs, Pulse has learnt.

The proposal, which could involve unidentified support functions being ‘off-shored’ to NHS Shared Business Service’s operations in India, is one of two proposals to provide services that also include processing medical records and performer and contractor list administration.

NHS England will vote on this proposal at its board meeting next week, alongside an alternative proposal to keep the services in-house but reduce the number of offices from 38 overall to 13.

But GP leaders have said that removing the local aspect of the support services could lead to the loss of local expertise, which could cause further problems for practices.

The vote, which will take place in a closed session at the board meeting, follows a review of support services intended to save £40m from its £100m primary care support services budget, including cutting a series of services no longer to be centrally funded

The proposal by Shared Services Connected Limited (SSCL) - a joint venture between the Cabinet Office and Steria - would see it subcontracting the service to NHS SBS, which itself is a joint venture between the Department of Health and Steria, and is currently responsible for administering GP payments.

Some staff would also subcontracted to another private company working with Steria, called Crown, and some functions could also be outsourced to India.

In a briefing document, NHS England said: ‘SSCL has indicated that it would build on the NHS SBS existing sites in the South, Central and London regions and establish new bases in the North. Their business model would be similar to that currently operated in the South-West of England. This proposal would therefore result in the closure of a number of current NHS England PCS sites.’

‘A small proportion of posts will be further sub-contracted to an NHS Shared Business Services delivery partner (Crown). Other functions may be considered for being off-shored to NHS SBS’s existing operations in India; this element is still to be agreed.’

This follows previous attempts by PCTs to outsource services to India via NHS Shared Business Services, which led to a series of complaints from GPs in 2011.

The other option would see NHS England keeping the service in-house but reducing the number of locations from which it undertakes the work.

While both options would see a reduction in services offered and the number of locations from which they are undertaken, members of the GPC have criticised plans for outsourcing the function, questioning whether it would lead to a further loss of ‘organisational memory’ from the old PCTs.

Dr Robert Morley, GPC member and executive secretary of Birmingham LMC, said NHS England’s vote was ‘a big concern locally’.

He said: ‘We have warned practices that this might happen, that they might lose their local health services [support] function and that it may get handed to a single, national provider. That they will lose their local contacts and local corporate memory.’

Dr Brian Fisher, chair of the Socialist Health Association, said: ‘We see almost no benefit from outsourcing to the private sector. There are so many examples now of bits of the NHS, both administrative and clinical, that have gone over to the private sector and the quality of service is by no means any better.’

‘In principal, I can’t see what benefits there are to the NHS for money to be siphoned out to shareholders - and I don’t see any reason why they should be able to do it cheaper [except] hiring people on poorer conditions and with fewer skills.’

A spokesperson for SSCL said: ‘SSCL has submitted a proposal to NHS England to provide primary care support services nationally. Under the proposal NHS SBS would act as the subcontractor in the delivery of the service. As the proposal is still under consideration we are unable to comment further at this stage.

32 Death by Default
Updated: 08 May 2014

A poor lifestyle could be behind almost a quarter of deaths in England and Wales, the Daily Express reports.

The Office for National Statistics looked at all deaths in 2012, concluding that 23% were ‘the result of certain

conditions which should not occur in the presence of timely and effective health care or through wider public health


However the research also showed that the rates of deaths that could be prevented have been in steady decline

over the past decade

33 One Finger, One Thumb -Keep Moving...
Updated: 07 May 2014

Increased daily activity time may reduce risk of disability

clinical blog

Posted by: Clinical Blog Tue, 6 May 2014

Increasing daily activity time may reduce the risk of disability, shows a recent study.

The four-year cohort study included 1680 community-dwelling adults aged 49 years or older with knee

osteoarthritis, or risk factors for knee osteoarthritis. All participants were free of disability at baseline, defined as

‘difficulty or dependency in carrying out activities essential to independent living, including essential roles, tasks

needed for self-care and living independently in a home, and desired activities important to one’s quality of life’.

The primary outcome was the development of disability at the two-year follow-up visit. Secondary outcomes

included disability progression, based on a change from the baseline disability level to a more severe level two

years later. Physical activity was measured using an accelerometer.

Greater time spent in light intensity activities had a significant inverse association with incident disability.

Compared to those who spent the least time performing light activity, those who spent the most time were 46%

less likely to develop disability that hindered the ability to carry out activities of daily living. Disability progression

was significantly related to increasing quartile categories of daily time spent in light intensity physical activities.

Those who spent the most time performing light activity were 50% less likely to move from baseline to a more

severe level of disability two years later, compared to those who spent the least time on activity, and this finding

was independent of time spent in moderate-vigorous activity.

The researchers note that ‘greater light activity time, independent of time spent in moderate-vigorous intensity

activity, was significantly related to reduced risk and progression of disability’ and that ‘greater daily physical

activity time may reduce the risk of disability, even if the intensity of that additional activity is not increased’

34 Tory Care Plan "lacks credibility"
Updated: 07 May 2014

Government's £3.8bn integrated care fund 'lacks credibility', reports claim

7 May 2014 | By Alex Matthews-King

A Cabinet Office report has found the Government’s flagship £3.8 billion fund to integrate health and social care ‘lacks credibility’, according to newspaper reports today.

However, the Department of Health was quick to dismiss reports that the implementation of the ‘Better Care Fund’ - which the Government has indicated could be used to help boost investment in primary care - was to be delayed from its planned start date of April 2015.

It added that CCGs were told to develop plans for how they would spend the pot in tandem with local authorities by March 2014.

The fund provides a pooled budget for CCGs and local authorities to promote integrated health and social care and includes £1.9bn from existing ‘NHS allocations’, which critics have said would have to come from secondary care efficiency savings.

But the reports, in the Guardian, had suggested this has been put on hold following a Cabinet Office review, which - the paper claims - found there was ‘little or no detail about how savings would be delivered’ and that hospitals had not been consulted on plans to spend the money.

The newspaper says that a joint group from the Cabinet Office and Department of Health have been tasked with producing extra evidence to make the scheme ‘credible’ and overcome Cabinet Office scepticism.

The Guardian cites a Whitehall source as saying the plans that had been submitted so far had failed to ‘show in detail where savings will be achieved’ or that hospitals will be able to reduce their spending.

The Guardian’s source states: ‘The Better Care Fund is based on the idea that if you invest to build up services outside of hospitals based on integrated care, that will help you to ultimately save money from the hospital budget. But the plans produced so far don’t show in detail where savings will be achieved as a result of the investment, or that hospitals will be able to reduce their spending.’

‘Because they don’t, the Cabinet Office don’t think the plans produced so far are credible enough and don’t have enough information in them about how the savings will be made, or detailed enough forecasts.’

However, the DH has said the fund was continuing as planned. In a statement, it said: ‘Successive governments and leading health professionals have talked about joining up health and social care for decades - the Better Care Fund is a major step to making this a reality and transforming the way people are cared for closer to home.

‘We have set aside time to make sure all areas have developed comprehensive plans for joined up care. The Better Care plans start from April 2015, and we asked for early versions to be completed a year in advance so we could review them, check their level of ambition and test how they would be delivered. This is what is happening now.’

Pulse revealed in September last year that health minister Earl Howe said NHS managers were looking at how the fund could be used to help boost investment into primary care.

The King’s Fund has cast doubt on whether these efficiencies could be made, saying emergency admissions would have to drop by 15% to achieve it.

The think-tank’s report last week said the NHS was approaching a financial ‘cliff edge’ and that ‘on its current trajectory the health and social care system in England is rapidly heading towards a major crisis’

35 38 Degrees -Hospitals Safer Today
Updated: 07 May 2014


  • Today at 1:17 PM
38 Degrees Logo

Dear Friend,

Some very, very good news. We did it! The government has accepted our amendment to the hospital closure clause in the House of Lords. [1]

Without our amendment the hospital closure clause would have given the government new powers to close any hospital in England, even if local doctors were against it.

The clause was voted through by MPs back in March, after the government made some concessions. Their changes didn’t go far enough, but it seemed like the government wouldn’t budge any further.

The clause was due to be passed today. So the government’s decision to accept - almost word for word - the changes proposed by lawyers funded by 38 Degrees members came right down to the wire - and it was a big surprise.

Our people powered pressure worked and our hospitals are now safer. Thank you for everything you’ve done to make this happen. Hurrah!

David Lock QC, an NHS expert lawyer, has checked the government’s changes and here’s what he said:
“This is a very satisfying outcome. It recognises the compelling logic of the position taken by 38 Degrees members.”

38 Degrees members, alongside others like the Save Lewisham Hospital Campaign, have been campaigning on this for months:

  • Over 150,000 of us signed a petition calling for the plans to be scrapped
  • After meeting with 38 Degrees members, Lib Dem MP and ex-health minister Paul Burstow tabled amendments to the clause. The government, fearing a rebellion from within its own ranks, made some concessions but they didn’t go far enough.
  • The campaign then moved to the House of Lords. Baroness Finlay, a well-respected doctor and influential crossbench peer, led the charge. 38 Degrees members funded briefings and advice from legal heavyweights and we wrote to peers. [2]

In the end, everything we did together - alongside other campaigners and parliamentarians like Baroness Finlay, Paul Burstow MP, Andy Burnham MP - worked. The government has made the changes that they needed to.

Regardless of what happened today, we’ve still got a huge amount to do to protect our NHS. But wins like this, especially on the NHS, don’t come along that often. Today gives us more proof that when we work together, we can achieve great things, and make the government sit up and listen. So for today, let’s celebrate.

Thanks for everything you do,

Becky, Blanche, Rachel, Ian, Rebecca, Maddy and the rest of the 38 Degrees team

PS: Here’s what Baroness Finlay said:
“I am delighted that the Government have recognised the need for equity and the importance of safeguarding good patient services in a population.

The campaign to achieve this would not have been as effective without the support of 38 Degrees members.”

36 Charging for Services - Will GP's Destroy the NHS Principle ?
Updated: 07 May 2014

GP leaders to vote

on whether to support patient charges for appointments

6 May 2014 | By


Exclusive GP leaders are set to vote on whether the GPC should ‘explore national charging for GP services’ at

the LMCs Conference later this month.

The motion, put to conference by the agenda committee and set to be proposed by Wiltshire LMC on the day,

suggests general practice is ‘unsustainable in its current format’ and that ‘it is no longer viable for general

practice to provide all patients with all NHS services free at the point of delivery’.

The motion concludes: ‘That conference… calls on GPC to explore national charging for general practice

services with the UK governments.’

A Pulse survey of 440 GPs last July showed that just over half of GPs are in favour of the NHS charging a small

fee for routine appointments, with many believing it is the only way of managing their workload and curbing

rising patient demand.

Other topics scheduled for debate at the annual policy meeting, set to be held 22-23 May in York, include whether

or not CCGs should commission primary care, with several LMCs arguing that this will ‘fatally damage relations

between CCGs and their constituents’.

However, in a counter motion, Merton, Sutton and Wandsworth LMCs will argue in favour of CCGs

commissioning primary care. This comes as NHS England invited CCGs to bid to commission primary care last


GP leaders will also be voting on a motion to ‘reject the concept of routine general practice care 8-8 seven days a

The agenda document also highlighted LMC concerns over the Government’s care.data scheme, which is now

set for a delayed rollout in the autumn. An agenda committee motion, to be proposed by Bedfordshire LMC will

say that ‘the introduction of care.data has been nothing short of a disaster’ and call for a patient ‘opt-in’ system to

replace the current process of patients having to opt out if they disapprove of their records being shared.

The motion says: ‘That conference believes the introduction of care.data has been nothing short of a disaster

and.. asserts that extraction should only take place with the explicit and informed consent of patients opting-in.’

The conference will also see LMCs debating the ‘unsustainable workload in general practice’; deplore ‘the CQC’s

plans for a simplistic rating system for practices’; and condemn the ‘disorganised mess’ resulting from the NHS

reorganisation, including delayed payments to GP practices.

37 Scottish NHS 111 Out of Hours "Improved" Service
Updated: 06 May 2014

Scottish NHS 111 goes live but is 'complete contrast' to English version

2 May 2014 | By Alex Matthews-King 

The Scottish NHS 111 service, launched yesterday, is the ‘complete contrast’ to the English version, the Scottish health minister has said.

As of yesterday, Scottish patients needing the telephone advice and out-of-hours gateway service NHS 24 will be able to use the three-digit phone number that was already introduced in England last year. However, in Scotland only the telephone number has changed while the service remains to be run as NHS 24, a nurse-led service which is publicly run.

Commenting on the launch, Scottish health minister Alex Neil stressed that the Scottish and English services were ‘in complete contrast’ with one another.

He said: ‘By introducing the 111 number we are removing any barrier for the public to access the health advice out of hours. This will help to ensure people have access to health information and support, including access to a GP, when they really need it.’

‘In Scotland, the 111 number will be run by NHS 24 as a public service, in public hands - serving the needs of patients. This is in complete contrast to the approach adopted by the NHS in England, where different organisations, including private sector providers, are contracted to provide the number in different regions.’

NHS 24 receives 1.5 million calls a year, and allows the public to speak to a nurse or other health professionals to receive advice on non-emergency health concerns.

GPC Scotland’s deputy chair Andrew Buist said: ‘Patients will no longer have to worry about the cost of a phonecall when seeking urgent health advice.’

The English NHS 111 service, introduced in March last year, had a troubled start, with some out-of-hours services having to step in to take back triage services and criticism of the use of lay call handlers. Last month, Pulse revealed that NHS England will start piloting having GPs working in the call centres.

38 Do you Smell right ?
Updated: 03 May 2014

Our noses enable us to detect the difference between men and women even when we don’t think we smell

anything on the conscious level, the Daily Mail reports.

Tests by researchers in in China found that heterosexual men can recognise the smell of women, and gay men

were able to distinguish the sex smell of men. Lead researcher Wen Zhou said: ‘Our findings argue for the

existence of human sex pheromones. They show that the nose can sniff out gender from body secretions even

when we don’t think we smell anything.’

39 Care Quality Commission Inspections-CQC -What have GP's to be afraid of ?
Updated: 01 May 2014

New look CQC inspections will be 'stressful and expensive'

30 April 2014 | By Alex Matthews-King


The new CQC inspections will be time-consuming, stressful and expensive for GPs, the GPC’s lead on contracts and regulations warned delegates at the Pulse Live conference in London today.

Dr Robert Morley, executive secretary of the Birmingham LMC and GPC member, said the new ‘regime’ would be even more ‘rigorous’ than the previous inspection process, which was replaced this month.

He also stressed that problems with the new ‘Ofsted-style’ ratings system - which lets practices be classified as outstanding, good, needs improvement, or inadequate - could have a ‘negative effect’ on GP morale.

Professor Steve Field, the chief inspector of primary care, introduced the new regime this month, which is in pilot stage until October.

Key changes he introduced include a GP on all inspection teams, and sending letters to patients in the practice area notifying them of the inspection’s outcome.

But Dr Morley warned that there was a concern that practices will face problems when the regime is up and running.

He explained the GPC had intended for it to be ‘non-bureaucratic’ and ‘non-costly’ but that the changes to the registration process – which had already caused GPs problems – were ‘worrying’.

Dr Morley said: ‘We’re now in a new era starting this month. What’s clear is that everything is going to be more rigorous.’

‘The registration process is going to be more rigorous including something called the “fit and proper persons test”, which basically means whoever’s running the practice, the partners in effect, need to show they’re fit and proper people to be providing the service. This, to me is worrying.’

Dr Morley added the four ratings leave a ‘gulf’ between a ‘good’ practice and a practice which ‘requires improvement’ which he was concerned would leave lots of practices in the latter category.

He said: ‘Now we know that the idea of this is to improve the standard of care if it’s going to have a negative effect on practices, if it’s going to reduce morale, and lead to [more negative] stories in the press […]I think it’s going to have an overall negative effect on the morale of the profession, and perhaps on the future of those practices.’

CQC chief executive David Behan has previously said: ‘Over the past six months we set out proposals for different types of care services and we have been testing our new style inspections in hospitals, mental health and community health services and will be testing them in adult social care services and GP practices from this month.’

‘The changes we are making are vital to ensuring that we are able to make sure that health and social care services provide people with safe, effective, compassionate, high quality care and encourage care services to improve. Throughout these changes, we will always be on the side of people who use services and it is important to us that we hear what people think of our plans.’

40 NHS (deliberately) underfunded say King's Fund
Updated: 01 May 2014

NHS is 'heading for major crisis' and needs new money now,

King's Fund warns

1 May 2014 | By


The Government needs to add new funding to the NHS budget now or it will enter a major crisis, an influential think-tank has warned.

In a new report, out today (1 May), King’s Fund researchers concluded that despite significant savings achieved under the QIPP programme - which aims to make savings of £20bn by 2015 - the NHS will soon run out of money.

And neither the Government nor the Labour Party can afford to wait until after the next general election to broach the topic of increasing the health budget, the report warned, especially with the new integrated care fund set to slice a further £1.8bn off the health budget from April 2015.

The report said: ‘There is growing evidence of financial pressures building in the NHS this year; 2015/16 has been cited as a possible financial ‘cliff edge’ as providers plan to cut emergency and other elective work as part of the opportunity cost of diverting a further £1.8 billion of NHS allocations to consolidate the £3.8 billion Better Care Fund.’

‘On its current trajectory, the health and social care system in England is rapidly heading towards a major crisis.’

But instead of just adding new money across the board, the Government should use it as a ‘transformational fund’, the King’s Fund said, ‘including to establish integrated health and social care teams in the community that would work closely with general practices to support people in their homes and over time reduce inappropriate use of hospital services’.

‘The NHS and social care need more money to make the transition to a more sustainable footing. This should be an explicit and upfront investment to enable services to invest in new models in primary and community settings and to help the hospital sector make the concomitant transition,’ the report said.

However despite the call for new money, the King’s Fund said there is still scope to improve efficiency in the NHS and these efforts should be ‘re-doubled’. This should include measures such as GP triaging in A&E departments, GPs providing more telephone consultations and GPs directly sharing patient records with other parts of the health and care service being spread throughout the NHS, the report suggested.

John Appleby, chief economist at the King’s Fund and lead author of the report, said: ‘There is still scope to improve efficiency in the health service, and efforts to release savings should be re-doubled. However, it is now a question of when, not if, the NHS runs out of money.’

‘Without significant additional funding, this will lead to rising waiting times, cuts in staff and deteriorating quality of care. It is essential that politicians from all parties are honest about the scale of the financial pressures facing the NHS and initiate a public debate about the long-term sustainability of the health and social care system before, not after, the general election.’

Commenting on the report, a Department of Health spokesperson said: ‘The difficult economic decisions this Government has taken have meant we have been able to protect the NHS budget and as a result the NHS is performing well despite rapidly rising demand.’

‘To ensure the NHS is sustainable in the long-term we need to continue to invest more in out of hospital care, make better use of technology and innovation while never compromising on the quality of care.’

Earlier this year, an influential group of MPs also warned that the QIPP programme was not enough for the NHS to remain sustainable.

41 Call the Midwife -While we still have one in the NHS
Updated: 26 Apr 2014

Call the Midwife – while we still have one

Posted by: Giselle Green April 25, 2014


Our London Euro candidate and maternity rights campaigner, Jessica Ormerod, is warning fewer and fewer women are getting access to good, comprehensive local care under this government. Four out of five hospitals are short of midwives, according to a new investigation, and midwife leaders are saying funding cuts mean the situation is “getting worse, not better”.

Writing in Open Democracy, Jessica Ormerod, who represent mothers in Lewisham, says the maternity problem is much more serious than a shortfall of thousands of midwives.

Maternity is unlike any other health service. The users are not patients. They do not need treatment. They need care – sometimes complex care – and they need respect. We know that small maternity units, midwife or obstetric-led give a better and more valued service. We also know that midwives prefer to get to know the women for whom they are caring.

Childbirth is intimate, it requires the mother to feel safe in her environment, confident about the support from her midwives. No one wants to be herded into cavernous hospital wards with anonymous carers and a conveyor belt service to give birth in fear or under the surgeon’s knife. We need to challenge the assumption that bigger is better, we need to demand named midwives for all women and a service that genuinely caters for all.

You can read the full article at: http://www.opendemocracy.net/ournhs/jessica-ormerod/call-midwife-while-we-still-have-one

42 The Nasty Death Government
Updated: 24 Apr 2014

Coroner blames man’s death on government cuts to ambulance service

23 Wednesday Apr 2014

(not satire – it’s the UK today)

It’s official.

Government cuts to ambulance and A&E services are causing deaths.

Hartlepool coroner Malcolm Donnelly ruled the death of William Gouldburn, 73, was a “sad consequence” of a lack of ambulance resources.

In his ruling the coroner also said about Mr Gouldburn’s death: “Had there been more ambulances available the

outcome might have been different.

Here’s the full story from the Hartlepool Mail:

Hartlepool man died after waiting two hours for ambulance

43 Stop the Nasties Privatising OUR NHS
Updated: 22 Apr 2014

Our hospitals: an ambitious plan

38 Degrees Logo

Dear Friend
Over the last week 38 Degrees members have been voting to decide our next move on the campaign to protect our hospitals. Together we’ve decided to throw everything at stopping the hospital closure clause - to keep our hospitals safe. [1]

The hospital closure clause is not law yet. It returns to the House of Lords on 7th May. It’s going to be difficult to persuade enough Lords to support it. Especially because peers aren’t elected by voters, so our usual people-powered tactics don’t work.

But, we’ve got an ambitious plan. Baroness Finlay, an influential doctor and crossbench peer has agreed to lead the charge in the House of Lords. She’s putting forward changes to the law that make sure that decisions about closing hospitals will only be made in the best interest of patients. [2] Now we need to get enough Lords to support the amendment.

So here’s the plan:
- We deliver a briefing backed by legal heavyweights to every single member of the House of Lords making the case for them to support the amendment
- We put on expert face-to-face briefings to persuade Lords to back Baroness Finlay's amendment 
- Lots of 38 Degrees members have personal relationships with members of the House of Lords. We ask those of us who do know members of the House of Lords to get in touch with them and ask them to support the Finlay amendment 
- The staff team will also get in touch with Lords we’ve worked with before to do one-on-one briefings

But to do this, we need the money to make it possible. Can you help by chipping in a few pounds to make this plan a reality? Click here to make a secure donation now:

The money you donate will go towards:
- producing a glossy, informative and persuasive briefing paper which the office team will send to every single member of the House of Lords
- putting on a face-to-face briefing, getting top lawyers and hospital campaigners along to persuade sceptical Lords to back the amendment

38 Degrees is funded by small donations by hundreds of thousands of us. Sometimes 38 Degrees members come together to pay for tactics like this to give us our best chance of winning, which otherwise we couldn’t afford.

We’ve got less than a month to convince as many Lords as possible to back an amendment which does as much as possible to keep our hospitals free from danger. So, together let's roll up our sleeves and get stuck in.

Please make a secure donation below:

Thanks for being involved,

Becky, Rachel, Ian, Maddy and the rest of the 38 Degrees team

[1] To see the results click here: http://blog.38degrees.org.uk/2014/04/10/poll-results-hospital-closure-clause/
[2] To read the amendment click here: http://blog.38degrees.org.uk/2014/04/22/the-finlay-amendment-to-the-care-bill/

44 The Salt of the Earth no more
Updated: 16 Apr 2014

Meanwhile the Telegraph reports that falling salt consumption has played an ‘important role’ in the plummeting

number of deaths from heart disease in Britain. Researchers have said that between 2003 and 2011 average salt

intake in England reduced by around 15 per cent while the number of deaths from heart disease and stroke fell by

40 per cent, their study found.

The research by Barts and The London School of Medicine and Dentistry and Queen Mary University, London,

examined more than 30,000 patients over an eight year period.

45 Scotland has more GP's per Head of Population
Updated: 13 Apr 2014

Scotland has highest number of GPs per head of population

11 April 2014 | By Alex Matthews-King


GP employment in Scotland was the healthiest of any of the four home nations in 2011 with around 0.9 GPs for every 1,000 patients, according to a wide-ranging longitudinal study of the NHS.

The Nuffield Trust study of full-time equivalent GPs found the Scotland had 1,407 patients per GP in 2011, with England at 1,504, then Wales at 1,641. Data wasn’t available for Northern Ireland.

The North East of England was the best performing region, with only 1,360 patients per GP.

The study - ‘The four health systems of the United Kingdom: how do they compare?’ - evaluated how the national health systems in each country have changed before and after devolution.

It found that health service investment across the UK has doubled between 2000/01 and 2013/13, but austerity has slowed spending in the last three years and decreased investment in Wales.

It found that satisfaction with general practice remained high, with patients in the North East of England most satisfied with ‘the way the NHS’s local doctors or GPs run nowadays’.

Around 80% of respondents in the North East of England were satisfied or very satisfied, followed by Wales with 78%, 76% in England and 68% in Scotland.

Andy McKeon, senior policy adviser for the Nuffield trust said: ‘Our study period coincided with the biggest sustained injection of cash the four health systems have ever seen, so it’s perhaps unsurprising that staff numbers have increased and performance has improved.’

He said that despite differing policies, no one health service was consistently performing best, adding: ‘The North East’s remarkable progress on reducing avoidable deaths and improving life expectancy suggest that local conditions, such as funding and the quality of staff are the real determinants of health service performance.’

46 NHS Contracts -70% now going to the Private Sector
Updated: 12 Apr 2014

70% of NHS contracts are being awarded to the private sector

Posted by: NHA January 15, 2014

70% of NHS contracts are being awarded to the private sector. A study by the NHS Support Federation has

revealed that over £5 billion worth of contracts to run or manage clinically related NHS services have been

advertised in the first 9 months since the competition regulations (section 75) were passed by Parliament. 70% of

those contracts that have been awarded since April 2013 have gone to commercial companies. If this trend

continues NHS providers will face a huge challenge to their income from commercial competition.


47 Fog & Smog as Cameron disappears in Clouds of White Smoke
Updated: 05 Apr 2014

Cameron takes action on smog by being driven around in a chauffeur-driven car more often

04FridayApr 2014

Posted by in pettiness



The Prime Minister David Cameron has moved quickly to tackle the growing health crisis caused by dangerously thick smog and pollution smothering parts of the country by not going for his usual run in the Oxfordshire countryside this morning.

The strong action comes after doctors warned patients with breathing problems to stay indoors until the worst of the toxic smug on the prime minister’s face has passed and to take immediate “urgent action” if they start to feel ill while looking at it.

As experts confirmed that pollution levels were set to rocket over the next few days, Mr Cameron also announced further urgent action to tackle the crisis by making sure he was driven around in a chauffeur-driven car instead of going by bicycle.

Mr Cameron’s urgent actions come after doctors say as many as two thirds of the country’s cabinet ministers have had to suffer being driven around in air-conditioned luxury cars since the pollution alerts were first made on Tuesday, with as many as 84 per cent saying they have had to use their chauffeurs more often

48 The Austerity Policy Hides a Multitude of Government Sins
Updated: 03 Apr 2014

Analysis: GPs take the strain of ‘Austerity Britain’

1 April 2014 

Many practices are increasingly finding their waiting rooms full of patients struggling as a result of the economic downturn.

Alisdair Stirling reports

The triple whammy of public spending cuts, welfare changes and the after-effects of the recession means practices are

increasingly finding themselves managing the repercussions of ‘Austerity Britain’.

Whether it is referring patients to food banks, supporting their benefits appeals or helping them to cope with soaring levels

of stress and anxiety, many GPs are now being confronted with ballooning social issues on a daily basis.

And with the introduction of a new disability payments system, and Chancellor George Osborne targeting a further £25bn in

spending cuts after next year’s general election, worse could be to come.

Dr Andrew Mimnagh, a GP in Sefton, Merseyside, says the additional workload resulting from social problems is becoming


‘My staff are spending a lot of time on this and a lot of booked appointments turn out to be patients expressing

dissatisfaction about their [benefits] claims,’ he says.

As an example of this trend, Dr Mimnagh cites the ratio of appointments about mortgages and personal medical attendance

reports to those about benefits, which, he says, ‘has exactly reversed since the height of the boom’.

‘In the good times, it was 80% mortgages and PMAs, 20% benefits. Now it’s 20% mortgages and 80% benefits,’ he says.

Huge rise in requests

Figures obtained by Pulse under the Freedom of Information Act last year indicated a 21% increase in Employment and

Support Allowance (ESA) requests to medical professionals – the majority GPs – on behalf of the Government in the first

three months of 2013, compared with the previous year.

Now new Department for Work and Pensions (DWP) figures obtained by Pulse reveal that, between September 2013 and

February 2014, ‘medical practitioners’ were asked for additional medical evidence by DWP contractor Atos for a third of

incapacity and ESA claims – some 305,533 cases in total.

A DWP spokesperson says requests for additional evidence are sent to GPs when face-to-face assessments are ‘clearly

unnecessary’, adding: ‘Claimants can also submit evidence in support of their claim at any point in the process.’

There was a furious row last year when the Black Triangle campaign group threatened legal action after several LMCs

advised GPs to ‘just say no’ to patient requests for evidence to support their benefits appeals.

That legal threat was later dropped by the Black Triangle campaign in favour of working more closely with the BMA. But in

any event, a Pulse survey of 449 GPs across the UK indicates practices do support the majority of requests.

GPs responding to the survey said they had, on average, supported 60% of requests for additional help from patients over

the past 12 months. Around 10% of respondents said they had been asked to help patients more than 100 times over that


Despite many GPs’ willingness to help their patients, figures released by the DWP in November 2013 showed that GP

evidence was the deciding factor in only 2.9% of benefits cases.

And GPs now say the pressure is becoming intolerable and is affecting the doctor-patient relationship. Dr Robert Morley,

executive secretary of Birmingham LMC and a GP in the city, says: ‘GPs are being asked to provide specific letters –

sometimes appropriately, sometimes not – which can cause difficulties in consultations.

‘These sorts of requests are certainly worse in the past year or two. It’s a combination of the recession generally and the

Government’s welfare cuts.’

Disability changes

The introduction of the new Personal Independence Payment (PIP) is already proving to be another headache for practices.

It was brought in as the replacement for the Disability Living Allowance nationally from June 2013 and the GPC says it is

concerned about the way it is being rolled out.

A PIP is given only after an independent assessment of a claimant’s ability to complete daily tasks. GPs are paid £33.50 per

patient to give details of their diagnosis, history and treatment, and the impact of the disabling condition on the patient’s


The new system is supposed to save £3bn in benefits spending by 2018-19, but Dr John Canning, chair of the GPC’s

professional fees and regulation committee and a GP in Middlesbrough, says practices could be hit by yet more requests for

help when PIP assessments are appealed.

‘There should be no presumption that doctors can work for nothing,’ he says.

 There are some signs, though, that the Government is beginning to recognise the burden on GPs, with its new Health and

Work Service due to be up and running by the end of this year.


Under the scheme, which will be run by the private sector, employers or GPs will be able to refer people who have been off

sick for more than four weeks for non-compulsory medical assessments and treatment plans – a move which could alleviate

some of the current burden on GPs.



GPC deputy chair Dr Richard Vautrey, who practises in Leeds, says that he has also noticed the impact of a very difficult

jobs market in his surgery waiting room.

‘The challenge of unemployment is a particularly big one, especially for young people,’ he says. ‘They are presenting more

and more because of stress and anxiety – normally you wouldn’t see young people in most GP surgeries.’

Some patients are even struggling to pay for prescriptions, he adds. ‘Patients are reluctant to tell us and it’s only later that

we’ll find out they haven’t been taking their medicine because they couldn’t afford it.

‘People will also sometimes ask you to print out separate prescriptions, as they can only afford to get one at a time. There

are quite a few people caught in the trap of low-paid jobs where they don’t qualify for exemptions.’

‘Buckling under’

A Pulse survey published last month found that as many as one in six GPs has been asked to refer a patient to a food bank

within the past 12 months.

Food bank charities are increasingly requiring a referral from a sanctioned support agency, which can include schools, GPs

or the jobcentre, to ensure that support ends up reaching the most needy.

And it is this type of additional work, often unfunded, that is crippling practices, says Dr Nigel Watson, chief executive of

Wessex LMCs and a GP in the New Forest.

He says: ‘It’s not unusual in surgery to have half a dozen patients who don’t actually need to see you. They might be

consulting to change a referral under Choose and Book or they might need to see a social worker or their benefits have

been cut and they don’t know what to do.

‘In the end, it’s the straw that breaks the camel’s back. There are lots of really good practices trying to go the extra mile for

patients that are buckling under the strain and about to implode.

49 PR Consultants - (per Rectum by another name )
Updated: 02 Apr 2014

Millions spent on public relations instead of public services

Posted by: Giselle Green April 1, 2014


The TayPayers’ Alliance has today criticised NHS bosses for wasting more than £46million of taxpayers’ money last year on

over a thousand ‘non-jobs’ including an art curator and a car park environmental officer. Most of the money, £36 million,

though went on PR consultants, according to the report.

Dr Louise Irvine says:


It’s ludicrous that millions of pounds are being wasted on public relations rather than being spent on public

services. Clearly a small fortune is needing to be shelled out on PR consultants to try and put a positive spin on this

government’s catastrophic health strategy.

But the tax payers’ alliance should be more worried about the way this government is squandering BILLIONS of

money on those reckless and damaging health policies. A5 Billion are wasted every

year to run the unnecessary NHS internal market,  £3 Billion has been lost implementing the totally unnecessary and

unwanted  top down reorganisation, billions are spent repaying PFI loans, and millions wasted on making staff

redundant, then re-hiring them. Billions wasted, billions that should have been spent on frontline care.

It would also be helpful if the TaxPayers’ Alliance brought attention to the massive amount of tax avoidance and

evasion which is costing the Exchequer up to £70 billion a year in lost revenue.

50 Five a Day or Six of the best ?
Updated: 02 Apr 2014

 5 a day is immaterial if your genes have you marked for an early death from say Prostate Cancer. A condition that

gets less publicity or little public money. The Radical


Health news headlines on Tuesday 1 April. Fools Day

The Guardian leads with story that scientists have recommended that people now eat seven portions of fruit and vegetables a day.

A study carried out by experts at University College London analysed the eating habits of 65,000 people using data from eight years of the Health Survey for England, and matched them with causes of death.

The clear finding was that eating more fresh fruit and vegetables, including salads, was linked to living a longer life generally and in particular to a lower chance of death from heart disease, stroke and cancer.

Eating at least seven portions of fresh fruit and vegetables a day was linked to a 42% lower risk of death from all causes. It was also associated with a 25% lower risk of cancer and 31%lower risk of heart disease or stroke. Vegetables seemed to be significantly more protection against disease than eating fruit, they say.

There was a surprise finding – people who ate canned or frozen fruit actually had a higher risk of heart disease, stroke and cancer.

51 NHS Charges - smashes the principle that Health is a Right
Updated: 31 Mar 2014

NHS Charges Would Be the Thin End of the Wedge

Posted by: Giselle Green March 31, 2014


Writing in the Huffington Post, Dr Louise Irvine says she is appalled at suggestions that NHS charges should be introduced:

I’ve been a GP for 25 years and I am shocked that this think tank is coming up with these suggestions. They will hit the poorest the hardest and are based on a misconception that the NHS is unsustainable. It is not unsustainable or unaffordable. It is underfunded.

Charging people £10 a month would breach the fundamental principle of equity on which the NHS is based. £10 per month may not be much for some people but it is a lot for people on low incomes, on top of all the other rising living charges they face. International research on user charges shows it deters some people from accessing healthcare because they would find it difficult to pay. Then they may end up arriving in hospital in a more serious condition later – when it will cost more and be more complicated to treat. So it’s a false economy and would only bring in a small revenue anyway.

These charges would be the thin end of the wedge. They would just get bigger and bigger. Look at what has happened with prescription charges, which have gradually crept up. Opinion polls show people want an equitable NHS paid for out of taxation and national insurance and continuing to be free at point of use.

Health policy academics have labelled patient charging as a ‘zombie policy’, because it is a dead idea that vested interests keep trying to bring back to life. We need to kill it off for good

Full article at:


52 NHS Scandalised by Private HealthCare Companies
Updated: 31 Mar 2014

Thinktank proposing monthly fee for NHS

is funded by private healthcare companies

31MondayMar 2014

Posted by in cynicism

(not satire – it’s the corrupt UK today!)

Labour peer Lord Warner – who has written a report released today proposing monthly charges for using the NHS – is personally funded by private companies which will directly benefit from this kind of privatisation of healthcare:

Why Lord Warner really supports NHS reform: he’ll make loads of money from it

Warner wrote the report on behalf of a thinktank called REFORM which claims to be non-party – but which was founded by Tory MP Nick Herbert and former Head of the Political Section of the Conservative Party Research Department Andrew Haldenby.

REFORM itself is funded by many companies which will directly benefit from further privatisation of the NHS:


A full list of REFORM’S corporate sponsors can be found here - again many of which would directly benefit from these reforms.


53 NHS England not fit for purpose
Updated: 27 Mar 2014
38 Degrees Logo

Dear Friend,

Private companies are helping to decide the future of the NHS.

It’s come to light that a lobbying outfit working for big drug companies was paid by NHS England to write an important report. It’s claimed that this report could help shape £12bn (!) of NHS spending over the next five years. [1]

The NHS is owned by all of us. But NHS England - the body that runs the NHS here - doesn’t have to publish conflicts of interest like this, or details of the lobbyists they meet with. We may never have even found out this was going on.

If enough of us kick up a stink, we could force NHS England to come clean about who’s deciding the future of our NHS. Let’s show them that the taxpayers who fund them expect honesty about who’s advising them, especially when these people might profit from the decisions.

Will you add your name to the petition to demand transparency over who’s deciding the future of our NHS?

Private companies getting involved in NHS decision-making is exactly what we all feared would happen when the government passed the Health and Social Care Act. As well as providing local services, private companies are now being ushered in at the top of the NHS.

There’s no reason why NHS England can’t publish potential conflicts of interest or meetings with lobbying firms. Government departments regularly do this. [2]

NHS England is less than a year old. They’re not used to being on the receiving end of a big people-powered petition. Thousands and thousands of names on a petition, delivered to their offices, could embarrass them into coming clean about who’s influencing them.

Can you sign the petition and demand that NHS England register any links to big business?

38 Degrees members have voted time and time again to ensure that protecting our NHS is at the core of what we do. [3] It’s moments like this where we can come together and take action. Let’s fight to protect our NHS from the vultures that are circling it. The first step is to find out who they are.

Thanks for everything you do,

Susannah, Maddy, Robin and the 38 Degrees team

[1] The Independent - Revealed: Big Pharma's hidden links to NHS policy, with senior MPs saying medical industry uses ‘wealth to influence government’:
[2] Who’s lobbying? - Government departments’ registers of meetings:
[3] 38 Degrees blog post: Poll results: March 22nd 2014:

54 Tories NHS Cuts Policy must be damned by voters at the 2015 General Election
Updated: 26 Mar 2014
‘NHS funding cuts threaten GP services in UK’
 Tue Mar 25, 2014 7:58AM GMT
The British government’s cuts to the National Health Service (NHS) threaten general practice services in the country, Press TV reports.

Experts believe that with the coalition government’s cuts to NHS funding and with growing demand for care in Britain’s health centers, GP services, which have been at the frontline of the NHS, are now in danger of “extinction.”

Anti-cuts campaigner Lee Jasper told Press TV that the government’s cuts to NHS funding and its attempts to privatize the health care service have led to “massive increasing waiting times, shortage of beds, shortage of nurses” across the country.

“We got people who need urgent treatment, who can’t get it and GPS are feeling the fallout of A&E hospital units which cannot cope with the volume of the walking wounded, who are trying to get to see their GPs. Our whole care service is in the state of national crisis as a consequence of these cuts,” he added.

New figures released by the Royal College of GPs (RCGP) showed earlier this week that funding for general practice in England has fallen by £400 million in real terms over the past three years and is at a 9 year low.

Royal college's president Maureen Baker said the huge and historic imbalance in NHS funding is putting general practice under “severe threat of extinction.”

Although general practice deals with 90 percent of patient contact, it only receives 8.39 percent of the overall NHS budget, the RCGP said.

55 NHS fraud escalates as creeping back door privatisation gathers pace
Updated: 26 Mar 2014

It’s the government that’s defrauding the country out of billions of pounds

Posted by: Giselle Green March 24, 2014

Escalating fraud in the NHS is inevitable as the government’s privatisation plans gather pace.

As a new report suggests the NHS could be losing £5 billion per year on fraud and error, we say the government itself is

defrauding the country out of billions of pounds.

Our executive member, John Hully says:

With the removal of the responsibility of the Secretary of State to provide healthcare in England, we now have a

fragmented and leaderless organisation: an open invitation to fraud and error. It’s particularly alarming that the

report points to procurement as a significant source of loss: the Coalition’s reforms have transformed the NHS in

England into a huge procurement service, with billions of pounds of contracts already out to tender.

Instances of fraud are set to increase as the number and size of private contracts increase. In the US, where private

healthcare companies are rife, it’s estimated that £80bn a year is lost on fraud.

In addition to the reported £5 billion per year in losses to fraud, this government is responsible for presiding over

losses of £5 billion per year to run the unnecessary NHS internal market, £3 billion for the cost of the Lansley

reorganisation, millions spent on making staff redundant, then re-hiring them, and paying for temporary and agency

staff, millions wasted every year to repay PFI loans, not to mention the millions lost to profit margins for private


The Secretary of State must urgently address the real waste and inefficiency – which his government has created

through unnecessary reorganisation, absence of leadership and absence of responsibility.

56 Health- No Budget Breaks for the Sick the Poor or the Vulnerable
Updated: 21 Mar 2014

This government gives tax breaks to millionaires while breaking our NHS

Posted by: Giselle Green March 19, 2014


 Dr Clive Peedell give his reaction to the Budget:

This government gives tax breaks to millionaires while breaking our NHS. The cutting of beer duty and the scrapping

of the alcohol duty escalator show up David Cameron’s blatant disregard for people’s health.

George Osborne says it’s a budget for the makers, the doers and the savers. The government is now openly and

unashamedly ignoring the sick, poor and vulnerable. 

This budget does nothing substantive to address wealth inequalities and health inequalities. The Government is

ploughing on with its austerity agenda, which hits the poorest and most vulnerable the hardest. This is tragic

considering the latest published evidence from academics and organisations including the IMF show that public

spending helps to drive economic growth.

57 Health- Drinking Water
Updated: 13 Mar 2014


How many people do you know who say they don't want to drink anything before going to bed because they'll have  to get
up during the night!!

I asked my Doctor why do people need to urinate so much at night time.

Answer –

Gravity holds water in the lower part of your body when you are upright (legs swell).  
When you lie down and the lower body (legs and etc) is level with the kidneys,
it is then that the kidneys remove the water because it is easier.

I knew that you need your minimum water to help flush the toxins out of your body, but this was news to me.

Correct time to drink water... Very Important. From A Cardiac Specialist! 

Drinking water at a certain time maximizes its effectiveness on the body:

2 glasses of water after waking up - helps activate internal organs
1 glass of water 30 minutes before a meal - helps digestion
1 glass of water before taking a bath - helps lower blood pressure
1 glass of water before going to bed - avoids stroke or heart attack

I can also add to this... My doctor told me that water at bed time will also help prevent night time leg cramps.  
Your leg muscles are seeking hydration when they cramp and wake you up.

A Cardiologist has stated that if each person after receiving this e-mail, sends it to 10 people, probably one life
could be saved!
58 Health - Nasty Pasty Politicians Against Patients
Updated: 12 Mar 2014

Voters must show their anger over government’s hospital closure law

Posted by: Giselle Green March 12, 2014


The public should vote for the NHA Party to show disgust at the government’s hospital closure law, says Dr Louise Irvine.

She was speaking after the government pushed through a new rule that will enable the Health Secretary to close local hospitals in the face of opposition from local people and staff.

Dr Irvine, the NHA Euro canidate for London, and chair of the Save Lewisham Hospital Campaign, whose success triggered the change in law, said all those who care about the NHS and our hospital services should be gravely concerned:

Here in Lewisham we experienced first hand Jeremy Hunt’s attempt to close Lewisham hospital because of the PFI debts of a neighbouring trust. We challenged him in court and we won. Now Jeremy Hunt has outrageously changed the law to make sure that never again will a thriving solvent hospital be able to use that defence against the decisions of a government appointed special administrator, regardless of the views of local people or clinicians.

She went on to atttack the Liberal Democrats for supporting the government, and failing to back event their own amendment to the Clause:
It is sickening that the Lib Dems voted to enable this legislation to pass. They claim to support “localism” in health care planning but this is the antithesis of localism. This is a centralised top down financially driven decision Local people’s and clinicians’ rights to be involved in these decisions have been fatally undermined by clause 119.
Dr Irvine issued this warning to the Health Secretary:
Jeremy Hunt may think this is a way to fast track hospital closures, but it won’t stop people fighting to defend their local NHS services. Lewisham did not win just because of its successful judicial review. It won also because of its mass mobilisation culminating in 25,000 people on the streets of Lewisham.  Any Government which tries to close or downgrade valued local hospitals to bail out other trusts in deficit, will, as in Lewisham, face the anger of local people and pay a heavy political price. 
She called on voters to show their feelings at the ballot box in the forthcoming elections:

Voters have the perfect opportunity to show their disgust and anger at both this decision and and the government’s NHS cuts and creeping privatisation by voting for the National Health Action Party in the euro and local elections in May. I would urge the public to use their vote to send a strong message of support for the NHS and tell this government to keep its hands of our NHS.

“Every MP who voted for this Clause should know that their constituents will blame them if it is used to drive through closures of their local hospital because of deficits in neighbouring hospitals – deficits caused in the main by Government funding cuts and unaffordable PFI deals.”
59 Health- Newark A&E Campaign to Re-Open It.
Updated: 07 Mar 2014

Shocking proof A&E closures cost lives: Death rate jumps more than a THIRD after

department closes

  • Health Minister orders investigation as Mail on Sunday uncovers rise
  • Data revealed under FOI rules show 37% rise in emergency patient deaths
  • Accident and Emergency in Newark, Notts, closed two years ago

By David Rose

PUBLISHED: 21:59, 11 May 2013 | UPDATED: 00:06, 13 May 2013





The Mail on Sunday today reveals the first shocking evidence that hospital casualty department closures are costing hundreds of lives.

Official figures uncovered by this newspaper show a 37 per cent rise in death rates for emergency patients from Newark in Nottinghamshire, where the Accident and Emergency unit closed two years ago. 

The figures, obtained under the Freedom of Information Act, come from the NHS trusts where Newark patients are now sent. They amount to the first authoritative study on what can happen when an A&E shuts.

Increase: The number of emergency patients dying since Newark A&E closed has risen by more than a third
Whenever you see this image, tap to view all the images in a gallery

Increase: The number of emergency patients dying since Newark A&E closed has risen by more than a third

Where the data came from
Where the data came from

Data: The Mail on Sunday obtained statistics on death rates from NHS Trusts

They show:

  • Of 5,441 Newark patients admitted for emergency treatment last year, 264 died – 4.85 per cent. Yet in 2009, when there were 5,431 emergency cases, just 192 patients died – 3.53 per cent. That was the year before NHS chiefs decided to close Newark A&E, promising ‘more lives being saved’. If the percentage rate had stayed the same after the closure, that would have meant 72 fewer deaths last year – in just one area, and in just one year.
  • When Newark had its own A&E  its death rate was lower than in nearby areas – despite the fact that the town has a higher than average elderly population. Now the Newark rate is higher.
  • Like other hospitals where A&Es close, Newark General now has only a so-called urgent care and minor injuries unit – banned from treating life-threatening conditions.

Having initially refused to investigate the MoS findings, health chiefs had a change of heart last night and, at 8pm, pledged to examine our evidence.

A spokesman for Health Secretary Jeremy Hunt said: ‘We always take changes in mortality data seriously and will look into the case in Newark in more detail.’


The U-turn came after doctors’ leaders said the data suggested the policy of axeing A&E units was placing lives in jeopardy. They called on Mr Hunt to order an immediate moratorium on further closures until more is known about their likely effects.

Their call was echoed by Tory MP Andrew Percy, a leading member of the Commons health committee.


Mr Percy said: ‘These shocking figures confirm what many local people already suspected. Shutting local A&E centres does not improve patients’ survival changes, it dramatically worsens them. 

‘There should be no more such  closures until we have a thorough review of this policy.’

Mr Percy  said the closure policy was begun under Labour and ‘regrettably’ not reversed by the Coalition.

Even a former Coalition Health Minister said the closure programme should now be reviewed.

Liberal Democrat MP Paul Burstow, the former Care Services Minister, said: ‘I find these figures on death rates very worrying. ‘I do have misgivings ... it is now time to review the whole approach.’

Chairman of the Royal College of General Practitioners Dr Clare Gerada said yesterday: ‘The Newark data revealed by The Mail on Sunday points to a close association between A&E closures and mortality. It is clear the provision of emergency care is in crisis across the whole of the NHS.

‘Before any further closures are contemplated, there must be a full, independent assessment of their impact on patients and on the system as a whole.’



No answer: Jeremy Hunt refused to respond to questions from the MoS

No answer: Jeremy Hunt refused to respond to questions from the MoS

The Mail on Sunday this weekend reports  the first official data detailing the impact on emergency care mortality rates when a local casualty unit closes. We asked Health Secretary Jeremy Hunt, left, the following questions:

1. Does he now accept this evidence that A&E closures can lead to greater mortality among emergency patients living in an area where a local casualty unit  has been closed?

2. Will he now order a moratorium on  34 pending A&E closures and downgrades until a nationwide  study has been completed?

3. If he still believes localised A&E closures are for the greater good, does he think higher death rates in areas where the closures happen are an acceptable price to pay?  

4. He and his government have previously insisted the A&E closure programme is localised NHS Trust policy and therefore nothing to do with the Government. Does he think the Government has ultimate responsibility for the nation’s healthcare? Will he now take responsibility for the programme?  

5. In Newark, the average time from 999 call to A&E handover is now more than two hours. Does he think this is acceptable?

Throughout yesterday Mr Hunt’s spokesman said the Health Secretary would not answer these questions as, she said, this newspaper had not established that Newark’s rising death rate was caused by the A&E closure – because the rise began in 2010, the previous year. 

Yet the figures reveal admissions there were already falling. With the axe poised over the department, ambulances were being told to take serious cases elsewhere.

But at 8pm last night Mr Hunt’s department changed its position.

A spokesman said: ‘We always take changes in mortality data seriously and will look into the case in Newark in more detail.’

She added that a closure in one hospital was likely to worsen the pressure elsewhere.  

One consultant from North-West London, where five out of nine A&Es are set to be closed, said: ‘Newark tells us what happens when you close an A&E. As a frontline hospital consultant, these excess deaths are no surprise to me, and they clearly demonstrate the risk.’

The figures – which detail the number of patients who die within 30 days of admission to an A&E unit – have come to light in a week when Ministers have finally admitted that emergency provision nationally is in deep crisis.

There has been a doubling of the number of patients forced to wait more than four hours for treatment over the past 12 months.

David Prior, head of NHS watchdog the Care Quality Commission, has said the entire health system is ‘at the brink of collapse’ because of the pressure on A&E. 

Yet in the face of this crisis, health chiefs are pressing ahead with an unprecedented programme of A&E closures and downgrades.

As this newspaper and its readers have been saying for the past 11 months, this is soon set to affect no fewer than 34 hospitals.

One of the most shocking aspects of the cuts is that there has never been any independent academic study of their potential impact.

This means the arguments made by supporters of the closures – that most patients will be better served by travelling to ‘superhospitals’, even if they face longer journeys – have to be taken largely on trust.

Deaths: The number of emergency patients who died jumped by more than a third after Newark A&E closed

Deaths: The number of emergency patients who died jumped by more than a third after Newark A&E closed

There is evidence that some patients, such as stroke victims, are more likely to survive if taken immediately to major centres where they can receive specialist treatment, rather than an ordinary A&E. Indeed in Newark stroke death rates have declined slightly.

But other research, led by Professor Jon Nicholl of Sheffield University, has found that overall, mortality will increase with longer ambulance journeys.

Further FOI data shows the average time between a 999 call in Newark and transfer to A&E at King’s Mill Hospital, near Mansfield, or Lincoln Hospital is almost two hours. In ten per cent of cases it is nearly three hours.

These hospitals, where most Newark emergency cases now end up, are both more than 20 miles away, along roads which can be difficult even for an ambulance with a blue light.

Professor Nicholl said: ‘The research indicates there is a relationship between the distance to hospital and mortality.’

Investigation: Health Secretary Jeremy Hunt has promised to examine the Mail on Sunday's evidence

Investigation: Health Secretary Jeremy Hunt has promised to examine the Mail on Sunday's evidence

Dr Clive Peedell, a consultant oncologist who is also co-leader of political party the National Health Action Party and chairman of the NHS Consultants’ Association, said it was now evident that pressing ahead with further closures would be ‘disastrous’.

He said: ‘There is no evidence base to justify what they are doing. In A&E trauma cases, doctors talk of the “golden hour” for treatment when patients’ chances are maximised. If it’s taking nearly two hours to reach hospital, mortality is bound to increase.’

In the case of Newark, The Mail on Sunday can reveal that David Bowles, the former chairman of the trust which runs Grantham and Lincoln hospitals, warned senior NHS management that increasing the burden on services there would have disastrous consequences.

He said that when closing Newark’s A&E was first mooted in 2009, he had warned the now-disbanded East Midlands Strategic Health Authority (SHA), the body which pushed through the closure, that Lincoln Hospital was already ‘close to a tipping point’ because its patient load was so great.

‘There were no vacant beds at all, and yet the SHA was saying we had to admit more patients,’ he said. In such circumstances, it was likely that patients would be sent to the wrong ward, and the control of ‘superbug’ infections would suffer, along with patient care in general.

Mr Bowles’s concerns were ignored. Now, in the wake of the Mid-Staffordshire hospital scandal, both Lincoln and King’s Mill are among 14 hospitals being investigated over ‘excess’ patient deaths.

Meanwhile, a report commissioned by the Say Yes To Newark campaign from independent health think-tank Dr Foster has found ‘higher than expected mortality’ among emergency case patients from the NG23 and 24 postcodes treated at Lincoln from 2008 to 2011. Doctors in other areas facing A&E closures now fear similar consequences. 

The trusts which run the hospitals where Newark patients are treated refused to comment yesterday.

Campaign: More than 30,000 Mail on Sunday readers have written to the Health Secretary to stop closures

Campaign: More than 30,000 Mail on Sunday readers have written to the Health Secretary to stop closures

They referred questions to Amanda Sullivan, chief officer of the Newark and Sherwood Clinical Commissioning Group – the GP-led body now responsible for buying hospital services in the area.

She claimed the increase in mortality was caused by Newark patients being ‘ill-er’ than they used to be because they have aged, while the criteria for admitting emergency patients to hospital had become stricter.

Those who might have been given beds in the past were now sent home, so that those who were admitted were ‘more likely to die’.

She admitted she had no hard data with which to back her assertions, but she insisted: ‘I don’t think the change [to Newark A&E] has worsened mortality.’

Last night a spokesman for Mr Hunt pointed out that the death rate increase began in 2010, the year before the A&E closed.


Delay: Muriel Powell had to travel 20 miles to Lincoln after Newark A&E closed, she later died

Delay: Muriel Powell had to travel 20 miles to Lincoln after Newark A&E closed, she later died

Muriel Powell, 85, was one of thousands of emergency patients affected by the closure of Newark’s A&E in 2011. 

She had been in good health, but when she started to cough up blood, her family dialled 999. 

A paramedic in a car was soon on the scene, but Mrs Powell had to endure a long wait for an ambulance to take her to Lincoln, more than 20 miles away.

Her daughter Pauline said she was eventually diagnosed with leukaemia. ‘They were constantly taking bloods, causing her great pain.

'No one lives for ever. But you do expect people at the end of their lives to be treated with dignity and compassion. That didn’t happen. My mother died in misery.’ 

In 2011 and 2012, Lincoln Hospital admitted 1,800 Newark emergency cases a year.

A staggeringly high proportion – 8.15 per cent in 2011 and 7.82 per cent last year – were dead within 30 days.

This is more than double the average death rates at Newark when it had its own A&E.


GP chief: It's a sign of what may happen in YOUR area

By Doctor Clare Gerada, chairman of the Royal College of General Practioners

GP chief: Clare Gerada in chairman of the Royal College of General Practioners

GP chief: Clare Gerada in chairman of the Royal College of General Practioners

We are facing a national crisis in emergency healthcare. The whole system  is under great strain – and this crisis  is not limited to hospitals. It also affects community and primary care.

Patients are waiting much longer to be seen in emergency departments. Trolley-waits, which had largely disappeared over the past decade, are returning.

GPs have seen consultation rates explode in recent months and now routinely see up to 60 patients a day – something which, in my 25 years’ experience as a GP in inner London, might usually occur in only exceptional circumstances, such as a flu epidemic.

In this context, The Mail On Sunday’s investigation into rising death rates among emergency patients from Newark, where the A&E department closed two years ago, is hugely important – and may well be only a portent of what will happen on a bigger scale when A&Es close elsewhere.

Without further analysis, it is impossible to conclude categorically that the increase in death rates is due to the A&E closure. But this would appear to be the most obvious and compelling explanation – especially when one factors in the impact of longer journeys to hospitals elsewhere.

Research led by Professor Jon Nicholl, at Sheffield University, has already shown that mortality increases with distance.

In his study, 5.8 per cent of patients who travelled less than 6.2 miles to A&E died before being discharged from hospital. Among patients who travelled more than 13 miles, almost nine per cent died – and it is around 20 miles from Newark to King’s Mill Hospital, near Mansfield, or Lincoln, where most Newark patients are now sent.

It is perhaps no coincidence that both King’s Mill and Lincoln are currently being investigated because of their overall excess deaths.

The former chairman of the Lincoln Trust warned in 2009 that A&E was under severe pressure and that closing Newark would only make matters worse. 

Unfortunately, he was ignored. It is good that the Government has finally recognised that urgent and emergency care is not as accessible as it should be.

But in doing so, they are unfairly blaming GPs by claiming that a new contract, introduced almost a decade ago which allowed GPs to opt-out of providing out-of-hours care, has led to the current crisis.

This lazy accusation masks more obvious reasons why some A&Es can barely cope. 

One far more likely explanation is A&E closures put more pressure on remaining A&E services.
The patients who would have used them won’t simply disappear. 

It makes no sense to close yet more A&E departments – unless sufficient resources are provided to pick up the inevitable shift in workload when closures occur.

Read more: http://www.dailymail.co.uk/news/article-2323141/Shocking-proof-Accident-Emergency-closures-cost-lives-Death-rate-jumps-THIRD-department-closes.html#ixzz2vFRb9kjf
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60 Health-National Health Action Party says The NHS is not Safe in Miliband's hands
Updated: 07 Mar 2014

Miliband evading the big questions on the NHS

Posted by: Giselle Green March 4, 2014


Ed Miliband has written about the NHS in today’s Daily Telegraph, saying people should be given more power to help

themselves and the importance of organising services around the needs of people, instead of organising people around the

needs of services. The full piece can be read here: http://www.telegraph.co.uk/news/politics/ed-miliband/10673978/Ed-


But John Lister, NHA policy advisor, says Miliband’s short article has succeeded merely in raising more questions than

answers about Labour’s plans for the NHS:

What Ed Miliband says in this article is basically what he said at last weekend’s Labour conference. We have seen similar

ideas from Shadow Health Secretary Andy Burnham, but with more concrete proposals for putting councils (via Health &

Wellbeing Boards) in charge of commissioning local services, along with GPs.

There’s nothing wrong with many of these ideas as such: but when this is all that Ed Miliband says, it seems to evade all the

big questions: 

  1. To do as he suggests means breaking down the fragmentation of health care and the split between health & social care. This means repealing at least the core of the Health and Social Care Act. Unlike Andy Burnham, who has repeatedly promised to do so, Miliband does not mention this. In fact he rejects the idea of any “top down reorganisation” — which might mean leaving the Act in place.
  2. To develop services on the level Ed Miliband suggests is quite impossible with the tightening budget for the NHS, and even less possible with Osborne’s planned further squeeze to 2021. To fulfil this ambition, Labour has to break from Osborne’s policy and spend more money. He says nothing about this.
  3. To develop mental health care on the level Miliband suggests means tackling the historic and now widening disparity between the resources of physical health and mental health. Mental health is 24% of the disease burden, but receives just 13% of NHS Budgets. Mental Health spending has been falling in the last 2 years, and Mental Health tariffs are to be cut next year by 20% more than acute tariffs. We are already desperately short of acute Mental Health beds, secure Mental Health beds and Child & Adolescent beds – and are sending patients miles from their homes to remote, costly and poor value private facilities. Labour has to stop this waste and resource starvation in services to those with the greatest mental health needs before it makes any sense to pump extra resources into the services for people with less serious needs, such as “talking therapies” and the type of mental health care Miliband is talking about.
  4. The community health, primary care and social care resources have to be put in place before it’s possible to get people to look after themselves better, empty hospital beds and rationalise hospitals. All this requires investment. Services were admitted by  Prof Keith Willett, director for acute care for NHS England on the BBC’s Today programme this morning to be “at full stretch”. So it will mean more money to do more. Will Ed tell the other Ed to get real and promise increased NHS, council and public sector funding?

Integrated services of the type Miliband proposes here need to be planned and controlled, and the best use needs to be

made of resources: there is no room for wasteful competition and the profit margins of private sector providers. Only 2

weeks ago Miliband was echoing Blairite commitment to “choice, contestability and competition” and insisting that the

private sector “has a role”. He was wrong then.  Has he changed his mind already? Labour needs to be clear on restoring a

publicly-funded, publicly provided NHS. Any choices should be within that framework.

61 Health- Fast Track Your Fat Burning
Updated: 02 Mar 2014

Fast track your fat burning

Your metabolism is your engine, it drives you, turning food into fuel and leaving fat for dust. So if weight loss is your goal, follow our lead for a full day of fat burning from morning to lights out

7am: put fruit in pole

Go...go... go! Get a grapefruit. Researchers at Scripps Clinic in San Diego found people who got their mornings off to a flying start with half a grapefruit – over a 12-week period – lost an average of 1.3kg (3.6lb). It’s all down to just one formula: the chemical properties in the citrus fruit reduce your insulin levels, which fires up your metabolism straight out of the grid.

7.30am: join the scramble

Add two scrambled eggs and a slice of bacon to your plate. A recent study at Purdue University found a high-protein breakfast fuels fat burning. This is since more energy is needed to digest it compared with a high-sugar or high-carb start to your day. It also avoids the blood sugar spike – and crash – that cereals packed with the sweet stuff can create.

8am: test your metal

Negotiate a sharp right turn into the weights room. "Devote a short amount of time to resistance work, to raise your metabolism," says health psychologist James Lamper. Perform one set of 8-10 exercises per muscle group, 2-3 days per week. A University of Wisconsin study found when men completed a full-body workout with just three big-muscle exercises – bench press, power clean and squat – their metabolic rates were elevated for 39 hours.

11am: burn up on the wet

Things are hotting up, and though you might not welcome wet conditions you need to take on water. Add a few ice cubes to every glass – this burns around 70 extra calories every day (nearly 500 calories a week). This will raise your metabolic rate by 30%, according to Berlin’s Franz-Volhard Clinical Research Center. "Water’s also an appetite suppressant that banishes bloating as it flushes out toxins," says the centre’s Michael Boschmann. The effect starts within 10 minutes and hits top speed after around 35.

12.30pm: smoke your engine

Stop to fill up your tank with a smoked salmon, soft cheese and spinach sandwich, and throw in a pack of yoghurt-covered nuts from Pret A Manger. Each of these contain the metabolism-firing mineral magnesium and polyunsaturated fats, which increase your testosterone levels. "Raised testosterone levels give your metabolism extra spike – so stock up on fish, seeds and walnuts to rev up your fat-burning at lunchtime," says Lamper.

3.30pm: stop to refuel

Keep your speedo maxed with half a chicken breast. "Metabolic rate goes up with the ingestion of food," says nutrition scientist Jeff Volek, associate professor of kinesiology at University of Connecticut. "This is the thermic effect of food (TEF)." The TEF of protein is about 25%, so a quarter of the calories it provides are burned during digestion. (Carbs have a TEF of about 10%, and fat just 5%.) "So eating several small protein meals a day keeps your metabolism elevated," says Volek.

5.45pm: weight to win

Return to the winning circuit of the weights room after work. "Muscle tissue burns more energy just ticking over than fatty tissue does," says Dr Catherine Geissler, head of the Division of Health Sciences, King's College. So, increasing your muscle/fat ratio will give you a higher resting metabolic rate. Geissler estimates that increased lean muscle mass will up your daily energy expenditure by up to 14% (286 calories per day).

7.30pm: track temperature

Pull in to give your engine some afterburn – courtesy of capsaicin, which is abundant in chillies. Chop a few fresh chillies into any dish to encourage thermogenesis – your body’s heat-generating response, which helps burn calories. "For maximum effect, it’s best to eat chilli-based foods on a daily basis," says Jeya Henry, professor of human nutrition, Oxford Brookes University. Not an excuse to have The Raj on speed-dial, mind.

10pm: drink to victory

Finish by popping open a bottle. A milk bottle. The calcium will act as a metabolic trigger. Mozzarella cheese and two plain yoghurts a day will also help you clock up your 700mg RDA of calcium. "Milk is also a source of simple carbs, keeping insulin low," says dietician Juliette Kellow. You need to keep insulin in a low gear as high levels tell the body to store fat – that’s one signal you won’t be penalised for ignoring.

62 Health - National Health Action Party on TV Sunday Morning
Updated: 01 Mar 2014
Dear Giles,

You might like to know that we’ll be on BBC's "The Big Questions" at 10am on tomorrow (Sunday) morning, immediately after the Andrew Marr show.

It's BBC1's flagship live moral and ethical debate show presented by Nicky Campbell. Each week, three topics are discussed on the show – these are ethical or moral questions connected to the week’s news headlines. Tomorrow one of the topics will be about the future of local hospitals. It seems we’re not allowed to publicise in advance who’s on the show  but please do try and watch.
Meanwhile both Dr Clive Peedell and Dr Richard Taylor were this week interviewed on LBC (now a national radio station) following the Mid Staffs statement.
Clive was also quoted in:
It’s encouraging that the media are reporting us and increasingly coming to us for comment too.
Just a quick  mention about local groups.  We now have lots of local groups springing up all over the country. Do check our local group forums to see if there's group in your area. http://nhap.org/local-groups-page/. If not, why not start one yourself?
And please let us know if you want to help with leafleting at your local hospital anywhere in the country by emailing contact@nhap.org. You can buy leaflets from our campaign shop: http://nhap.org/products/flyers/
Finally a huge thank you to all the people who have set up local groups, offered to volunteer for us in so many different ways and made donations. We really appreciate the help.
Thanks for your support
The NHA Campaign Team
63 Health-Drug Resistant Malaria in Asia - A Concern for Western Tourists
Updated: 25 Feb 2014

Concern rises Over Drug-resistant Malaria in SE Asia

Written by IRIN
Print Friendly
Asia Sentinel
Fighting malaria in Cambodia. Photo from WHO Cambodia

Worldwide malaria control and treatment threatened

Despite intensive efforts to stem the spread of malaria across Southeast Asia, concerns are rising that new strains of the

malady are resistant to the drugs developed to fight it.

“The emergence of resistance… threatens worldwide malaria control and treatment since there is no alternative to this drug

if its efficacy decreases further and the resistance spreads outside the region,” according to the Global Fund to Fight AIDS,

Tuberculosis and Malaria, which is providing US$150 million for malaria prevention and elimination programs in the Greater

Mekong sub-region within the next two years.

The region includes southern China, Laos, Vietnam, Cambodia and Myanmar.

In 2008, artemisinin-resistant malaria was first discovered in Cambodia’s Pailin Province along the Thai border, immediately

alarming health experts.

About 60 years earlier, malaria strains had also developed resistance against chloroquine, then the most common drug to

treat malaria. A spread of resistance could not be stopped, and several years later, chloroquine was deemed useless


Now, as the parasite’s most deadly strain, Plasmodium falciparum, is proving resistant to drugs not based on artemisinin,

the government - with the World Health Organization (WHO), the US government-funded Control and Prevention of Malaria

(CAP-Malaria) and other development partners - is trying to stop further spread.

One fear is that, like before, drug resistance will reach sub-Saharan Africa, where the majority of malaria deaths occur.

 “In the last year, it got worse, and we also found resistance in locations including [Cambodia’s northwestern provinces of]

Oddar Meanchey and Preah Vihear, so it’s getting a bigger and bigger concern and we need to contain this,” said Nguon

Sokomar, country director for CAP-Malaria based in Phnom Penh.

Between 2003 to 2011, the number of malaria cases diagnosed in Southeast Asia dropped from almost 6 million to 3.4

million, a decrease of 43 percent, while the number of deaths declined by 68 percent during the same time period. But

during that time, resistance was spreading.

“The findings show that the number of resistant strains is increasing… In percentage of treatment failures, it’s about 40

percent in Oddar Meanchey,” bordering Thailand, Sokomar said.

Credible evidence for artemisinin-resistance has in recent years been found in Cambodia, Vietnam, Thailand, Burma and


As part of an emergency response, WHO established a regional malaria hub in Phnom Penh in April 2013, following the

success of Cambodia’s village malaria workers, said Sonny Krishnan, communications officer for WHO’s Emergency

Response to Artemisinin Resistance.

Best practice

Village malaria workers - trained individuals who educate and screen other villagers - have been a best practice model in

Cambodia, where 1,500 village malaria workers have been trained in priority areas.

“Now, we try to translate this to other areas,” Krishnan said.

 To “confuse” the parasite and hinder the development of resistance, different drugs are being used in combination with

artemisinin in different provinces.

“It’s a dodging game, you confuse malaria by switching the treatment,” he said.

The regional hub is now also coordinating efforts to reach out to ethnic minorities in Laos and Vietnam, who speak minority

languages and have to be educated through signs, as they are commonly overlooked in malaria interventions.

Cambodia’s National Malaria Control Center has also suggested that peacekeepers who are to be deployed to Africa be

better educated on the risks of malaria in case they carry the disease.

In addition, the WHO has established a three-tier system, where Tier 1 is regions with evidence of artemisinin resistance,

Tier 2 has an inflow of migrant workers from Tier 1 regions, and Tier 3 is areas with no evidence of artemisinin resistance.

The Global Fund said it has allocated $100 million (in addition to its $150 million pledge) to fight artemisinin resistance in

Tier 1 and Tier 2 regions in Southeast Asia, as mobile migrant workers are of particular concern.

Migrant workers part of the problem?

Legal migrants can be monitored and governments of provinces along the Lao-Cambodian and the Thai-Cambodian border

are cooperating with each other to screen workers.

“There is a good cooperation between Chanthaburi [Thailand] and Pailin [Cambodia] where they screen people crossing the

border. The moment you cross the border, there are also bilingual posters about malaria,” Krishnan said.

Undocumented migrants, however, can only be reached through village malaria workers.

 “It’s a serious problem because there are more and more illegal migrant workers,” Krishnan said.

Due to low surveillance and the country’s only recent opening, drug-resistant malaria has not been confirmed in Myanmar

yet, but is of concern.

“We don’t know if there is a resistance yet, but there is a strong belief that there could be, and there are studies being done

now,” he said.

Despite efforts to stop the spread of artemisinin-resistant strains, overall joint operations in the region need to be scaled up

further, Sokomar said.

“We need to intensify prevention, capacity-building, screening and educate all vulnerable people,” he said.

The mosquito-borne disease causes more than half a million deaths annually globally.

(IRIN is a service of the United Nations Office for the Coordination of Humanitarian Affairs This report does not necessarily

reflect the views of the UN.)

64 Health- Unable to See Your GP ?
Updated: 24 Feb 2014

Millions Of Patients 'Unable To See GPs'

The Royal College of GPs says a growing number of patients are unable to book appointments with their doctors when they need to.

10:47pm UK, Saturday 22 February 2014

By Thomas Moore, Health and Science Correspondent

More than 34 million patients will fail to get an appointment with their GP this year, according to figures seen by Sky News.

The Royal College of General Practitioners (RCGP) used official NHS statistics to estimate the number of patients who will be unable to see a GP or practice nurse because surgeries are too busy.

It believes patients have to look after themselves, try again at a later date, or seek medical attention at walk-in centres or A&E. And it warns some conditions may get worse as a result.

Latest figures from the GP Patient Survey, which is carried out by NHS England, show one in 10 patients is unable to see a GP or practice nurse when they need to.

Doctors warn of a lack of access to GPs

And with general practice now offering 340 million appointments a year, the Royal College estimates that 34 million will miss out.

That is a rise of 3.4 million since the survey a year earlier, which showed 9% reported they were unable to book an appointment.

Dr Maureen Baker, chair of the RCGP, told Sky News care is being compromised.

"People do need to see a GP as soon as possible for right action to be taken and the right treatment to be delivered," she said.

"And this is a worry we have: that the lack of access to GPs might be making some problems worse."

The College blames a real-terms funding cut of £9bn for GP services since 2004/05, leaving surgeries unable to hire the staff they need to meet rising demand.

It says GPs have already provided an extra 40 million appointments, but are now struggling.

The RCGP is calling for more funding for GPs

Dr Baker warned: "The unprecedented decline in funding for healthcare in the community has brought general practice to its knees. GPs can't keep doing more for less."

The RCGP and the National Association for Patient Participation are urging the Government and NHS England to increase GPs' share of the budget to 11% by 2017 - up from 8.5% now.

The concerns were echoed by Dr Peter Swinyard, chair of the Family Doctor Association and a GP in Swindon.

"We can't give a gold-plated service to all of our patients on a share of the resources which is dropping so significantly," he said.

"We have had a 25% cut in resources in general practice to look after patients who are sicker, who are more complex, and who are taking more of our time and attention. Something has got to give."

By switching to a GP-callback system his practice has reduced the number of patients who need a face-to-face appointment.

That has helped to deal with rising demand, but it's not a long term solution, Dr Swinyard said.

It is estimated 34 million people will not get a GP appointment this year

Susannah Fernandez, who brought in her two-year-old daughter Olivia because of a chest infection, said waiting times at the surgery were long.

"There used to be days when you could queue outside," she said.

"Waiting in the cold was not ideal. And then it would be pot luck what time you were seen.

"Obviously children get bored quite quickly too, so waiting in a waiting room was not ideal."

But the Department of Health dismissed the RCGP's claims.

A spokesperson said: "It's complete nonsense to suggest that 34 million people won't be able to get an doctor's appointment this year.

"Misleading extrapolations of partial data have been used to generate a sensationalist headline.

"The GP Survey showed the vast majority of patients are satisfied with their GP and rated their experience of making an appointment as good."

The Department of Health is providing £50m to help modernise general practices and allow them to stay open longer.

:: Watch Sky News live on television, on Sky channel 501, Virgin Media channel 602, Freeview channel 82 and Freesat channel 202.

65 Health- Painful Left Hand Spasms ?
Updated: 21 Feb 2014

Painful left hand spasms? 
Do you get awful painful spasms of your left hand that makes your fingers curl up like claws?
Are you terrified it is something deadly? Perhaps a heart attack?
Be reassured:  it is probably nothing serious and can be stopped in a couple of hours.
Left hand spasms suddenly occurred about 2pm on the afternoon after I came home from hospital and terrified me into thinking I was having a heart attack.  My hand suddenly curled up with awful pain in the palm that travelled up past the wrist.  It took a couple of minutes before the pain subsided and I could force my fingers straight again.  I wondered if I should phone for an ambulance but I had a catheter and bag after my operation and didn't want the fuss so I decided to wait and see what happened as my pulse and breathing were bobbing gently along nice and regular.  Two minutes later the spasm happened again.  And then again. Something seemed seriously wrong!  So I decided to look online and found a link that made sense:  it said it was calcium deficiency!  
You might think this is crazy and highly unlikely but in fact it is quite logical and true.
I had had to have a colon operation to remove a few inches of colon - for lining something else not because I had any colon cancer.   I was told to eat a low residue diet for a few days and the day before the operation I had to have my stomach/bowel emptied with Picolax and water and then I had a liquid diet for a further six days with no fruit juices. So basically for about 12 days I an empty stomach and of course none of my usual good diet of fruit/veg/meat/fish/bread.  When finally allowed light food I couldn't face most of it so had another two days with small nibbles of chicken and fish but I did eat rice crispies for breakfast and three cream crackers at suppertime.  I must have been quite malnourished when I was sent home.
9 days after the operation my left hand suddenly spasmed into a claw with awful pain.
The internet revealed that a possible cause was calcium and potassium deficiency - this seemed logical in view of the extended fasting and lack of calcium and potassium rich food.   In my kitchen I had milk, bread but no cheese as I had emptied the fridge before the operation but I did have some cheese spread which I think is quite nice and luckily it was an extra calcium variety.  So I gulped down two glasses of milk with two slices of bread with a very think layer of the spread.
My hand spasmed again a few times over the next couple of hours then from about 6pm I had no more.   So the whole episode lasted about 4 hours but the pain and spasm had been so strong that my forearm was painful for about three weeks more.
I complained to the hospital and suggested that the long fast and bowel cleaning was not very good and maybe similar patients should be given caclium tablets as well as some tasty sweets such as fruit pastilles to stimulate the taste buds to get the appetite back as well as drip feed a little sugar into the system.  Perhaps glucose tablets or drink would be a better bet?
A few months later the spasm suddenly occurred again after I had been on a strict diet of mostly fruit and veg with zero bread or cheese and I had also been drinking quite a few glasses of a fruit drink which was very tasty.
This time my internet turned up the possibility that vitamin C from fresh fruit and fruit juice can prevent the stomach absorbing calcium so I immediately ate some bread and cheese and the spasms disappeared.  I threw out the fruit drink and oranges and had no more spasms for months.
Just today the spasm suddenly occurred several times in a few minutes and it dawned on me that in the previous few days I had not eaten any bread as well as being constipated then diarrheoic from some prescription pills and had eaten some tinned pineapple.
I threw out the rest of the pineapple, drank some milk and ate bread and cheese and the spasms disappeared.
Therefore I suggest that if you are having spasms regularly then the cause may be as simple as taking too much fruit and fruit juice especially of strong acidic ones like pineapple which is known to have enzymes that can soften meat.  Cut fruit and juice out of the diet and add milk, bread and cheese to see if the symptoms disappear.
Following on from left hand spasms it seems that there is a distinct link to other medical problems involving the muscles and temporary loss of control of them as in: Guilliame Barre Syndrome, Scarlatina Projectile Vomitting and related sicknesses where stomach upset precedes serious muscle problems.
What seems to be happening with Guilliame Barre and Scarlatina is that the digestive system suddenly has difficulty absorbing certain nutrients from the liquid food flowing through it due to the 'bad bacteria' overwhelming the 'good bacteria' so that the food is not properly digested and so the nutrients are not properly released to be available to be absorbed and processed into the blood stream. 
Also the stomach bug temporarily both poisons the body with the toxins as well as attacking its lining to release the blood that reddens the vomit and diarrhoea and all this stops the intestines working well for some time and the reserves of nutrients drops until the critical level then the spasms and paralysis start.
What is really happening is that our bodies work by the muscles being instructed to work by the brain sending electrical messages along the nerves telling a particular muscle or muscle group to do something.
For instance, to type this article I have to think the words I need to type and without my consciously aiming my fingers my brain sends signals along all the nerves between the muscles of my fingers, arms, shoulders telling the muscles to move my fingers over the keyboard. My eyes have also to follow the finger tips or watch the screen. As each muscles moves it also needs input from its neighbours to ensure the finger tip is aimed precisely and as the finger tip reaches the key the muscles all have to cooperate to stop the travel of the finger tip and control the pressure on which it taps the key.
At the instant of tapping other nerves in the skin register the contact and on feeling sufficient pressure to make the key work correctly the nerves signal the brain to stop forward movement while my eyes check that I have hit the correct key.  If the correct letter appear on screen my brain instantly starts the process of retracting the finger tip from that key and start searching for the next letter.
As I type my brain is thus:
working on one level of thinking about exactly what I want to say and how the sentences should be made with the best words,
white it is controlling the physical and optical typing,
 at the same time it is working at another level of maintaining my posture in the chair by controlling all the back and hip muscles using balance signals from my ears,
and at the same time another lever of brain is maintaining my health needs of blood pressure and body temperature by constantly monitoring all sorts of chemical levels, temperatures and pressures in my entire body,
and at the same time it is aware of my bodily comfort needs such as the fullness of my bladder and bowels and the slight drop of energy due to the last intake of caffeine or sugar wearing off,
and at a further level it is also maintaining alertness by being aware of noises or shadows caused by people passing the window and cutting the light reaching my eyes and at the same time,
and perhaps lastly it is maintaining a check on the television chat to check for any bits of the program that maght be interesting to me.
As all these functions have to occur constantly and at great speed it is obvious the brain really is an amazing supercomputer that must be processing millions of bit of information every second. (Its impossible to believe it evolved but that's another story.)
So following the brain being the ultimate command centre tasked with keeping the person alive then like any good 'General' it will have to allocate its resources when trouble appears.
When we feel a left hand spasm, or collapse in a pool of vomit from scarlatina or die from Guilliame Barre Syndrome pparalysis what has really happened is that the General has lost contact with its furthest sentries - the fingers and hands, toes and feet and its messages are not getting through. 
Without essential input from the fingers and toes about what pressures and orientations they are subject to or are trying to achieve and without them being able to receive signals instructing them to make certain movements they just stop working or get a false signal that confuses the muscles so they spasm illogically.
Calcium deficiency seems to be a separate short circuiting of the nerves to the muscles that operate the left hand.
As the body finds itself short of essential nutrients it cannot maintain the insulation around the nerves that transmit the electrical signals between the brain and muscles and so the body first loses sensation and then becomes paralysed as the muscles cannot either contract or relax from the position they were in as the last message arrived.
With the lethargy or paralysis of projectile vomitting the researchers have found that the cause is the nerves between the brain and the muscles lose their protective myelin coating so the electricity short circuits out into the flesh rather than running down the nerve all the way to the muscle.
To cure the problem needs the nerves too regain their coating and this seems to need efficient absorption of B vitamins from the food.   B12 is thought to be the essentail one.
66 Health - NHS Leadership - Medical Matters
Updated: 20 Feb 2014

19 February, 2014

An open letter on NHS Leadership

to Sir Stuart Rose, Sir David Nicholson and Simon Stevens

Over the last several years it has become widely accepted that clinical leadership and clinical followership are essential

components of successful NHS leadership and NHS change. Under the previous government, the Darzi NHS Next Stage

Review stated that "clinical leadership is a topic central to the success of the health service".

A recent report by the NHS Institute for Innovation and Improvement and the Academy of Medical Royal Colleges titled

Engaging Doctors highlighted a review of the clinical leadership literature by Professor Chris Ham and Helen Dickinson and

concluded: "Without doctors, attempts at radical large scale change were doomed to fail."

This review also concluded that effective leaders require followers to implement change. The development of "followership"

is therefore just as important as the development of leadership.

Clinical leadership is arguably now even more important considering the current reforms have supposedly put clinicians at

the heart of the reforms.

The http://www.hsj.co.uk/topics/nhs-leadership/">NHS Leadership website states: "Effective clinical leadership is critical if

we are to achieve an NHS that genuinely has the quality of care at its heart… With the economic challenges facing the NHS

it is imperative that frontline clinicians have the leadership skills to drive through radical service reform."

The development of effective clinical leadership is dependent on clinical engagement, which in turn requires trust, shared

values and a shared vision of the direction of NHS reform.

However, the last 25 years of NHS reform has seen all three main political parties in England support a market based vision

for public service delivery. Labour MP and former cabinet minister John Denham summed this up well in an article in the


He wrote: "All public services have to be based on a diversity of independent providers who compete for business in a

market governed by consumer choice.

‘This pro-market vision is the antithesis of what medical professionalism is about’

"All across Whitehall any policy option now has to be dressed up as ‘choice’, ‘diversity’ and ‘contestablity’. These are the

hallmarks of the ‘new model public service’."

The Conservatives have now taken this much further with the Health and Social Care Act 2012 which legislates for a

regulated external economic market with a much greater role for private provision of NHS care. Yet this pro-market vision is

the antithesis of what medical professionalism is about.

Professor Eliot Friedson stated that medical professionalism was underpinned by an ideology that assigns a higher priority

to needs based work rather than to economic rewards. It focuses on the quality and social benefits of work rather than its

profitability. Thus medical work is "totally unsuited for control by the market or by government or business," he said.

The obstacle of medical professionalism

Medical professionalism also presents an obstacle to market reforms because "medical sovereignty" exerts control over the

market through cultural authority over patients. This represents the age old problem of information asymmetry as a cause of

market failure.

In addition, doctors control access to the healthcare market and the allocation of resources.

 A recent BMA and MORI poll confirmed that most doctors want to work collaboratively rather than in competition, and most

GPs and patients want to use their local hospitals as long as they provide good care.

This all poses a huge problem for the Coalition’s pro-market reforms because the first guiding principle according to

Andrew Lansley, the architect of the Health Act, is to "maximise competition… [it] is the primary objective".


This type of collaborative working fundamentally undermines the functioning of a market system. I therefore subscribe to

the view of Professor David Marquand, who stated that public service professionals "are in a profound sense not just non-

market, but anti-market".


This is almost certainly the reason why doctors have been excluded from the policy making process ever since Margaret

Thatcher’s Working for Patients white paper in 1989 which introduced the internal market into the NHS.

This signalled the end of the "double bed" of policy making between the medical profession and the state which was so

eloquently described by Professor Rudolph Klein at the time.

Another key issue surrounding markets and medical professionalism is public choice theory which rejects the idea of

professionalism and the public service ethos, and views market competition as necessarily the route to greater efficiency in

public service delivery.

Julian Le Grand’s work in this area using the "knights, knaves, pawns and queens" metaphor has been particularly

influential in favouring this approach in policy making.

Public choice theory underpinned the rise of new public management (managerialism) which favours narrow economic

priorities and micromanagement practices – for example, audit, inspection, performance indicators, league tables,

monitoring and centrally imposed targets – over professional judgment. Unsurprisingly this approach hasn’t been popular

with clinicians.

The bottom line

 Markets also undermine the social contract between doctors and patients and damage the doctor patient relationship

because decision making becomes increasingly based on financial concerns rather than patient needs.

This was well summed up by David Coates from The Work Foundation.

He said: "Relationships between medical professionals and patients depend on trust rather than contractual obligations and

attempting to reduce the provision of healthcare to economic transactions erodes the intrinsic motivations on which the

doctor patient relationships depend."

‘There is clear evidence that a shared vision is vital to effective clinical leadership’

 It should therefore come as no surprise that the American medical profession lost public support faster than any other

profession during the rapid commercialisation of the US healthcare system in the 1970 and 80s. This was also recognised

by the Nobel prize winning economist Kenneth Arrow in a recent interview. He said: "One problem we have now, is an

erosion of professional standards."

This all poses a huge problem for the crucial issue of clinical leadership and its importance within the framework of NHS

Leadership and the success of healthcare reform, because there is clear evidence that a shared vision is vital to the

effective clinical leadership.

J. Silversin and M.J. Kornacki wrote: "Leadership is ineffective if doctors are not in agreement around a vision for the

organisation, and physicians’ expectations of their practice life are incompatible with what change requires of them."

Since market based reforms undermine medical professionalism and the very essence of what it means to be a doctor, this

"shared vision" is impossible to achieve in the context of a market driven NHS, and also explains why there was such mass

opposition to Lansley’s Bill from the medical and nursing professions.

I therefore believe that market reforms and market solutions for the NHS are indeed "doomed to fail".

 There will never be effective NHS clinical leadership and followership, and successful NHS reform until the failed market

based policies of the last 25 years are abandoned and the medical and nursing professions are brought back into the policy

making process.

I will finish with a quote from Arnold Relman, Emeritus Professor of Medicine at Harvard University and former editor of the

New England Journal Medicine, which sums up the situation.

He said: "Medical professionalism cannot survive in the current commercialised healthcare market. The continued

privatisation of healthcare and the continued prevalence and intrusion of market forces in the practice of medicine will not

only bankrupt the healthcare system, but also will inevitably undermine the ethical foundations of medical practice and

dissolve the moral precepts that have historically defined the medical profession."

Dr Clive Peedell, co-leader of the National Health Action Party and co-chair of the NHS Consultants’ Association

67 Health- Antibiotics -Overuse
Updated: 19 Feb 2014

Antibiotics have transformed human health and saved millions of lives. Now, as a

result of overuse, they are no longer working. The golden age of medicine has

come to an end

Needwood House Farm is easy to miss. Only a small sign - the bright pink image of a pig - suspended from a fence post hints at anything of significance down the one-way track that leads off the main road. After a few hundred metres of bouncing over mud and gravel, it is the pungent smell that smacks you first. Then, the sound; the squealing, grunting and growls of 5,000 pigs crammed into this corner of rural Staffordshire.

A hundred or so piglets are excitedly clambering over each other or snuffling around the muddy floor of the gated outdoor enclosure where they are waiting to be transported for slaughter. Inside the great barns, 500 sows lie side-by-side in pens while their offspring fight for space at their teats.The air hangs heavy with ammonia, so thick it stings the lungs.

This is the flagship operation of Midland Pig Producers, which runs nine farms across the country producing 80 tonnes of meat a week to supply leading supermarkets including Tesco, Marks and Spencer and Asda. It is big. But only a few miles away over the border into Derbyshire, something even bigger is planned.

A decision is expected shortly on Midland Pig’s so-called Foston Mega Farm, which will house 25,000 intensively reared indoor pigs, making it one of the largest in Europe. The proposal has attracted huge opposition, with more than 20,000 letters from across the world. Pig welfare is, of course, an emotive issue. But campaigners insist that something greater is at stake here - something that the Chief Medical Officer has referred to as one of the greatest threats of the 21st century, alongside terrorism and climate change, and which this spring, is expected to be placed on the national risk register. Such farms rely on the use of antibiotics for sick animals, but as we rush to produce industrial quantities of ever cheaper food, we have sleepwalked into a human health crisis.


National Risk Register

The government’s list of the greatest threats facing the country. Adding antibiotic resistance is being actively considered
Pandemic influenza

This remains the most significant civil emergency risk. Three worldwide influenza pandemics occurred in the 20th century (1918, 1957 and 1968)

Coastal flooding

The east coast floods of 1953 were the worst peacetime disaster to hit the UK. As a result a national emergency was formally declared

Catastrophic Terrorist Attacks

Major terrorist attacks are an ongoing threat. The likelihood of terrorists obtaining effective biological or nuclear weapons remains 'not negligible'

Volcanic eruptions abroad

Volcanic eruptions abroad, such as the 2010 Icelandic ash cloud, can affect the UK. Effusive (gas-rich) eruptions are the most dangerous

Severe wildfires

A newly-assessed risk, wildfires - such as the Swinley Forest blaze in 2011, the largest in Berkshire’s history - spark massive devastation


70 per cent of the world’s bacteria have now developed a resistance to antibiotics. We have used - or are using - the drugs of last resort

Antibiotics are no longer effective. The drugs that have transformed life and longevity and saved countless millions since penicillin was discovered by Sir Alexander Fleming in 1928 now saturate every corner of our environment. We stuff them into ourselves and our animals; we spray them on crops, dump them in rivers, and even – as emerged at a meeting of science ministers from the G8 last year - paint them on the hulls of boats to keep off barnacles.

As a result an invisible army of super-resistant bacteria has evolved, one that is increasingly claiming lives – currently more than 25,000 a year in Europe alone, around as many as die on the continent’s roads.

Many leading scientists and doctors and politicians are freely adopting the language of global catastrophe. Infections such as tuberculosis and septicaemia - the scourge of earlier centuries - are once again killing us at frightening rates. We have used, or are using, our so-called drugs of last resort. There is nothing left in the armoury and new drugs are not being developed. Welcome to the post-antibiotic age.

n 2012, at Needwood House Farm, a pneumonia outbreak swept through the herd. The piglets were taken off site and sows fed antibiotics with their food for six weeks. Those few that didn’t survive were incinerated. The outbreak – the first in eight years at the Farm - cost Midland Pig Producers £100,000.

“Antibiotics are expensive,” says owner James Leavesley. “The last thing we want to do as a business is use them. We don’t unless we have to. It’s done because an animal – just like a human – can fall ill. If we need to stop using them on farms, can we stop using them in hospitals as well, please?”

Leavesley says intensive farming has come a long way since “barbaric” and “abhorrent” practices in the Sixties and Seventies. Nowadays, pens are better ventilated and excrement is sluiced away through grates.

“What we are proposing [at Foston] is going to be a cultural evolution. The whole point of the thing is to create an environment where we don’t need antibiotics.”

It is an admirable goal, but the reality is that modern British farms rely on antibiotics and on a vast scale. In 2012, some 409 tonnes of antibiotics were sold for animal use (a rise on the 346 tonnes sold the previous year), of which 85 per cent was for food-producing animals. The use of three classes of antibiotics classified by the World Health Organisation as “critically important in human medicine” has also increased. According to the latest Department for Environment Food and Rural Affairs (DEFRA) report, in 2012, 2.4 tonnes of fluroquinolone antibiotics were given to animals compared to 2.1 tonnes in 2011. Sales of the other “critically important” antibiotic classes - third and fourth generation cephalosporins (1.3 tonnes) and macrolides (40.9 tonnes) - also recorded small rises on the previous year.

“It’s getting worse, not better. It may be OK for five to 10 years but it’s not a sustainable model for the future. Otherwise we will lose our antibiotics.”

Zac Goldsmith MP

Veterinary medicine accounts for around 30 per cent of antibiotics use in this country, and yet, we are one of the better regulated in the world. An EU-wide ban on the use of antibiotics as growth promoters in livestock has been in place since 2006. In Britain, only vets can prescribe antibiotics for animals, although critics say this raises an obvious conflict of interest when they also sell them. Worldwide, the majority of the 100,000-200,000 tonnes of antibiotics manufactured every year is freely used in the agricultural, horticultural and veterinary sectors to keep animals healthy on industrial-scale farms. “It’s getting worse, not better,” says Zac Goldsmith, the Conservative MP for Richmond and treasurer of the newly-formed All Party Parliamentary Group on Antibiotic Resistance. “When you concentrate a very large number of animals, particularly pigs, in very cramped conditions, you are going to create all kinds of local and environmental problems.

“History tells us you can’t keep animals in those conditions without almost daily use of antibiotics. It may be OK for five to 10 years but it’s not a sustainable model for the future. Otherwise we will lose our antibiotics. There are all kinds of implications about mega farms. I know that the total use [of antibiotics] per head per animal has gone up 18 per cent in the past 10 years.”

Goldsmith talks with a quiet urgency from the corner of a tearoom in the Houses of Parliament. For a long time, he says, he has been one of the few outspoken voices from the backbenches on antibiotic resistance. But not any longer. There is growing concern at the highest levels of Government over the seriousness of the issue. The June meeting of the Parliamentary and Scientific Committee to discuss antibiotics was standing room only in the Commons committee room. Looking down from the wall was a portrait of Lord Palmerston (prime minister 1855 to 1858 and 1859 to 1865). Once more we are engaged in gunboat diplomacy, the rhetoric of war.

Interactive Graphic

The global habit that created a crisis

Six ways we have undermined a wonder drug. Click to read more
  • Agriculture

    Globally more than 70 per cent of antibiotics are used in animal agriculture including some of the most potent antibiotics available. In more than 100 countries antibiotics are routinely added to animal feed to promote growth. So-called mega farms, intensive meat and poultry farms where diseases can sweep through herds, are blamed in particular for overuse.

  • Aquaculture

    Intensive aquaculture (shrimp and fish farming) has led to growing problems with antibiotics routinely used to treat diseases. The industry supplies the world with 110 milllion metric tonnes of food fish per year. 75 per cent of the antibiotics fed to fish are excreted back into the water.

  • Veterinary

    In Britain the veterinary sector has been criticised for irresponsible prescription of antibiotics, as vets can profit by selling the same drugs they prescribe. The government does not track the use of veterinary antibiotics in detail, with the main data available the total annual tonnage of antibiotics sold. In 2012, 409 tonnes of antibiotics were prescribed by vets in Britain.

  • Prescription

    Antibiotics are commonly prescribed for respiratory infections, but most of these are caused by viruses not bacteria. Most patients are prescribed antibiotics without the doctor knowing the cause of the infection. GPs in England currently prescribe 35million courses of antibiotics a year.

  • Patient pressure

    Doctors say they are put under huge pressure to prescribe antibiotics. Private doctors who see patients outside of hospital systems, such as those working in private offices, contribute disproportionately to the spread of antibiotic resistance. A 2012 survey in Australia, which has one of the highest rates of antibiotic use in the world, found 80 per cent of people who visited a doctor expected a prescription.

  • Over the counter sales

    Over the counter antibiotics are available in many countries and are also easy to order over the internet. In some countries, hospitals make money from antibiotic sales. Up to a quarter of revenues in some Chinese hospitals derive from antibiotic sales. In March, the sale of antibiotics over the counter in India will be restricted for the first time.

  • Water

    Urban wastewater treatment plants are among the main sources of the release of antibiotics into the environment. Hospitals and drug manufacturing sites have the highest concentrations of antibiotics in their effluent, especially in developing countries where the majority of drugs are manufactured. Antibiotics have been detected in drinking water.

  • Soil

    Many antibiotics are non bio-degradable and can persist in high concentrations in soil for a long time. An estimated 70 million tonnes of animal manure waste is spread on to agricultural land each year in Britain. Crops can take up substantial amounts of antibiotics by the roots. Antibiotics are also sprayed on to crops, such as high value fruit trees, to prevent bacterial diseases.

  • Wildlife

    Studies are now finding antibiotic resistant bacteria among wildlife. Resistant genes have been detected in the bacteria of numerous animals ranging from gulls, crows and moths, to foxes and sharks. A study conducted in the Wirral found high levels of resistant bacteria in the faeces of forest rodents.

  • Travel

    Last year the number of international tourist arrivals across the globe broke through the one billion barrier for the first time ever. We carry drug resistant pathogens everywhere we go. One recent study of Swedish world travellers found one in four young men were returning with antibiotic resistant bacteria present in their guts.

  • Migration

    Migrant workers have also led to unprecedented movement of antibiotic resistant organisms across international borders. Since 2004, more than one million migrants from Eastern Europe have arrived in Britain (around half have returned home) further spreading antibiotic resistant strains of tuberculosis. TB rates are higher than the UK in seven of the 12 accession countries.

  • Trade

    According to the World Health Organisation, the growth of global trade allows resistant microorganisms to be spread rapidly to distant countries and continents through food. Global meat trade is a complex web of supply and demand. 60 per cent of the pork eaten in the UK is imported and around 40 per cent of fish produced in China is bought by EU countries.

Medical tourism
  • Patient movement

    Many healthcare patients now travel to foreign locations for medical treatment. Cosmetic, dental and even organ transplants are becoming more common as experienced surgeons and hospitals offer care at a fraction of Western prices. By 2015, it is predicted 3.2 million people will travel to India for cosmetic surgery or other operations.

  • Hospital cleanliness

    Hospitals have become hotbeds for highly-resistant pathogens, like MRSA, ESBL, and CPE, increasing the risk that hospitalisation kills instead of cures. In many countries, the pharmaceutical industry is the principal source of prescribing information for doctors. Hospital patients generally have weaker immune systems and more wounds to infect.

Development failure
  • Profit

    Only four drug companies are left in the development of antibiotics. Antibiotics are not as profitable as other drugs taken for chronic conditions. Successful treatment with effective antibiotics takes only a few days compared to drugs for diseases like diabetes or blood pressure which people take for years.

  • Difficult science

    Between 1935 and 1968, 14 different classes of antibiotic were developed. In the 45 years since then, only five have been brought out. The pipeline for new replacement antibiotics is virtually dry. Mergers between pharmaceutical companies has reduced the number and diversity of teams seeking to discover new antibacterials.

  • Complex regulations

    Leading global drugmakers have said they need new incentives to stimulate research. Clinical trials are complex and cost a lot of money. The regulatory process is risk averse with high levels of bureaucracy and lack of clarity in the process.

AnimalsAgricultureAquacultureVeterinaryMedicinePrescriptionPatient pressureOver the counter salesEnvironmentWaterSoilWildlifeGlobalisationTravelMigrationTradeMedical tourismPatient movementHospital cleanlinessDevelopment failureProfitDifficult scienceComplex regulationsHumansAntibioticresistance

Last autumn, Britain launched its new Five Year Antimicrobial Resistance Strategy. Ministers accept the urgent need to reduce the use on farms, but it is not just in the food chain where resistant bacteria thrive in a generous swill of antibiotics. According to Chief Medical Officer, Professor Dame Sally Davies, GPs in England currently prescribe 35 million courses of antibiotics a year. As patients we demand them, putting huge pressure on doctors to prescribe pills for viral infections such as a sore throat for which they are useless. Too many GPs who should know better acquiesce.

Dame Sally and other experts say it is a practice we must stop now. “I care about my children and grandchildren, let alone my own old age,” she says. “If we don’t sort this out, not just as a nation, but globally, we risk going back to a time where people die young.

“We risk going into a post-antibiotic era, and that could start any time in the next 10 or 20 years, when modern medicine becomes impossible. Routine surgical procedures - hip replacements, caesarean sections, modern cancer treatments - all are based on using antibiotics to prevent or treat infections. Without them, people will die.

“Before antibiotics, 43 per cent of people died of infection in this country. At the moment it is seven per cent. I predict without proper conservation and new antibiotics, our death rate will steadily creep up. We risk returning to a situation like that. And the stupidity is, we don’t have to.”

o truly understand the extent of the problem, one must look beyond Britain’s borders. Compared to other countries, in particular the emerging powerhouses of India and China, we are well ahead in reducing use of antibiotics. But there is only so much we can do alone.

This frustration was evident at the first evidence session of an ongoing parliamentary inquiry into antimicrobial resistance at Portcullis House which started in December. As Sharon Peacock, professor of clinical microbiology at the University of Cambridge told MPs: “Much of the resistance we see in this country is actually potentially imported from other places. We have to recognise that and understand what is happening in the bigger picture.”

Ours is a globalised world, and 70 per cent of the bacteria in it have now developed a resistance to antibiotics – including those drugs regarded as our last line of defence. Superbugs spawned in a Chinese hospital or a polluted Pakistani river cross continents quicker than we can discover them. One recent study of 100 Swedish travellers visiting countries outside of Northern Europe found one in four young men had antibiotic resistant bacteria present in their guts on their return.


How resistance breeds


We carry resistant microbes wherever we go. In 2011, there were almost 35,000 cases of multi-drug resistant tuberculosis recorded in Europe – a six-fold increase in as many years. London is now known as the TB capital of the western world. During the past year around 3,500 residents were diagnosed with the disease (out of around 9,000 across the UK) with boroughs like Newham and Ealing experiencing rates of infection comparable with the developing world.Treatment of multi-drug resistant TB is vastly expensive, costing between £50,000 to £100,000 per patient over two years, and putting a huge strain on hospitals and budgets.

Necessity negates political correctness. Only last month, Professor Ajit Lalvani, from the National Heart and Lung Institute, called for more screening tests to identify latent symptoms of TB that could be brought into the country by immigrants. For it is from distant shores where much of this bacteria comes from.

About 75 per cent of the cases nationwide occur among people born in countries where TB is more common, mostly South Asia (60 per cent of cases) and sub-Saharan Africa (22 per cent). Multi-drug resistant cases are also increasing in Eastern Europe. The complicated therapies required to treat the disease are more difficult to impose over language barriers and with vulnerable patients, resulting in unfinished courses of antibiotics; another major factor that increases resistance.

TB is by no means the only disease of concern. In November, the EU’s disease monitoring agency warned that Europe now faces a growing threat from bacteria that are resistant to the last-resort class of antibiotics known as carbapenems, with almost all European countries now having reported cases. The data from the European Centre for Diseases Prevention and Control showed that the proportion of bloodstream infections due to Klebsiella pneumoniae, a common cause of illness in hospital patients, that were resistant to carbapenems was now above five percent in 2012 in five countries - Greece, Cyprus, Italy, Romania and Slovakia. In 2009, only Greece and Cyprus exceeded that threshold.


Antibiotic consumption in Europe

Defined daily doses per 1,000 inhabitants per day
Antibiotic dosage across the EU bar chart Greece*35.1mCyprus*32mRomania*30.9mBelgium29mFrance28.7mLuxembourg27.6mSlovakia*23.8mMalta23.5mPortugal23.2mIreland22.7mIceland*22.3mPoland21.9mSpain20.9mFinland20.1mBulgaria19.5mLithuania*19mUnited Kingdom18.8mCzech Republic18.5mDenmark17.4mNorway16.5mHungary14.8mAustria14.5mSlovenia14.4mSweden14.3mGermany14.1mLatvia12.8mEstonia12.1mNetherlands11.4m
Data applies to prescriptions outside of hospitals *Country provided only total care data, which applies to community sector and hospital use
Source: ECDC

Even some of those sent out to protect us are bringing back killer diseases from abroad. Multi-drug resistant gram-negative bacteria have been recorded in British and American soldiers returning from Iraq and Afghanistan. Bacteria fall into two categories: gram-negative and gram-positive. Gram-negative bacteria possess thin cell walls (5 to 10 nanometres) adept at flushing out antibiotics, making them much harder to treat. Gram-positive, which include methicillin-resistant staphylococcus aureus - better known as hospital superbug MRSA - have thick cell walls (20-80 nanometres) that better retain antibiotics.

So many infections of gram-negative Acinetobacter, which causes a variety of diseases ranging from pneumonia to serious blood or wound infections, were recorded in troops in Iraq, that the disease was nicknamed “Iraqibacter”. Pathogens would also blow into soldiers’ wounds in the dust and dirt of Helmand Province in Afghanistan, causing a variety of diseases ranging from pneumonia to serious blood or wound infections. The number of cases fuelled claims that insurgents were lining IEDs with excrement or rotting animals.

And then, there are the medical tourists. Those who visit hospitals in Asia for cheap cosmetic surgery or other operations to avoid waiting lists are another main driver of the problem. In 2015, it is predicted 3.2 million people will travel to India for surgery. Here antibiotics are freely available for sale over the counter (at least until later this year when new laws come into place). “I think things have got progressively worse in Southern Asia, largely because of the medical tourism industry,” says Professor Tim Walsh, a microbiologist at Cardiff University. “If you look at the Calcutta Times, on the front page is a huge advertisement for cosmetic operations. People come from all over the world.”

“It’s almost like the perfect storm. It’s going to be very difficult for us to win this battle. In fact, I would say it’s impossible.”

Professor Tim Walsh

Walsh was part of the team that discovered NDM-1, an enzyme that confers resistance on a range of bacteria. In short, it makes already dangerous bacteria such as E.coli and cholera, far worse. The ND stands for New Delhi, where it was discovered in 2008. In the ensuing years it has claimed lives and spread panic far beyond the subcontinent. Walsh is currently assisting the UK government with estimates on the extent of antibiotic resistance by 2030-2050 and at the same time overseeing the world’s largest clinical trial in Pakistan and India looking at multi-drug infection in extreme drug resistant bacteria. The data, he says, “is quite frightening”.

“Bacteria are able to adapt, mutate, their DNA is very fluid. This is all happening in real time. We are up against a foe and it is a scenario combined with antibiotic industries around the world pumping out drugs and polluting environments, as well as overuse in our communities. Lots of countries have no idea at all about resistance rates.

“It’s almost like the perfect storm. Putting all that information together I would say it’s going to be very difficult for us to win this battle. In fact, I would say it’s impossible. Certainly it is going about it the way we are at the moment.”

One British man who, unlike the medical tourists, ended up in an Indian hospital against his will is freelance journalist Russell Cronin. In April 2011, during a meditation trip to Bihar, in northeastern India, the 49-year-old Londoner was electrocuted by a faulty shower at his hotel. He suffered horrific burns, which eventually resulted in him having his left hand amputated. After being treated at two Indian hospitals, the hotelier agreed to pay for a flight home to England, if Cronin wrote a note exonerating him from further liability. When he landed he was rushed from the plane to Bristol’s Frenchay Hospital where it was discovered, aside from the devastating injuries, that he had contracted five multi-drug resistant gram-negative bacteria carrying the NDM-1 enzyme, including a super immune strain of cholera.

“I was in a really bad way,” he says. “I didn’t know about the bugs until I came round and found myself in the isolation unit. They told me what it was but I had no idea what it all meant. I was still in a state of shock to discover that my hand had gone.”

Cronin was eventually discharged after 11 weeks in hospital. He was treated with colistin, an antibiotic so toxic it was discarded in the 1960s but has now been dug out again in desperation. Renal toxicity is the most common adverse effect of colistin treatment, none the less it may well have saved his life. “The doctors have told me how close I came to dying,” he says.

Hospitals are increasingly being confronted with cases such as Mr Cronin, with antimicrobial resistance now costing the economy an estimated £10 billion a year. But those within the medical profession say students exhibit a staggering lack of knowledge about the issues we face. “One of the major problems we find is the lack of microbiology training that junior students have,” one consultant microbiologist says. “It is just two hours, in that time you can’t do anything. And it is now a very common practice in hospitals to use antibiotics of last resort. It’s very widespread and I have seen a lot of drug-resistant bacteria.”

In November, a Europe-wide study of final year medical students tested knowledge of antibiotic prescribing and resistance. Laura Piddock, professor of microbiology and deputy director at the institute of microbiology at the University of Birmingham and director of Antibiotic Action, describes the results as “lamentable”. “It’s not the fault of the students or the medical schools. The problem is the curriculum. What it means is we don’t get the time we would like to teach this area properly.”

ithout new drugs, there is no hope. Between 1935 and 1968, 14 different classes of antibiotic were developed. In the 45 years since then, only five have been brought out. No new classes have now been developed since 1987. The problem, is profit potential and profit depends on volume. Many pharmaceutical companies have pulled out of development altogether, focusing attention instead on drugs for chronic conditions, such as diabetes or blood pressure which patients have to take for years, rather than courses lasting just days or weeks. Professor Anthony Kessel, director of Public Health Strategy at Public Health England, says it is time to engage in a “moral debate” over the lack of new drugs, and admits rationing could now be on the horizon.

“We may get to a situation where we have to think about rationing antibiotics. We are not there yet but if we really run out you can imagine that as a possibility. You can imagine a situation in the future where we have to develop a new antibiotic but not make it available straight away and keep it for emergencies. These are the type of solutions that we haven’t really talked about in great depth yet, but are possibilities.”

Interactive Graphic

A history of resistance

  • Antibiotic discovered
  • Antibiotic resistance identified
  Some governments are now so concerned they are taking an active role in research. In a large glass and chrome facility near a small town called Collegeville, 30 miles northwest of Philadelphia, scientists are working to discover new antibiotics that can save the world. Since 2009, some 30 scientists and technicians have been based here in a GlaxoSmithKline “discovery performance unit”. Last year, the company was awarded up to $200 million by the U.S. government to develop new drugs to counter antibiotic resistance and bioterrorism – in particular, in case of anthrax attack. David Payne, head of the unit, says there are three possible molecules currently being tested, although admits the scale of the challenge is immense. “You’re working in very unknown territory because nobody has ever done it before.”

“A lot of companies have withdrawn from developing antibiotics. Only very few are doing it now”

David Payne

Payne says the difficulty is three-fold: poor profit potential; difficult science (the easier discoveries have already been made); and working around complex regulations, although he says the latter problem is now changing. According to a Chatham House report published last October, in 2004, only 1.6 per cent of drugs in development at the world’s 15 largest drug companies were antibiotics. GlaxoSmithKline is now just one of four major pharmaceutical companies left working on antibiotics.

“A lot of companies have withdrawn from this area,” Payne says. “If you go back 10 years just about every big pharmaceutical company you were aware of would have had a pretty large antibacterial discovery group. Only very few are doing that now.”

It may seem a bit rich for the global pharmaceutical industry to complain about profits when, this year, its value is expected to reach £550 billion. Yet it can cost, we are told, hundreds of millions of pounds to bring a new single drug to market. The profit imperative ensures that the drugs chosen for research are those most likely to provide high returns, while far more gets spent on marketing products than developing new ones. According to an analysis of drug company spending published in the British Medical Journal in 2012, for every £1 spent on basic research, £19 is spent on marketing.

The result is a yawning void, one that has prompted the Association of the British Pharmaceutical Industry, among others, to call for a comprehensive review of the research and development environment. The UK government’s new five-year strategy to tackle resistance does address this in part; some £4 million being allocated for a new research unit on antimicrobial resistance to be established by the National Institute for Health Research from this April. There are also plans to encourage greater public-private investment in discovery and development and promote more streamlined research and collaboration within the industry.

here is a growing political will to address a complacency that set in as far back as the 1970s and even now – without new drugs in the pipeline - better infection control has been proven to make an immediate impact on winning the fight against resistant bacteria. Health professionals point to plummeting MRSA death rates in Britain, which have fallen by around 80 per cent since 2008. Improving public awareness is also key. Around half of people in the UK still do not know that antibiotics are inappropriate to treat colds, flu and viruses, according to evidence given a few weeks ago to the Commons Science and Technology Committee.

But it may yet still all prove to be too little, too late. Sir Alexander Fleming did warn us. During a speech in Stockholm in 1945 after accepting his Nobel Prize, Fleming sounded “one note of warning” over bacteria becoming resistant through inappropriate use of the drug. “The time may come when penicillin can be bought by anyone in the shops.’’ he said. The idea of his precious discovery being stockpiled by online pharmacies, used to fatten up our fish and livestock, dumped in rivers and sprayed over fields, would have baffled and horrified him in equal measure.


At St Mary’s Hospital in London a plaque marks Fleming’s discovery in September 1928 “to the glory of God and immeasurable benefit to mankind”. His laboratory is perfectly preserved. His old Beck’s microscope sits on the wooden desk amid dusty glass bottles, books and test tubes. Fleming’s bacterial samples were deemed so vital to the future of mankind, contingency plans were drawn up in case of Nazi invasion during World War Two for them to be smuggled out of the country in the lining of his suit.

Today at St Mary’s – as in every other British hospital – that wonderful armoury, in which Fleming laid the first weapon, has been picked bare while the enemy has evolved. As Professor Jeremy Farrar, director of the Wellcome Trust, said in an interview last month, “We have been through a golden age and we have become complacent. We’re watching evolution happen. This will come up steadily over years and it has already started. It’s been happening for the last decade or more and will continue. It will creep up on us almost without noticing. This is getting to the tipping point where you and your families will start to see this.”

We are sleepwalking back into a time where something as simple as a grazed knee or a scratch acquired in the garden will start to claim lives. The golden age of medicine is behind us

68 Health- "This May Hurt a Bit" -A New Play about the NHS
Updated: 19 Feb 2014

“This May Hurt a Bit” – a new play about the NHS

Posted by: Giselle Green February 18, 2014



A new play about the personal impact of the government’s top-down reorganisation of the NHS will be touring theatres around the country from March.

“This May Hurt a Bit” is based on the best-selling book NHS SOS, co-written by one of our founder members, Dr Jacky Davis.

Written by Stella Feehily and directed by Max Staffford-Clark, the play explores one family’s journey through the NHS in the wake of the changes.

It opens on March 6 in Bury St Edmunds, and will be in Bolton, Edinburgh, Cheltenham, Oxford, Bristol, Liverpool and London.

For details on the show, see here: http://www.outofjoint.co.uk/prods/productions/this-may-hurt-a-bit.html

And you can buy Jacky’s book here: https://www.oneworld-publications.com/nhs

It would be really helpful if we could leaflet theatre-goers after the play, so if you decide to book tickets, please get in touch with us if you might be able to help with this. Email contact@nhap.org.

Thanks – and enjoy the play if you go.

69 Health - NHS and Immigrants
Updated: 15 Feb 2014

Immigration minister exposes flaws in his own government’s policy on migrants using NHS

Posted by: Giselle Green February 9, 2014


The resignation of the Immigration Minister over an illegal cleaner has exposed the flaws in the government’s policy of

clamping down on migrants using the NHS.  Mark Harper resigned after it emerged that he was unable to do a through

enough check on his cleaner’s documents and then found out she was an illegal migrant. The government is currently

drawing up legislation to impose charges on migrants using A&E, which will require checks to find out if they are here


Dr Louise Irvine, NHA’s prospective MEP for London, said:

If the Immigration Minister can’t even check his own cleaner is here legally, how does he expect hard-pressed NHS

staff to check up on patients? Doctors, nurses and receptionists don’t have the time or skill to be immigration

officers. Mark Harper has rather embarrassingly exposed the difficulty of implementing his own government’s

immigration policy.

70 Health - The NHS is not safe in Labour Party hands !
Updated: 15 Feb 2014

Miliband’s public service speech was a bad spray paint job

Posted by: NHA February 13, 2014

Ed Miliband’s Hugo Young Lecture on Labour’s plans for the future of public services was nothing more than a bad spray

paint job. He was clearly trying to show that his One Nation Labour party has new ideas on how to run our public services,

but it was clear from his speech that Labour is still wedded to New Labour Blairism.

The speech was based in pure triangulation, which Blair and Clinton would have been proud of, except for the fact it was so

obvious. Miliband tried to frame his plans for public service reform by addressing the issue of societal inequalities, and

spoke out against the use of markets in public services, which obviously resonates so strongly with the left of the party.

However, his solutions were based in the market driven ideology of citizen consumerism with it’s “voice and choice” and

“patient held budgets”; the promotion of using the private and third sectors to deliver public services, which require the

marketization of public systems ; and more funding cuts for the public sector, which will remove the “crowding out “

problem to open up greater opportunities for the private sector to fill the gap.

Miliband has shown in one speech that Labour cannot be trusted to look after our public services and our NHS.

The rhetoric of repealing the Health and Social Care Act and re-instating the NHS as the preferred provider is meaningless

unless Labour come out strongly to demand that the NHS is exempted from the EU/US Free Trade Agreement (TTIP). John

Healey the Labour MP and former shadow Sec of State for Health, who sits on the All Party Parliamentary Group for EU-US

Trade and Investment, has made no effort to call for an exemption for the NHS.

In fact Labour’s health policy actually puts the NHS at risk, because any marketization of public services can prevent

exemptions from TTIP.

It was therefore fitting that Miliband referred to Thatcher a number of times in his speech, since he clearly demonstrated that

the Labour party still remain Thatcher’s “greatest achievement in politics”.

71 Health-The NHS is not a Supermarket-Patients are not Consumers
Updated: 15 Feb 2014

The NHS is not like a supermarket. Patients are not consumers.

Posted by: Giselle Green February 14, 2014

by Dr Clive Peedell

The appointment of ex-M&S boss Sir Stuart Rose as an NHS advisor is consistent with the Tory party’s pro-

commercialisation, pro-privatisation agenda for the NHS.

The NHS is not like a supermarket. We do not want to encourage overuse of the service by turning patients into consumers.

We are wasting billions on a market driven system designed to increase the amount of private sector involvement of the

NHS. The government had promised that it would rule out any question of privatisation but it has clearly lied to the public,

because that is precisely what its legislation is designed to deliver.

Sir Stuart Rose may well have some interesting and important ideas that could help the NHS, but any suggestions need to

be put into context with the fact that he is an advisor to Bridgepoint Capital, a private equity company which has been

involved in multi-billion pound deals in the health sector.  It also has a large stake in the private health care firm Care UK

which donated over £100,000 to Lansley’s election campaign.

Sir Stuart should also consider the importance of clinical leadership in the NHS. Markets undermine professionalism

because financial transactions damage the doctor-patient relationship. In addition, doctors and nurses don’t want to see

increasing fragmentation of the service. They would like to see less commercialisation and less marketisation in the NHS.

Effective clinical leadership requires a shared vision amongst NHS staff.  That is impossible with the current direction of


72 Health- Why We need the National Health Action Party
Updated: 15 Feb 2014

Why We Need the National Health Action Party

Posted by: Giselle Green February 9, 2014


I want to believe that we can exist in a society where compassion isn’t metered according to quarterly profits. I want to

stand in the way of those who would choose personal gain over doing right by others. I will be doing this with the National

Health Action Party because I believe the other parties have lost their way.


73 Health-Male Cancer Statistics -Shock News -Men's Health Ignored, & Discriminated Against
Updated: 15 Feb 2014

Gloomy global statistics show men are 50% more likely to die from cancer, reports the Daily Mail this morning.

The data published by Cancer Research UK shows over 4.6 million men die from the disease every year, compared with

around 3.5 million women.

The gender disparity varies across the world, with the greatest increase in risk for men seen in Central and Eastern Europe,

while the risk in men is around 30% higher than for women in the UK.

Nick Ormiston-Smith, head of statistics at Cancer Research UK, said: ‘The contrast in cancer death rates between the sexes

may be down to more men being diagnosed with types of cancers that are harder to treat, such as cancers of the bladder,

liver, lung and oesophagus.

74 Health-Salt is Cheap, Sugar is Sweet But Profits come First & Last to the Nasty Pasty Party
Updated: 03 Feb 2014

Government attacked over deals with fast-food industry:

‘Pure illusion’ to think this approach can cut obesity

Scathing World Health Organisation report warns UK cannot tackle epidemic unless Government changes policy

Charlie Cooper

The Government’s plan to fight obesity through voluntary deals with fast-food chains is founded on "pure illusion" and will lead to ever-worsening ill health in Britain, a leading expert claims today.

In a wide-ranging report for the World Health Organisation, Professor Roberto de Vogli of the University of California and other leading academics said all the evidence pointed to government regulation of the fast-food industry as the only way to slow down or reverse the world’s escalating obesity epidemic.

The Government has consistently held back from passing legislation to limit the marketing activity of the fast-food industry and improve the nutritional value of their products.

Speaking to The Independent, Professor de Vogli highlighted this flawed approach, which he said was typical of countries with the worst rates of obesity.

"The UK has a deregulated, liberal economy model," he said. "There are a few supermarkets that dominate the food system, a high concentration of market shares in few hands and substantially high levels of fast-food consumption and ultra-processed food production. In terms of Body Mass Index (BMI) and obesity the UK is one of the top five of our 25 sampled countries."

Asked about the Government’s voluntary "responsibility deals" with industry, which the Department of Health claims "tap into the potential for businesses and other influential organisations to make a significant contribution to improving public health", Professor de Vogli was scathing.

"There is no question," he said. "Big corporations have a mission to maximise profit. If we hope and expect that profit-driven businesses will safeguard public health, it is pure illusion."

In their report, published in the Bulletin of the World Health Organisation today, Professor de Vogli and his colleagues from Queens University Belfast and the University of Texas found that obesity rates have risen alongside increases in the number of fast-food purchases made each year.

The slowest increases in fast-food transactions occurred in countries with the strictest market regulation, such as the Netherlands, Greece and Italy. Across 25 sample countries, people’s average BMI was found to have increased from 25.8 to 26.4 between 1999 and 2008.

A BMI of more than 25 is considered overweight and BMI of more than 30 obese.

A 2012 survey of adults in England found that more than a quarter are obese, while 41 per cent of men and 33 per cent of women are classed as overweight.

Obesity increases the risk of heart disease, diabetes and has even been linked to a heightened chance of developing dementia later in life. Health problems directly linked to obesity already cost the NHS £5bn a year.

The researchers said that a number of interventions would be needed in all of the world’s developed nations to slow the obesity epidemic, which they said would also increasingly affect developing nations during the coming decades.

Policies that governments should adopt include subsidising fruit and vegetable growers’ economic disincentives for producers of ultra-processed fast food such as french fries, burgers, soft drinks, sweets and ready meals; and penalties for excessive use of fertilisers, pesticides, chemicals and antibiotics, the report said.

Fast-food and soft-drinks companies should also be restricted in their advertising activity, particularly on promotions aimed at children, they argued.

"Governments should take steps to regulate the economies – not let the invisible hand of the market self-regulate the food system," Professor de Vogli said. "That will only lead to more obesity in the future."

A spokesperson for the Department of Health said the Government was "serious" about tackling obesity, and acknowledged that England has some of the highest obesity rates in the world.

Action was being taken to "make it easier for people to make better choices," they added.

"Through initiatives such as Change4Life, NHS Health Checks and the National Child Measurement Programmes in schools, we are taking the lead in helping tackle obesity and are seeing encouraging signs of progress, with obesity rates in children falling to their lowest levels since 1998," they said.

75 Health-CQC Chief-Note Well-It's Also Patients who are Bullied, Mistreated & Ignored by NHS Managers
Updated: 03 Feb 2014
Watchdog warns of UK’s NHS ‘alarming’ culture
Sun Feb 2, 2014 2:30PM GMT

A health watchdog has warned about “an alarming culture” within the British National Health Service (NHS), calling for a radical reform to the country’s care system.

Writing in the Sunday Telegraph, David Prior, chairman of the Care Quality Commission (CQC) which is an independent regulator of all health and social care services in England, said the NHS risks going bankrupt without serious "transformational change" of the health service, including greater private-sector involvement and hospital mergers.

Prior also highlighted results of a survey of some 100,000 NHS staff, which found that one in four had complained about bullying, harassment or abuse from colleagues and managers.

"Too often it [the NHS] delights in the ritual humiliation of those deemed to fail, tolerates and institutionalizes outdated working practices and old-fashioned hierarchies, and can almost encourage 'managers' and 'clinicians' to occupy opposing camps,” he said.

Prior, who was appointed to run the CQC last year, also criticized the NHS for having a culture that “stigmatizes and ostracizes” whistleblowers.

Moreover, he warned that a “dysfunctional” rift between NHS managers and its clinical staff jeopardizes the safety of the most vulnerable patients.

  1. TheTelegraph  also disclosed on Saturday how almost half of NHS hospitals are facing a combined finance “black hole” of £330 million by the end of March.

The warning comes at a time when a series of scandals has shaken public trust in the UK’s health service over recent years.

In November last year, the CQC warned that NHS hospitals had failed to improve the quality of patients’ care in the three years since the 2009 Mid Staffordshire scandal.

The scandal at Stafford Hospital, a small district general hospital in Staffordshire, emerged in 2009, when it was revealed that between 400 to 1,200 patients died as a result of poor care from January 2005 to March 2009

76 NHS-"A&E Attendances Up"-The Government has gone it wrong again, Dad
Updated: 02 Feb 2014

Those figures about rising A&E attendances…

the government’s admitted they’re wrong – in all sorts of ways

Posted by: NHA January 30, 2014

National Health Action

Misleading and confusing A&E figures

The government’s Health and Social Care Information Centre has issued a statement that “a labelling error” meant incorrect statistics were used yesterday and that there had in fact been a 104% rise in elderly people attending A&E rather than 81%.

A spokeswoman appeared to confuse the situation further when she admitted the increase seen could be partly down to changes in the way the data had been collected.: “When looking at figures it should be noted that over time the completeness of the dataset has increased, meaning that changes over time may be partly attributable to improvements in data coverage.”

In plain English what she really means is that you can’t make accurate comparisons between current and past figures because they’re based on different information.

To muddy the waters even more, Nuffield Trust researcher Ian Blunt has written a blog showing how if you dig down further and compare like with like and take into account of all sorts of important factors, the rise in the number of elderly people attending A&E drops right down to 5%.  Are you still with us?

Meanwhile as we have previously pointed out, the number of people attending traditional A&E departments has actually stayed fairly static since 2003, contrary to press reports.  What’s changed is that the statistics for A&E attendances now include people who attend minor injury units and walk-in centres.

More on this here from the King’s Fund: http://www.kingsfund.org.uk/blog/2013/04/are-accident-and-emergency-attendances-increasing

 A&E logjam – blame the government

There is an A&E crisis but the crisis isn’t that increasing numbers are attending;  the crisis is how patients are dealt and the resulting A&E logjam. Latest figures show that A&E waiting times are rising and targets being breached. (http://www.bbc.co.uk/news/health-25681660)

The A&E logjam is due to government policy. Patients are stuck in A&E because they can’t be:

  • admitted (the government has axed 4000 hospital beds in the past 5 years)
  • discharged (the government has cut social care by £3bn)
  • treated (10% national shortage of A&E doctors, over 40% in some areas of London).

Stop blaming patients

Patients are not responsible for this situation. It’s wrong to blame elderly patients (http://www.telegraph.co.uk/health/healthnews/10603413/Scandal-of-elderly-forced-into-AandE-as-faith-lost-in-care-outside-hospitals.html) or younger patients (http://nhap.org/young-patients-without-gp-add-growing-pressure-ae/) for turning up at A&E.

Yes maybe some could be avoided with better public education about what constitutes an emergency and better sign posting of where to seek treatment. NHS111 was supposed to fix this, but has actually exacerbated the problem as non-medically qualified staff (cheaper to employ for the private companies running NHS11) play it safe and advise callers to head for A&E.  And as Dr Louise Irvine explained here yesterday (http://nhap.org/whats-going-on-with-ae/) treating elderly patients is very complex.

Stop blaming the 2004 GP contract

When Jeremy Hunt tries to pin the blame on the 2004 changes to the GP contract, he’s talking nonsense. His claim that poorer out of hours services have led to an increase in A&E attendances was dismissed out of hand by health experts last year. Yet the Health Secretary continues to repeat the lie. As NHS Confederation Chief Executive Nick Farrar said last May:

“We do not see a correlation between the changes to the 2004 GP contract and the NHS four-hour waiting standard for A&E departments. In fact for the vast majority of the last decade, A&E waiting time standards have been improving. It is in recent years where the pressures have started to bite, and there have not been any discernible structural changes to out-of-hours GP contracts during that time.” (http://m.gponline.com/article/1183473/gp-contract-not-blame-a-e-pressure-nhs-leaders-say)

So now we all know

77 Health- Diabetes Type 1 Vaccine
Updated: 28 Jan 2014

The Express reports that diabetes experts are confident they can wipe out the disease within 20 years.

Dr Nick Oliver, diabetes consultant at Imperial College Healthcare NHS Trust, told the paper: “There is a race on, that’s why what we are doing is incredibly exciting.”

Asked whether the disease could ever be cured he added: ‘I really hope so. I am reasonably early in my career and there is lots of really exciting work going on behind the scenes.’

Dr Alasdair Rankin, director of research for Diabetes UK, said: ‘We think it is possible we could have a vaccine for Type 1 within 20 years.’

78 Health -Alzheimers linked to DDT
Updated: 28 Jan 2014

Today’s particularly glum Digest starts off with a report in the BBC that says researchers have found a link between the use of the DDT pesticide and Alzheimer’s disease.

A study by US researchers, published in JAMA Neurology, found that patients with Alzheimer’s had four times the levels of DDT lingering in the body than healthy people.

The pesticide was banned in the US in 1972 but the World Health Organization still recommends using DDT to keep malaria in check

79 Health- Obesity and Good Living - Remember- A Balanced Diet is also a Healthy one
Updated: 26 Jan 2014

GPs should routinely record waist circumference, say obesity experts

13 January 2014

GPs should measure waist circumference rather than just BMI to help them identify patients who most at risk, recommends a new report into how to tackle the obesity crisis in the UK.

The report recommends that the measure is used as an indicator of ‘visceral adiposity’, as this predicts worse outcomes for patients.

It also recommends that QOF points should be linked to ‘action taken’ on behalf of overweight patients, rather than simply requiring GPs to record numbers of patients who are overweight.

The ‘State of the Nation’s Waistline’ report, published today by the National Obesity Forum, says that GPs have a ‘key role’ to play in tackling the looming obesity crisis which a new report warns is ‘one of the biggest threats to the UK’ in both damage to personal health and financial and societal cost.

It recommends the DH should encourage training and accredited schemes in obesity and weight management, to help GPs make ‘every appointment count’.

The report says: ‘GPs should be encouraged and indeed required to make every contact with patients count. Very few patients will cite obesity or weight management as the reason for seeing their GP, and will instead present with conditions that are clearly a result of weight issues. GPs should talk with their patients about weight in these instances.’

It adds that ‘increasing awareness’ is needed amongst GPs of the importance of ‘waist measurement during medical appointments in order to identify indicators of visceral adiposity or ectopic fat deposits, which can adversely affect health outcomes’.

The report also questioned whether existing national programs, such as the PHE’s flagship ‘Change4life’ campaign, were fit for purpose.

The report states: ‘Schemes such as Change4Life are well intentioned and extremely important. However, they cannot be expected to alter the public situation on their own, despite their merits. Harder hitting campaigns, similar to those for anti-smoking, are required.’

A spokesperson from Public Health England said: ‘PHE is also working with health professionals and local authorities to support the commissioning of weight management services. PHE have partnered with the RCGP to support the training of GPs in how to work with their local community to tackle obesity.’

80 Health - Transforming Women
Updated: 26 Jan 2014

Transforming Women’s Health

Written by Shobha Shukla, Citizen News Service (CNS)


Sexually transmitted infections is one of the great public health challenges of our time

Millions of women and around the world are still unable to protect themselves from sexually transmitted infections, with more than a million people contracting such infections every day. Half of them are young people - mostly women. In fact women are five times more likely to get STIs than men. Also, currently 222 million women have an unmet need for contraception and approximately 290,000 women in developing countries die from complications related to pregnancy and childbirth every year.

While in India unmet need of contraception has remained static around 15-21 percent since the last one decade, the Philippines has the highest rate of teen pregnancy in the Asean region, recording a 70 percent increase in teen pregnancy in the past decade. Birth control information and devices have been banned for decades because of the opposition of the Catholic Church, although it is hoped that last year’s passage of a Reproductive Health Act – now before the Supreme Court – will change that.

The consequences of unsafe sex are a great public health challenge of our times. Women risk unintended pregnancies as well as HIV and other infections, leading to high rates of maternal and child mortality. With 86 million unintended pregnancies around the world every year and a young woman getting infected with HIV every minute, women need user-friendly products that provide more comprehensive protection.

The female condom is perhaps one of the very few currently available female-initiated methods that provide multiple protections against a range of STIs including HIV, and unintended pregnancies. It also provides bi-directional protection to both partners. However, although female condoms were approved by the US Food and Drug Administration in 1993, more than 20 years later even today they represent only 1 percent of all condoms distributed worldwide.

In India they are still far from being available and accessible to women, while male condom use continues to hover around 5 percent despite it being an effective multipurpose prevention option for STIs and unintended pregnancies.

Multipurpose Prevention Technologies
Multipurpose Prevention Technologies for sexual and reproductive health are new tools in development that are designed to address multiple sexual and reproductive health needs, including prevention of unintended pregnancies, sexually transmitted diseases including HIV, and other reproductive tract infections (RTIs). MPTs that are safe, acceptable, affordable and easily available would save lives and money and improve the health of women and their families across the world.

Promising and innovative MPTs in the pipeline include multipurpose vaccines and gels, easier-to-use vaginal rings and single sized diaphragms that may provide simultaneous protection against unintended pregnancy and STIs and have a major impact on the health of women and their families. New microbicide gels can lead to declines in HIV and STIs while contraceptive technologies appropriate for dual use can increase the positive global health impacts of family planning.

Jeross Aguilar, Chairperson, Youth Steering Committee, Family Planning Organization of the Philippines and a Member of International Steering Committee of the 7th Asia Pacific Conference on Reproductive and Sexual Health and Rights being held in Manila, said: "MPTs can be great tools to empower women and improve their sexual and reproductive health. Devices like intra-uterine devices (IUDs), male and female condoms, all should be available free of cost, if possible, to those in need. Women should have a wide variety of choices, which are most conducive to their life style, available when it comes to choosing family planning techniques as no one method suits all. Some women may not like taking pills and maybe more amenable to using injectables or IUDs.”

So while there should be more research to have better devices, Aguilar said, “merely inventing new and better techniques is not enough. It is equally important to make them freely available and informing people adequately about their use to remove the stigma and misconceptions surrounding them. I feel that to increase male condom use we need to change the method of propaganda and promote it innovatively. We need to propagate that one who uses the condom and understands and respects the women is a cool and responsible guy. 'You are not a man if you do not use condoms'; 'it is sexy and cool to use condoms'; 'a man who does not use a condom is irresponsible'; 'you are cool if you respect women' - these are the kind of slogans and advertising we need."

MPTs, many of them though still in the research and development stage, can empower women, make them healthier and improve their economic opportunities. These products that can simultaneously address multiple sexual and reproductive health needs of women will go a long way in helping policymakers meet multiple health and development goals.

A survey, facilitated by Citizens News Service and an Initiative of Multipurpose Prevention Technologies for Reproductive Health, is also being carried out with delegates of the 7th conference. This survey was earlier carried out at the International Conference on Family Planning 2013, 11th International Congress on AIDS in Asia and the Pacific and the International Conference on AIDS and STIs in Africa (ICASA) 2013.

(Shobha Shukla is Managing Editor of Citizen News Service (CNS))

81 Health - The US Vultures are Hovering over our NHS
Updated: 25 Jan 2014


“Come, and we’ll kick you out” – 

TUC warns US healthcare companies to keep away from NHS

by - 24th January 2014, 8.38 GMT

NHS logoThe TUC has warned US healthcare companies that unions will be campaigning to kick them out of the UK when a new government is elected

TUC general secretary Frances O’Grady was yesterday in Davos to meet with EU Trade Commissioner Karel de Gucht to discuss the forthcoming Transatlantic Trade & Investment Partnership (TTIP) – a plan to remove tariffs, regulations and restrictions to make trade easier between the EU and the US.

Unions were among 200 organisations who this month wrote to European and US trade negotiators to express their concerns about the plan, saying it would allow multi-national corporations to sue individual governments if they feel that public policy is contrary to the principles of free trade, and as a result they have lost out financially.

Frances O’Grady said: “US healthcare companies should know that they have been put on notice. They should not expect the forthcoming EU-US trade deal to protect them from a future British government restoring NHS services currently run by private firms to the public sector.

“The EU Trade Commissioner has assured me that the consultation exercise on foreign investors’ rights will now – as a result of union pressure – include the option of dumping the deeply undemocratic Investor-State Dispute Settlement (ISDS) mechanism. I left him in no doubt that unions and their campaign partners will be demanding its removal from the TTIP.

“We must ensure that future governments are not bound to pay unlimited compensation to companies seeking to make a killing from the implementation of the Health and Social Care Act. Democratically elected governments must be free to do what voters decide, and not be frightened off by the prospect of secretive litigation.”

82 Health - The NHS Campaign against Privatisation
Updated: 23 Jan 2014


Patients claim victory in NHS privatisation battle

by - 22nd January 2014, 8.15 GMT

Unite NHS HuntPatients have scored a significant victory against the possible takeover of elderly care by private healthcare companies, in what Unite has called a big set-back in the increasing culture of secrecy engulfing the accelerating privatisation of the NHS.
As a result of a legal challenge by Stop the NHS Sell Off in Cambridgeshire, Cambridge and Peterborough Clinical Commissioning Group (CCG) have agreed to publish commercially sensitive documents in relation to the contract, worth up to £1 billion, for integrated older people’s services.
Unite said the contract attracted interest from private healthcare companies interested in making profits from the privatisation of elderly care, and that the campaign for greater openness by clinical commissioning groups to stop powerful private healthcare companies ‘cherry picking’ the most profitable NHS services in England needed to be stepped up.
Unite head of health Rachael Maskell said: “The government has adopted a culture of secrecy, as well as legal and parliamentary ruses, to hide from the public the extent that the NHS is being put up for sale to private, profit-hungry healthcare companies.
“Openness and transparency should be the gold standard of how CCGs behave when it comes to considering contracts which are leading to the rapid piecemeal privatisation of the NHS. Pro-NHS campaigners in Cambridgeshire should be congratulated for their strong stand.
“The public has every right to know in great detail what is happening to the NHS in their local community. This culture of encroaching secrecy needs to be eradicated.”
Unite is campaigning against health secretary Jeremy Hunt’s attempt to insert clause 118 into the Care bill which would make it easier to close or privatise any hospital in England without proper public consultation.
Hunt wants these extra powers, despite the decision of the High Court, subsequently upheld by the Court of Appeal, that he did not have the authority to implement cuts to the emergency and maternity units at Lewisham hospital in south east London.
The clause is due to be debated on 28 and 30 January by the bill committee and in a letter to the committee, Rachael Maskell described clause 118 as “a dangerous move which will put thousands of lives at risk by removing local clinical decision making”.
Unite is also urging MPs to support Easington MP, Grahame Morris’ Freedom of Information (Private Healthcare Companies) bill which is due to receive its second reading on 28 February.
This bill aims to extend Freedom of Information legislation to encompass public healthcare services delivered by private companies and charities, and open up this information for public scrutiny.
Rachael Maskell said: “If you join up the dots, you can see how ministers are creating a culture that gives private healthcare companies a distinctive advantage when they bid for NHS work. This must be fought tooth and nail.”
Clinical commissioning groups (CCGs) are the NHS organisations set up by the Health and Social Care Act 2012 to organise the delivery of NHS services in England.”
83 Health - So Dark Choc and Red Wine do go well with Diabetes
Updated: 20 Jan 2014

Some good news for you chocolate and red wine lovers, researchers have shown that the flavanoids contained

in these foodstuffs help to regulate insulin levels.

Professor Aedin Cassidy from the University of East Anglia said that: ‘Small changes to the normal diet you have

can have significant effects on prevention efforts.’


Daily Digest is celebrating by breaking out the Lindor or -Dark Choc with Nuts moment -On offer at Sainsburys

200gms x 2 = £2.50 ( Thats not advertising thats being indulgent)

84 Health- Work for the NHS or Private Practice - not both
Updated: 19 Jan 2014

Doctors using NHS in 'abhorrent' way to push private practice,

Whitehall boss admits

Doctors are using the NHS to further their own private businesses in an “utterly abhorrent” way, Britain's most senior medic has said.

GPs fear sending their relations to hospitals
Some doctors are using the NHS to 'push their own private businesses' Photo: Alamy
Rowena Mason

By , Political Correspondent

6:26PM BST 01 Apr 2013


Sir Bruce Keogh, the Government's medical director, admitted that some of his colleagues have been abusing the system by using the NHS to “push” their personal interests.

He admitted there is a problem after MPs complained that some NHS doctors are trying to persuade patients to pay unnecessarily for private services.

There are fears that the Coalition’s NHS reforms, which came into force on April 1, will allow even more doctors to promote their own personal business interests.

However, MPs are concerned that doctors have been allowed to abuse the system even before the new reforms come into force.

In a hearing of the health select committee, MPs warned that doctors are trying to get people to go to their own private practices rather than use the NHS for free.

Margaret Hodge, the Labour chairman of the public accounts committee, also said “it happens to a lot of the people who come to see me”.

Asked whether he accepts there is a problem, Sir Bruce said he “lives in the real world” and has heard “anecdotal stories” that this has been happening.

“I am not denying that it happens,” he said. “I am saying that professionally, as the most senior doctor in the NHS, I regard it as utterly abhorrent.”

A spokesman for the Department of Health said last night: "As Sir Bruce has made clear, this is clearly wrong and should not be happening. If hospitals are aware of behaviour like this occuring, they need to take action to ensure that it stops."

Labour has warned that the Coalition’s health reforms could give rise to more conflicts of interest for doctors providing both NHS and private services.

The party said yesterday that the NHS will now be open to “full-blown commercialisation”, with GPs forced to put all contracts out to tender and hospitals able to earn up to 49 per cent of their income from private patients.

Under the new system, GPs will be given much more freedom to buy medical services for the NHS from private providers. The system will be run by doctors, rather than middle managers, sittin on new clinical commissioning groups.

A survey by the British Medical Journal has found around a third of doctors in charge of the new groups have interests in private medical companies.

Doctors are meant to declare conflicts of interest between their NHS and private work.

However, The Sunday Times this weekend found evidence that some clinical commissioning groups have already given awarded contracts to companies linked to their members

85 Health- The Whole NHS is suffering from Cuts
Updated: 19 Jan 2014

Why A&E departments are fighting for their life

The marketisation of the NHS pits hospital against hospital, and specialism against specialism. The whole service is suffering, not just A&E
a&e pollock
'Contrary to popular belief, attendances have stayed static since 2003 in what the Department of Health calls type 1 units – the big hospital-based A&E departments.' Photograph: Christopher Thomond

Not a week passes without a news story about A&E departments: seven threatened with closure in London; ambulances queueing around the block as patients wait for hours to be seen; insufficient staff; high spending on locums. Emergency medicine is a tiny speciality, with fewer than 4,000 doctors in contrast to 32,000 GPs – and yet it consumes an inordinate amount of airtime. Why?

A&E is the canary in the mine; it tells the story of what is going on elsewhere in the service. Cuts, competition and the fight for survival are at the heart of the story. Over the past 20 years many hospitals and A&E departments have been closed, usually as part of private finance initiative projects: what drove the closures was the high price of PFI, not changing patient needs.

Hospital beds have been lost at a rapid pace too, not because there isn't a need for them, but because the government is paving the way to divert patients to the private sector in the future, or removing NHS services to allow foundation trusts to generate income from private patients. Over two and half decades successive governments have closed over 50% of NHS beds. In 2013/14 there were 135,000 NHS beds compared with 297,000 in 1987/88. England now has one of the lowest number of beds in Europe and the highest bed occupancy – over 100% in some specialities – which means medical patients are being displaced on to surgical wards, leading to cancelled elective surgery and increased waiting times.

And without beds, pressure builds in A&E. No one is monitoring or measuring this: community health councils, once the voice of local people, have long since been abolished, and there is no census of emergency departments.

At the same time, the government is closing services in primary care and local authorities are axing services in social care. GP out-of-hours services are no longer functioning as they should and neither are social services and community support. More pressure builds.

The Labour government set up walk-in centres and minor injury units as an alternative to GP out-of-hours services. But now these are also being closed; of the 230 opened under Labour, 53 have shut down in the past three years.

Contrary to popular belief, attendances have stayed static since 2003 in what the Department of Health calls type 1 units – the big hospital-based A&E departments. The increase has occurred in type 2 and 3 units – the minor injury and walk-in centres – and so can be explained by the decline in GP out-of-hours services. So why are alarm bells sounding in the big A&E departments?

Since the Health and Social Care Act removed the duty on the secretary of state to provide universal care, it is every hospital for itself, competing against each other in a market place; there is no planning, only forecasting for income and sales. But A&E is expensive and, like geriatric care and children's services, the price the government pays may not meet the costs. Hospitals would rather concentrate on niche markets like cancer, cardiac and elective care, especially if they can raise some private income at the same time. Markets don't like risk or uncertainty.

Thus the new NHS pricing model works against A&E. Professor Keith Willett, the man leading NHS England's review of emergency services, has described the model as "wrong", and says it has led to an "adversarial" relationship between hospitals. But it is not just between hospitals – it is also within each hospital, as speciality fights speciality for survival. This means specialisms lobbying for resources, and trying to raise their voices above all the others in order to be heard. At the moment A&E is shouting the loudest

86 Health - The More Sugar & Salt in Food the Fatter the Profits
Updated: 18 Jan 2014

Cutting sugar is a different challenge to slashing salt

A war on sugar has begun in the UK that echoes the nation's successful crusade against salt. The effort is welcome because it could help to reduce obesity, but cutting sugar out of people's diets poses fresh challenges.

Last week, a group of academics and policy experts specialising in medicine and nutrition announced that they had formed a campaign group, Action on Sugar. Their idea is to convince manufacturers to collectively and gradually lower the amount of sugar added to foods – so slowly that it isn't missed by consumers.

It is essentially the same strategy as a campaign that is widely credited with reducing British people's salt intake – and the same people who created the Consensus Action on Salt and Health (CASH) are now behind Action on Sugar.

Over the past decade, CASH, a non-government organisation, helped to create anti-salt advertising aimed at the general public, plus year-by-year targets for companies to reduce salt levels. These were voluntary but had the backing of the government, and it was implied that the targets would be legally enforced if companies resisted. Most manufacturers lowered their salt levels – and, on average, there has been a 15 per cent drop in salt intake in the UK, according to CASH.

Sweet nothings

Repeating the trick with sugar may be more complicated, not least because we do not know for sure if our palates can adjust to eating food that is less sweet. By contrast, studies have shown that if volunteers are forced to eat a less salty diet, over several weeks they gradually begin to prefer food that is less salty.

"There's no reason to think that would not hold true for sweet taste too," says Charles Spence, a neurogastronomist at the University of Oxford. Still, the same studies have not yet been done with sugar, says Danielle Reed, a geneticist at the Monell Chemical Senses Center in Philadelphia in the US. "It's never been demonstrated that it actually would work," says Reed. "It's just a guess."

The option to use artificial sweeteners such as aspartame and saccharin to replace sugar may complicate things further. CASH hasn't explicitly recommended this, but it seems like an obvious strategy. Yet a few studies suggest that artificial sweeteners, although they are less calorific than sugar, may still promote weight gain. That's because sweeteners do not send the right signals to the satiety monitoring centres in the brain, the theory goes. Sugar may not make you feel as full as fibre, say, but it does encourage satiety more than artificial sweeteners.

Beating obesity

As well as promoting weight gain, non-sugar sweeteners might make it difficult to ensure that different companies' products taste similarly sweet with the same reduction in sugar content. This will be important for getting our palates to adjust to food that is less sweet.

A further challenge could be the UK government, which has changed since the CASH campaign began: the current Conservative-led government tends to be less keen on regulation.

Still, Action on Sugar does have the potential to significantly improve health in the UK, which, like much of the rest of the world, has seen steadily climbing obesity levels over the past few decades. Meanwhile, the sugar added to processed foods – from ready meals to bread, flavoured water and even soup – is increasingly seen as one of the unhealthiest aspects of modern diets.

A 20 to 30 per cent reduction in the sugar added to food would cut the average person's energy intake by about 100 calories a day, enough to halt the obesity epidemic, according to Action on Sugar. And the group isn't the first to suggest a concerted effort to reduce sugar intake.

87 Health - Care Homes without the "Care" are Prisons
Updated: 17 Jan 2014

The number of elderly patients in care homes and hospitals who are subject to restraint is soaring, the Telegraph reports.

New figures from the CQC reveal there has been an 85% rise since 2009/10 in the number of applications to

deprive those over 75 of their liberty, with more than 7,000 such applications in 2012/13 - more than half of which

ended up being authorised.

Care workers are supposed to restrict the liberty of the most vulnerable only if it is required to protect them, and

hospitals are supposed to inform regulators if such steps are taken. But they did not to do so in two thirds of

cases, thus breaking the law, the CQC report found

88 Health- MP's Waistlines - Are they eating too much of the GNP ?
Updated: 16 Jan 2014

On a lighter note (or not as the case may be), MPs are to be put in the spotlight, but not for their winding rhetoric.

The Telegraph reports this morning that Lord McColl of Dulwich - a surgeon with 50 years’ experience in the NHS

- has commanded that every MP and Lord will measure and report their waistline and height to check they are

not obese.

Lord McColl told the paper: ‘It is an important issue and we notice quite a bit of obesity in the ranks - they are

eating too much of the gross national product.

89 Health - Promoting Prevention and the Barriers
Updated: 14 Jan 2014

Promoting Prevention - and Barriers to Prevention

Our resources on Promoting Prevention - and Barriers to Prevention

PatientPlus articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use, so you may find the language more technical than the condition leaflets.

Everyone knows the adage that 'prevention is better than cure' and few would disagree with it. However, there are many barriers to achieving effective prevention of disease. These range from educational and behavioural factors to cultural and economic considerations. For example:

  • Ignorance of risk. This may be lack of knowledge of what constitutes high-risk behaviour, but perhaps more often the individual chooses to ignore preventive advice (for example, in smoking, unhealthy eating or abuse of drugs).
  • Lack of choice (for example, where there is shortage of water, dirty water is chosen rather than no water).
  • Cultural pressures. These may encourage high-risk behaviours, especially in young people.

Types of prevention

Primary and secondary prevention

Prevention may be classified as primary or secondary:

Primary prevention
This is aimed at healthy individuals, to prevent disease from occurring. Examples include:

  • Vaccinations.
  • Adopting a healthy lifestyle. For example:
  • Diet
  • Weight
  • Exercise
  • Avoidance of smoking
  • Avoidance of excess alcohol
  • Practising safe sex
  • Avoidance of drug abuse

Secondary prevention
This is aimed at patients with an existing pathology, to reduce the risk of recurrence or progression. For example:

Primary or secondary prevention
Many interventions may be either primary or secondary, depending upon the circumstances. For example:

  • Smoking cessation in ischaemic heart disease and COPD.
  • Statins may be used in both primary and secondary prevention.

Levels of prevention

Prevention is also classified according to the level at which action is taken. Thus, it can be at the national, local or personal level.

National level

At this level, interventions include legislation such as:

  • Compulsory seatbelts or motorcycle crash helmets.
  • Appropriate taxation. This can reduce alcohol-related harm and can work in other areas as well.[1]
  • In other countries it may involve the eradication of mosquitoes or the provision of clean drinking water and sewage disposal. Dental disease can potentially be tackled through fluoridation of the water but this can be controversial and is discussed further in the separate article Some Dental and Periodontal Diseases.

Local level

  • The provision of cycle paths and sports centres facilitates exercise, and healthy eating in school canteens and places of work.
  • At work, health and safety is overseen by the Health and Safety Executive. They are a helpful organisation who prefer to facilitate. However, where regulations are breached they have powers to act as well.

Personal level

  • Individuals make personal decisions about lifestyle.
  • Individuals consulting with health professionals may be advised about diseases, treatments and personal management of preventive health measures.

Wherever possible, doctors as individuals and as a profession should encourage national government, local government or other organisations in measures to prevent disease and to promote health. However, the majority of interventions by most health professionals will be at the personal level with the individual patient.

Public health doctors work more often at other levels with opportunities to advise and influence local and national government. On a personal level, doctors are well placed to set an example by following a healthy lifestyle. There is evidence that shows that patients of healthy doctors are more likely to undergo preventive measures and have better outcomes.[2] 

The challenges of prevention

Political challenges

The scope for the prevention of diseases is enormous. There will be scope for prevention of all types and at all levels, and much of this will require political change. Many people in the developed world are dying from diseases of 'excess', for example, those related to smoking and obesity. In large parts of the world malnutrition and infectious diseases kill millions, often at a young age. AIDS has caused devastation throughout much of sub-Saharan Africa and other parts of the world. Smoking-related diseases are increasing in developing countries where tobacco companies have been promoting sales. Widespread disease and death still occur in many countries which don't have a clean and plentiful water supply. Wars and armed conflict have hindered or destroyed the development of basic infrastructure in many parts of the world. Worldwide, it is evident that measures at government level will yield the greatest gains.

Specific challenges

Many of these are clinical or individual challenges. Almost every PatientPlus clinical article on disease has a concluding paragraph about prevention of that disease. This may include the barriers to prevention. Articles of particular note include:

Screening for disease

The UK has a number of screening programmes in place for adults and children. See the separate article Screening Programmes in the UK for the current list and links to more information.

There are a number of criteria that must be fulfilled for a screening procedure to be viable. These were outlined by Wilson in 1966:[3] 

  • The disease must be sufficiently common within the group to be screened that a reasonable number of cases can be expected to be detected.
  • There is benefit in early detection. This may mean offering treatment at a more favourable stage or taking action to prevent or ameliorate the disease.
  • The screening procedure must be cheap, easy and acceptable. The last is a problem with regard to faecal occult blood for colorectal cancer or prostatic biopsy for prostate cancer. It is also a problem for cervical cytology amongst some ethnic groups.
  • The screening test is not usually the 'gold standard' for diagnosis and so there must be an acceptably small number of false positive results. Low specificity will overload the system with further investigation and lead to unnecessary anxiety.
  • There must be a very low level of false negatives. Low sensitivity with too many false reassurances will bring the test into disrepute.

The problem with sensitivity and specificity is that there may be some overlap between normal and abnormal results. It is important that the public should realise that a screening test is not infallible and that false positives and also some false negatives will occur. The overall assessment of a screening test, particularly one where some false positives may be generated, needs to take into account the potential harm of further investigations in those who will turn out to have no disease.

Screening for prostate cancer is a problem.[4] Estimation of  prostate specific antigen (PSA) is insufficiently discriminative, whilst transrectal ultrasound may have difficulties with uptake, and many detectable malignancies would not advance to clinical significance in the patient's lifetime. Hence, it would not benefit the individual.

The cervical screening programme is associated with improved rates of cure of cervical cancer.[5] Further details on the UK programme can be found in the separate article Cervical Screening (Cervical Smear Test).

The breast cancer screening programme in the UK was initiated in 1998 following the Forrest Report.[6] Further details on this programme can be found in the separate article Breast Cancer Screening

Integrating prevention in the consultation

There is now, politically and professionally, an expectation of a preventive component to every general practice consultation.

  • Professionally seminal works such as The doctor, the patient and his illness,[7] as well as Doctors talking to patients[8] and Consultation analysis[9] considered the issue of health promotion within the consultation.
  • Financial incentives have been used to influence behaviour and are now used routinely under the existing GP contract, which makes provision for regular review of targets and incentives.

This still poses a challenge when consultation time is limited and patients come with their own aims and expectations.

Targets for prevention

Some primary prevention is relevant to all of us. For example, advice on diet and exercise may be applicable to everyone. However, most measures need to be targeted so that they can be cost-effective and clinically appropriate. Giving statins to everybody over 21 years of age might eventually prevent death from strokes and ischaemic heart disease but it would be prohibitively expensive and the adverse events may well exceed the benefits. Giving statins to those with established coronary heart disease is cost-effective and is now standard practice. Anticoagulation of patients with atrial fibrillation is very effective but the evidence suggests that large numbers of people who would benefit still do not receive anticoagulation and the uptake is particularly poor in those aged over 80.[10] 

Uncovering the target group


An up-to-date practice database is an essential tool for primary and secondary prevention. Even the simplest of lists will have the patient's age and sex but most databases are more advanced and will allow searching by disease so that at-risk patients can be identified.

Opportunistic screening

This is widely used to identify at-risk patients and promote prevention. It can be useful in reaching patients who do not take advantage of screening initiatives or perhaps would not otherwise be included in the at-risk group.

Barriers to prevention

Taxation and cost issues

Raising the taxation on tobacco and alcohol does reduce consumption.[1][11] Only a minority of drinkers are 'problem drinkers' but there is a spectrum of drinking habits. As total alcohol consumption rises or falls, the number of people in the 'problem drinker' category rises or falls too. However, raising taxation on tobacco and alcohol by a large amount may have a number of perceived consequences that act as barriers:

  • Consumption may fall so much that total revenue from that source falls. This can be politically challenging with industry concerned about economic damage.
  • It may be very unpopular with the electorate and in a democracy politicians have to be constantly aware of the effects of their actions in terms of votes won or lost.
  • Unintended health consequences may arise from the use of tobacco and alcohol from illicit and unregulated sources.
  • Most interventions have costs and do not have the advantages of revenue generation associated with, for example, taxation on tobacco. This includes screening programmes or advertising campaigns.
  • Screening programmes also generate further costs associated with the investigation of the false positives.
  • Immunisation programmes cost money to set up, administer and change.

Demographic issues

A major economic problem facing all developed nations is the rising cost of healthcare associated with the change in demographics of the population. A growing elderly population puts more strain on health and social services. A significant number of people now spend a quarter of their lives as pensioners retired from working life.

Other political barriers

The Black Report was a careful study of health inequalities with a long list of recommendations.[12] The Black Report is discussed in the separate article Health and Social Class. It also examines the 'Inverse Care Law'.[13]

Some measures generate interest from pressure groups who seek to protect personal freedoms. Politicians are keen to protect their popularity when faced with the prospect of an election. In addition, the lobbying power of certain industries, such as food manufacturers and the alcohol industry, is considerable and may affect the measures politicians put in place.

Politicians were wary about the feasibility and acceptability of restricting smoking in public places. Experience in a number of countries had shown it to be surprisingly effective and acceptable. Even smokers accept that they do need pressure to make them quit, and non-smokers enjoy a smoke-free environment in public spaces.

Financial and political pressures may also impair health promotion at local government level. Employers might also see promotion of healthy eating and safety at work as unaffordable. Some industries even have a financial interest in indirectly promoting unhealthy living.

Personal barriers

Cost and quality

Many people feel that expense is an impediment to a healthy lifestyle. Food labelled as 'organic' may be substantially more expensive and benefits are often dubious. Processed food may be easier and cheaper to access for people who lack the education and skills to cook from scratch.


Deciding what is healthy and what is unhealthy food can be challenging. Processed food may contain a great deal of added salt, sugar and fat. Contents (fat, unsaturated fat, salt, sugar and other ingredients) are often on the package but not easily legible or understandable. Salt may be given as grams of salt, grams of sodium or milliequivalents. Fat content may be per package, per 100 grams or per serving. Food labelling in the UK is moving towards a consistent approach but it remains voluntary with many manufacturers not participating.


There may be many barriers to people taking regular exercise. This can be complex but again cost need not be a barrier. It is possible to choose recreations and pastimes that are both healthy and cheap. Building exercise into daily routines can help - for example, cycling to work. This is cheaper than taking the car and could be considered a healthy option. However there are problems:

  • Work must be a reasonable cycling distance away.
  • The car must not be required at work.
  • There should be facilities to shower and change.
  • Adverse weather conditions.

Social, educational and cultural barriers

There are many examples of how these factors can present a barrier to the promotion of health. Social and cultural factors which discourage healthy lifestyles are evident in the media and in advertising. These both reflect and shape attitudes and fashions connected with unhealthy habits and behaviour. For example:

  • The tobacco industry and tobacco advertising tried hard, both to discredit the research that exposed its dangers and to present its product as desirable. Hollywood continued to portray smoking as cool and sophisticated. Often younger people do not consider health warnings as relevant to them, whereas the images and positive attributes of smokers portrayed in advertising and films can be alluring.
  • Peer pressure can encourage young people to experiment with drugs and to drive dangerously. Alcohol consumption amongst the young is a major concern with a rise in binge drinking in recent years - see separate article Alcohol-related Problems.
  • Misinformation, ignorance and lack of education can all lead people to miss out on healthy choices or to adopt an unhealthy lifestyle. For many years the media undermined the measles, mumps and rubella (MMR) vaccine by referring to it as 'the controversial MMR vaccine' and implying that significant scientific uncertainty persisted.

Administrative barriers

Badly run prevention programmes are often responsible for lack of effectiveness. Inadequate lists, unachievable targets and lack of follow-up for non-responders are typical problems. The greatest barrier to effective prevention is lack of effectiveness in modifying the risk factors in patients identified as at-risk.

Role of prevention in primary care

Prevention is better than cure. It has to be, but the management of change is a complex and difficult issue, not least transformation of lifestyles.

In recent decades general practice has, through several mechanisms, embraced prevention to help produce a National Health Service, rather than just a National Sickness Service. Doctors, educators and politicians have a duty to ensure that the facts are delivered in a form that can be understood by all. What is rather more contentious is the degree to which prevention should be enforced. People should be allowed to have personal freedom and make informed judgements about how they live their lives.

Further reading & references

  1. Martineau F, Tyner E, Lorenc T, et al; Population-level interventions to reduce alcohol-related harm: An overview of systematic reviews. Prev Med. 2013 Jun 27. pii: S0091-7435(13)00211-9. doi: 10.1016/j.ypmed.2013.06.019.
  2. Frank E, Dresner Y, Shani M, et al; The association between physicians' and patients' preventive health practices. CMAJ. 2013 May 14;185(8):649-53. doi: 10.1503/cmaj.121028. Epub 2013 Apr 8.
  3. Office of Health Economics; Wilson J.M.G. (1966) in Teeling-Smith G: Surveillance and Early Diagnosis in General Practice: OHE pages 5-10.
  4. Ilic D, O'Connor D, Green S, et al; Screening for prostate cancer. Cochrane Database Syst Rev. 2006 Jul 19;3:CD004720.
  5. Andrae B, Andersson TM, Lambert PC, et al; Screening and cervical cancer cure: population based cohort study. BMJ. 2012 Mar 1;344:e900. doi: 10.1136/bmj.e900.
  6. Forrest APM; Breast Cancer Screening: report to the health ministers for England, Wales, Scotland and Northern Ireland, HMSO, 1986.
  7. Balint M; The doctor, his patient and the illness. Churchill Livingstone; First published 1957, update 1964.
  8. Byrne PS, Long BEL; Doctors talking to patients, Royal College of General Practitioners, 1984.
  9. Pendleton D, Schofield T, Tate P & Havelock P; The Consultation: An Approach to Learning and Teaching; OUP. 1984
  10. Cowan C, Healicon R, Robson I, et al; The use of anticoagulants in the management of atrial fibrillation among general practices in England. Heart. 2013 Aug;99(16):1166-72. doi: 10.1136/heartjnl-2012-303472. Epub 2013 Feb 7.
  11. Chaloupka FJ, Straif K, Leon ME; Effectiveness of tax and price policies in tobacco control. Tob Control. 2011 May;20(3):235-8. doi: 10.1136/tc.2010.039982. Epub 2010 Nov 29.
  12. The Black Report of 1980; (Chapter 10 gives a summary of findings and recommendations), Socialist Health Association
  13. Tudor Hart J; The Inverse Care Law. Lancet 27 Feb 1971. 1(7696):405-12
90 Health - United Lincolnshire Hospitals NHS Trust Complaints
Updated: 12 Jan 2014

United Lincolnshire Hospitals NHS Complaints

Have you been badly treated ?

 Has it cost you money ?

 Have you only thought about complaining ?

 Don’t take it lying down !

 Make a Claim

 Do it yourself through the Small Claims Court.

 Don’t be brow beaten by the system

 Keep your resolve


This was a claim for Travelling Expenses for poor service.

 Throughout the complaint I was continually refused justice by the Hospital Authorities.


The complaint !


  1. Sent for overnight tests at Boston General NHS from Lincoln –Reported at 6pm and they sent me home without treatment. I claimed 45p per mile travelling expenses, to and from home, they offered 15p.


2 Sent to Gainsborough Hospital NHS from Lincoln for a Neurological Consultation and shortly after another at Lincoln County – I claimed 45p per mile travelling expenses, to and from home, they offered 15p


3 Refused Orthopaedic Surgery at Lincoln County NHS, GP requested surgery at Sheffield NHS. Travelled 9 times to Sheffield from Lincoln for the Surgery- I claimed 45p per mile, they offered 15p


Total claimed  £605 .67 including Court fees and Expenses


They paid me £37.10 which I rejected

They paid me another £175.25 which I rejected

After taking them to the Small Claims Court they paid me £393.32 as an Ex Gratia Payment, ie 45p per mile.


The moral to this story is that Lincolnshire NHS and their successor Lincolnshire West CCG did not want to challenge my claim in a Court of Law, so they coughed up and those who feel badly treated succeed, if they don’t weaken.


Don’t give up – Get Justice


Need help? - Get in touch here.

91 Health - NHS under Pressure -Funding, Closures and Increased Demand
Updated: 11 Jan 2014

The NHS is already under massive pressure.

If you keep pushing and pushing, the service will fall apart,

says Dr Clive Peedell

Posted in Press Releases |
Summary of Dr Clive Peedell’s interview on Murnaghan, Sunday January 5th 2014

“The NHS is facing a perfect storm. There are 3 serious problems it’s facing”: a predicted funding gap of £50-55bn by 2020 because of unprecedented government cuts and efficiency savings which have already led to service cuts, hospital closures and not enough staff ; increasing demand due to an ageing and increasing population, and the impact of austerity on public health; and the government’s £4 billion top-down reorganisation that’s a costly policy fiasco.

“The government’s £4 billion top-down reorganisation is actually going to increase the cost to the health service because it’s going to introduce more bureaucracy. The market system that’s being driven accounts for about 10% of the NHS budget. The National Health Action Party is calling for the purchaser-provider split (where GPs have to buy services from hospitals) to be abolished, because that’s wasting billions. We should be spending money directly on patient care. There are loads of ways we could be saving money and  running the NHS in a much better and more efficient way .

“The NHS is already under massive pressure. If you keep pushing and pushing, the service will fall apart and it will be the poorest and most vulnerable in society who will suffer because the wealthy will be able to afford to go private. And that’s exactly what Liam Fox wants. He’s been quoted in the past that he wants to see a privatised health care system. He wants to see an end to the NHS. His ideology is about a small state. That means privatising large swathes, large chunks of the public sector, including the NHS.

“If you want a privatised NHS, vote for the Conservative Party.  If you don’t want that, consider voting for my party, the National Health Action, that is clearly against that because we feel that a publicly funded, publicly delivered service is most cost effective way to look after our nation’s health

92 Health - Charging Patients for A&E is Missing the essential point
Updated: 11 Jan 2014

“The argument that there are a lot of time wasters in A&E has been greatly exaggerated. The vast majority of people who use A&E actually do have serious health problems and even if they have minor problems, they’re worried there’s something seriously wrong.

“All evidence shows if you bring in charges you discriminate against the poor and introduce health inequalities. There are serious risks if you put people off seeking health care because they can’t afford to pay for it.  £5 may not sound like much but for many people it will be a deterrent.

“This is also the thin end of the wedge it is. A £5 charge will soon become £10 or £20. And we’ll soon see charges extended for other things and that will breach the fundamental principles of the NHS – care should be free at the point of use for all who need it regardless of the ability to pay.

“The real reason A&E departments are stretched is not because of patient admissions, which have actually NOT increased. It is because of the crisis in the capacity to deal with patients. This is due to huge cuts imposed by this government: 4000 beds have been cut in the past 5 years, thousands of nurses have been fired and there are simply not enough doctors. The College of Emergency Medicine warned the government two years ago there wouldn’t be enough A&E doctors.

“Don’t target patients; blame the government for this A&E crisis. Charging patients for A&E is missing the point – the government is to blame for this A&E crisis not patients.”

93 Health - There's a Lansley About -Again !
Updated: 11 Jan 2014

He is back! Former health secretary Andrew Lansley is in many of the newspapers criticising campaigners for suggesting that sugar is as dangerous as tobacco.

According to the Guardian, he criticised ‘inaccurate analogies’ from doctors leading the campaign, after several compared the harmful effects of sugar to drinking alcohol and smoking. But he also comes from the party that promised no reorganisation of the NHS, so maybe we should take what he says with a pinch of demerara.

Moving on, a Press Association survey of nearly 6,000 doctors has found that (wait for it) they think that revalidation will not weed out any dodgy doctors. If you had read Pulse earlier this week, then you would have known that already, but sometimes it takes others a little more time to catch up.

Elsewhere, it seems almost sad that it has to be said at all, but the director of one of the leading providers of the NHS 111 service says the advice line will only work if patients are put before profits.

Sky News reports that Lorraine Gray, director of IC24, a not-for-profit NHS 111 provider in Essex and Norfolk, said: ‘We don’t pay big dividends, we don’t drive around in big cars, so it goes back to our patients. And we don’t take on contracts that we don’t believe we can deliver to a high standard.’ Good for her.

94 Health - Support Ambulance Staff Working Conditions
Updated: 11 Jan 2014


10 hours without meal break? Ambulance staff ballot for ‘hunger’ strike

by - 10th January 2014, 8.15 GMT

Yorkshire ambulanceYorkshire ambulance staff are being balloted for strike action over changes in shift patterns which could mean paramedics going more than 10 hours without a meal break and staff being forced to work 12 hour shifts.

Unite is balloting its 450 members at the Yorkshire Ambulance Service NHS Trust for strike action over the introduction of new elongated shift patterns next month.

The shift patterns are not family friendly and will lead to an overtired workforce. There has been no consultation with Unite over the rotas which are being ‘rushed in’ early next month. The ballot closes on January 24th.

Unite said that the proposals would impact on patient safety as hard working ambulance staff could go more than 10 hours without a meal break, as such breaks would be at the whim of managers. The union wants a protected meal break of 30 minutes after six hours.

Unite regional officer Terry Cunliffe said: “Our members, who are doing their best for the Yorkshire public in very difficult circumstances, have been under sustained attack by the trust’s hardline management for more than a year.

“The latest erosion in their employment conditions is the demand to work elongated shifts which could mean them working more than ten hours on the trot before managers deign to give them a meal break. This could affect their ability to do their jobs – helping people in distress.

“I think the people of Yorkshire will find that this is completely unacceptable.”

Unite has been in a long-running dispute with the trust, headed by chief executive David Whiting, over its concerns relating to patient safety and large scale funding cuts of £46 million over a five year period.

The first anniversary of the trust’s de-recognition of Unite for raising these concerns falls on February 4th. In November, the paramedics lobbied the county’s MPs on the situation which includes their replacement, in some cases, by emergency care assistant  (ECAs) who are being given only six weeks training, while paramedics have to undergo a two-year degree course.

The union is also increasingly concerned at the continued and increasing use of private ambulance firms to ‘plug the gaps’ in NHS 999 responses which was particularly noticeable in December and over the Christmas and New Year period.

According to the trust’s own figures, the number of responses by private ambulances between 1 April 2012 and 31 March 2013 was 3,903. This had jumped to 10,297 in just five months, 1 April 2013 and 31 August 2013 – an increase of 164%. While in December, in some large cities, at least a third of crews attending 999 calls were supplied by private firms.

Unite believes that this is part of the trust’s unspoken strategy of preparing the ambulance service for privatisation by the back door.

Unite has called for more training for the ECAs, so they have the proper skill set to tackle the more demanding tasks now being asked of them.

Unite ambulance members previously took strike action on 2 April and June 7th 2013 over concerns regarding patient safety.

95 Health - Obesity - A worldwide issue
Updated: 10 Jan 2014

Obesity epidemic becomes worldwide phenomenon

Much of the world should go on a diet in 2014. More than a third of adults globally were estimated to be overweight or obese in 2008, according to a report by the Overseas Development Institute (ODI), a think tank in London. That's a 23 per cent increase on 1980.

In the last three decades, the number of adults estimated to be obese in the developing world has almost quadrupled to 904 million, overtaking the number in rich countries.

"The most shocking thing is the degree to which obesity is now affecting developing as well as developed economies," says Tim Lobstein of the International Association for the Study of Obesity in London. "The problems caused by overconsumption of fats and sugars are now global, not just Western, problems."

The rise is linked to a "creeping homogenisation" of diets across the world, says the report, which says rising incomes, advertising and globalisation all play a part.

It criticises policy-makers in most countries for being slow or unwilling to tackle the problem. "We see a big gap in what governments recommend people eat as part of their nutrition campaigns and what people actually eat," says Sharada Keats of the ODI, a co-author. "We need governments to acknowledge the scale of the problem and start putting in place stronger steps to tackle it."

Growing trend

Some countries have managed to go against the grain and improve diets. For example, South Koreans ate four times more fruit in 2008 than they did in 1980. The report attributes this to government health drives, which include training programmes on how to prepare low-fat meals, showing what governments can do when they act.

The report's figures are based on trends extrapolated using body mass index data from 199 countries.

Given that there are very few bits of hard evidence of obesity prevalence available historically in such a wide range of countries, the authors of the report have made pretty good use of the data, says Lobstein.

Although the change is most pronounced in the developing world, the US remains the fattest country with 71 per cent of its population obese or overweight. The UK is ranked a weighty fourth with 64 per cent.

In 2006, the World Health Organization predicted that obesity in the developing world would overtake that in rich countries by 2010.

96 Health- Defusing the Dementia "Time Bomb"
Updated: 10 Jan 2014

Defusing the Dementia ‘time bomb’

Home > Our News > Our Blog > 16 March 2012

Toby Williamson, Head of Development and Later Life:

"Recently, Professor Peter Piot (director of the London School of Hygiene and Tropical Medicine) declared dementia to be the ‘next global health time bomb’ and called on the World Health Organisation to add dementia to its top priorities in terms of funding research and treatment across the world.

Professor Piot is certainly right about the rising prevalence of dementia. The disease now affects 820,000 people in the UK alone and 25 million of the UK population have a close friend or family member with dementia. These are truly staggering figures and this is without even considering the reality behind the statistics, the personal experience of dementia and the emotional toll it takes on friends, family and carers.

But while the Professor’s ‘time bomb’ metaphor is useful to highlight the increasing incidence of dementia, his language also has the potential effect of sensationalising the disease; his imagery linking it with idea of destruction and devastation. We do need to increase awareness of dementia, but this should not be at the expense of stigmatising the illness, which adds to the distress for those living with the condition, as well as their families. Above all, we need to actively challenge the language that is so commonly used in the media when the subject of dementia is being discussed.

If you spend a few minutes researching the disease on the internet, which is something that a person newly diagnosed with the illness would conceivably do, you inevitably find news items such as a 2008 article from the Guardian with the headline ‘Dementia is a living death for 700,000 Britons’.

This particular article, which is predominantly about a woman whose husband had been diagnosed with dementia, is filled to the brim with sensationalist language and there is not a paragraph that does not contain some highly-charged phrase or other. For example, the journalist describes how dementia is a ‘terrible burden on families’ and talks of the ‘insidious onslaught’ and ‘inexorable advance’ of the disease. In describing the lady’s husband, the journalist talks of the ‘timebomb inside him’ that began to ‘lay siege to his brain’ and that ‘four years later his mind is on the cusp of untethering itself from its final mooring posts’.

This is just one example, picked at random, of many hundreds of articles and blog posts about dementia that are steeped in this kind of intensely negative language.

Of course, to level the charge of sensationalism at journalists would be pretty futile, when, after all, it is their job is to ensure maximum sales for their newspapers. But they do need to be aware that the use of exaggeration and other shock tactics can have a negative effect on people who actually have to live with dementia. This effect is particularly pronounced in the newly diagnosed, at a time when they are still coming to terms with the illness.

An important part of ‘coming to terms’ with a new diagnosis of dementia is accepting the reality of the condition, and this reality is bound up with the language used to describe it. So if someone has just been diagnosed with dementia and they read phrases like ‘living death’ and ‘ticking time bomb’ then they are bound to feel that there is no way out and that they are condemned to a life of misery.

But this is simply not the case. That is why at the Mental Health Foundation we are spending so much time working on how people with dementia can maintain as good a as good a quality of life and mental well-being for as long as possible and how things like self-directed support, involvement and participation, can help them achieve this (check our projects Dementia Choices and DEEP for more information).

So it is crucial that we move away from the image of dementia as a ‘living death’, and instead use language that is realistic but positive, and without resorting to euphemism. Above all, the message we need to get across is that people are ‘living with’ dementia and not ‘dying from’ it."

97 Health-Fatty ? You consume more energy than we expend
Updated: 09 Jan 2014

Why is Britain fatter than ever?

Britons are no greedier now than in the past,

so why are we piling on the pounds – and what can we do about it?

Daniel Lambert, who was reported to weigh 50st before he died in 1809: the fact that he charged people money to see him shows how rare obesity was  Photo: Alamy

By Cherrill Hicks

6:10AM GMT 06 Jan 2014

On April 2 1806 an intriguing advertisement was placed in The Times newspaper. It described a Mr Daniel Lambert, “the greatest Curiosity in the World who at the age of 36 weighs upwards of FIFTY STONE.” Mr Lambert, it went on, “will see Company at his House, No 53 Piccadilly, opposite St James’s Church — Admittance 1s.”

Originally from Leicester and a well respected breeder of sporting animals, Lambert had in his youth been fit and strong, fighting a bear in the streets of the town on one occasion. By all accounts it was only when he succeeded his father in the relatively sedentary job of keeper at LeicesterCity gaol, that he dramatically gained weight.

He died at the age of 39, probably from an artery blockage – but not before having made a fortune from taking up residence in London and exhibiting himself, becoming, according to the Leicester Mercury in 2009, “one of the city’s most cherished icons”.

Whether Lambert would attract the same attention today is doubtful. Two hundred years on, according to a report last year, there are in Britain a staggering 100,000 Lamberts: the “super-obese”, with a body mass index of 50 or more, in need of triple width aircraft seats and wardrobe sized coffins.


That figure, though, is just the tip of the iceberg. As all the research shows, we Brits are fatter and heavier than ever before in history, with one in four of us now classified as obese (a BMI between 30 and 40) - a figure which has more than doubled in the last quarter of a century - while a further third are overweight (a BMI between 25 and 29).

It’s not only our BMIs that are on a dangerous upward curve. Waistlines are expanding too, especially as we get older, when metabolic rate slows and body fat accumulates. Recent figures show that 30 per cent of men and 55 per cent of women aged 60 to 70 having a waist size of 102cm/40 inches and 88cm/34.5 inches respectively.

Corpulence has always been with us of course, although in former times it was associated with the rich. The lower classes, fed mostly on bread and jam with maybe a few scraps of meat on Sundays, tended to be weak and scrawny - as was noted with some alarm by officials sizing up recruits for the Boer War, in the first systematic measurements of height and weight ever undertaken.

These days, obesity is unequivocally linked to poverty, while the rich - especially rich women – tend to keep thin. Looking around the Telegraph offices, one wouldn’t be aware of any obesity “epidemic” and the same would be true of any gathering of the educated, metropolitan elite. That said, the middle classes shouldn’t get too complacent – figures from the government’s National Obesity Forum show that weight problems are increasing at all levels of society – and with them, an increased risk of chronic, life-threatening conditions such as heart disease and diabetes.

How did we get so fat? The answer is simple: we consume more energy (measured in kcals) than we expend. In other words, we eat too much and move too little. Many experts now hold that this is not our fault and that we are no more gluttonous or slothful than our predecessors. The theory is that when it comes to appetite, we are at the mercy of evolution and the “thrifty gene”, which has primed us to eat whenever food is available.

“In the past, the person with the feeble appetite would be the one that died in winter,” says Ursula Arens, a dietitian who has written extensively on nutrition. “Everyone alive today is a survivor thanks to having fat, greedy ancestors. This is why we can’t endlessly tell people to eat less - they come up against their own brains and bodies telling them to eat at all times food is available.”

And today, in contrast to the distant past, food is constantly available, plentiful and (notwithstanding today’s rising prices) cheap. It was at the end of World War Two that the government, determined that the spectre of hunger which had haunted both world wars was never again an issue, launched what was pretty much an agricultural revolution to maximise yields, encouraging farmers with guaranteed subsidies and markets.

“One hundred years ago, food was phenomenally expensive – up to 70 per cent of the average income,” says Arens. “As a result of government policy and for the first time in history, it has been falling since the 1950s and is now cheaper than it’s ever been – about 10 per cent of average earnings (excluding alcohol).”

The entry of women into the workplace followed, radically changing the kind of food we ate: with wives unable to go to the market every day and coming home at the same time as their husbands, meals had to be easy, convenient and with a long shelf life. Hence the popularity of baked beans, fish fingers, tinned mandarins and Angel Delight. Increasingly, manufacturers added fat and sugar to this highly processed food, to make it palatable.

Yet surely our grandparents were also fond of their fat and sugar, in the form of syrup puddings and spotted dick, not to mention the fatty meat and mounds of bread and dripping people ate (aside from wartime)? Arens points out that in the past, with men going to the fields or the factory and women doing their own laundry and housework, they needed the calories. And whatever people ate, they followed a pretty strict regime of three meals a day, with little in between.

“If you look at food diaries of the 1950s, food was plainer, the portions were moderate and there were still a lot of vegetables - turnips, swedes, carrots - used in stews. If you were hungry in between meals you ate an apple or a slice of bread. Chocolate was reserved for special occasions.”

Today, with food available 24/7, we snack and graze at will on calorie-dense smoothies and soft drinks, savouries, pastries and triple-choc-chip biscuits. The trend, associated with weight gain, is especially common among the young, with UK consumers between six and 24 being the biggest snackers in Europe.

And some snacks are bigger than others. “When I was a girl and we went to the seaside I’d take a sandwich in a Tupperware box,” says Dr Susan Jebb OBE, professor of diet and population health at the University of Oxford. “Now you can get a three course meal in a petrol station.”

Increasing choice (the latest kick being tabasco-flavoured chocolate) means we are ever more food-obsessed and never bored enough to stop eating. A typical dinner of 50 years ago - lamb chops say, with boiled potatoes – was pretty untitillating; now we have Indian, Chinese, Mexican, Thai to choose from – an abundance of stimulation that leads us to overconsume.

“If you had to eat the same food over and over, you would lose weight very quickly,” says Professor Jimmy Bell, from the MRC Clinical Sciences Research Centre in Hammersmith. Increased plate, cup and portion sizes – especially of ready meals - are another factor: research by the British Heart Foundation found that in the last 20 years, individual chicken pies grew in size by 40 per cent and curry meals by 50 per cent.

“When I was young a bag of crisps weighed 25g,” says Prof Jebb. “Now it’s 40-50 grams – and no one saves half a bag of crisps for the next day.”

Alcohol may also be contributing to our weight problems – and not just in the form of the classic (male) beer belly. Women in particular have been drinking more over the past 30 years and they tend to favour wine, yet there’s evidence that even a small amount of alcohol before or with a meal will mean we eat more. And few people realise alcohol has an energy value of 7kcal per gram – second only to fat (9kcal/g) in energy density.

Then there are the food companies’ ingenious marketing strategies – the meal deals, the three-for-two offers, the carefully thought out packaging and positioning, all designed to trick us - or rather our brains - into believing we want more.

Prof Paul Fletcher, a neuroscientist at the University of Cambridge, says that certain “reward centres“ in the brain light up not just when we eat our favourite food but when we see images associated with it – hence the power of certain symbols like the McDonald's yellow arches. “It’s a bit like what happens when a former drug addict passes a house where he used to score. He will have a sudden intense desire to do so again as the brain is stimulated.”

Why can’t we just exert some willpower and consume less? It’s not so easy, according to Prof Jebb, scientific adviser to the government on nutrition and co-author of the influential Foresight report on Obesity published in 2007. “The amount of time food has been plentiful has been the blink of an eye – we haven’t had a chance to evolve to catch up,” she explains. "Our biology is not well developed for the modern world.”

In particular, she says, “there is an asymmetry between our powerful biological drive to eat and a weak appetite control system, in which signals of fullness are weak. “ Which is why in restaurants it’s hard to resist the dessert even when we are comfortably full.

“We have got locked into this and it is a vicious cycle. The more you eat, the heavier you become and the more food you need to sustain your weight because your metabolic rate goes up (it’s a myth that overweight people have a lower metabolic rate)."

To lose excess weight, we would have to exert “very powerful cognitive control” and tolerate feeling hungry, says Prof Jebb.

Oddly, surveys appear to show that we eat dramatically fewer calories than people did in the past (excluding the two world wars): one recent report found a 20 per cent drop in calorie intake over the last 30 years. But the data isn’t considered that reliable: most food surveys, relying on self-reporting, are thought to underestimate what people actually eat by about 25 per cent.

In any case, even if we are eating less, we’re still getting fatter – because our physical activity levels have plummeted even further. Car ownership, the loss of manual work, technology taking over household chores and “screen time” at home have all contributed to our increasingly sedentary lifestyles. The loss of school playing fields – with some 10,000 being sold off between 1979 and 1997 and a further two a month since the 2012 Olympics – are held by many to be another cause of obesity in children.

“Our grandparents may have had a higher calorie intake than we do but they walked miles to the shops, did the laundry by hand and mostly had physical jobs like farming or labouring so they needed the calories.” says Arens. ”You don’t need them if you’re going to sit in a call centre all day.”

“Physical activity was not a choice – but part of life.”

By contrast, the latest research examining the lifestyles of a million adults in England, funded by the Economic and Social Research council, found that nearly 80 per cent of the population is failing to hit key government targets (150 minutes of moderate exercise weekly). And nearly one in ten adults does not even walk continuously for even five minutes a day.

As with food, the forces ranged against us are similarly strong when it comes to (voluntary) exercise. “We all know the message – we can and should go to the gym or whatever every night, but many people feel they have neither time nor energy.” Exercise has to compete against all the other options for our limited leisure time: the choice between an evening at the gym and a film with a friend is frankly a no-brainer.

Then there’s the seductive power of Facebook, Twitter, TV – all sedentary activities, with watching TV in particular linked to snacking, according to a recent review by LoughboroughUniversity experts.

The result, says Prof Jebb, is that on average we consume 25 calories a day more than we expend in activity. It’s not a lot, but enough, as it accumulates over the years, to make us fat. “It’s not rampant gluttony but a minor error in our homeostatic balance that is the problem,” she adds.

Clearly individual genes play some part in explaining why some people are more inclined to put on weight, in the same environment. “We’ve so far discovered about ten gene mutations which make it likely that someone will put on weight and we think there are many others that contribute,“ says Professor Sadaf Farooqi, from the MRC-Wellcome Trust Institute of Metabolic Science in Cambridge. But this doesn’t explain why at a population level, Britons are getting heavier, she concedes.

It’s not all bad news. The latest child measurement figures show that obesity levels in primary school are levelling off compared to the previous year (from 9.5 per cent to 9.3 per cent in 4 to 5-year-olds and from 19.2 per cent to 18.9 per cent in 10 to 11-year-olds), possibly because of improvements in school food standards and the drive for more sports (60 active minutes a day as a minimum). The food companies are being “nudged” into bringing down levels of sugar and fat (as well as salt) in their products. And over the past decade levels of physical activity have increased, with 14 per cent of adults in the UK now playing sport regularly, higher than the EU average of 9 per cent.

What else needs to be done? Ban cars once a week so that people walk more? Teach children how to cook proper food? Provide more sports facilities at the workplace and more time to use them? Work on making all neighbourhoods safe to walk? Replace junk food outlets in deprived areas?

The Foresight report says our “obesity “epidemic” can be compared to climate change, arguing that action at all levels is needed. The problem, it says, has been at least three decades in the making – and will probably take just as long to reverse.


Body Mass Index is your weight in kilograms divided by your height in metres squared.

A BMI of below 18.5 is classified as underweight

Between 18.5 and 24.9 is classified as healthy

Between 25 and 29 is classified as overweight

Between 30 and 40 is classified as obese

A BMI of over 40 is seen as morbidly obese

98 Health- Vote Tory if You Want a Privatised NHS
Updated: 07 Jan 2014

The NHS is already under massive pressure.

If you keep pushing and pushing, the service will fall apart, says Dr

Clive Peedell

Posted in Press Releases |
Summary of Dr Clive Peedell’s interview on Murnaghan, Sunday January 5th 2014

“The NHS is facing a perfect storm. There are 3 serious problems it’s facing”: a predicted funding gap of £50-

55bn by 2020 because of unprecedented government cuts and efficiency savings which have already led to

service cuts, hospital closures and not enough staff ; increasing demand due to an ageing and increasing

population, and the impact of austerity on public health; and the government’s £4 billion top-down

reorganisation that’s a costly policy fiasco.

“The government’s £4 billion top-down reorganisation is actually going to increase the cost to the health

service because it’s going to introduce more bureaucracy. The market system that’s being driven accounts

for about 10% of the NHS budget. The National Health Action Party is calling for the purchaser-provider split

(where GPs have to buy services from hospitals) to be abolished, because that’s wasting billions. We should

be spending money directly on patient care. There are loads of ways we could be saving money and  running

the NHS in a much better and more efficient way .

“The NHS is already under massive pressure. If you keep pushing and pushing, the service will fall apart and

it will be the poorest and most vulnerable in society who will suffer because the wealthy will be able to afford

to go private. And that’s exactly what Liam Fox wants. He’s been quoted in the past that he wants to see a

privatised health care system. He wants to see an end to the NHS. His ideology is about a small state. That

means privatising large swathes, large chunks of the public sector, including the NHS.

“If you want a privatised NHS, vote for the Conservative Party.  If you don’t want that, consider voting for my

party, the National Health Action, that is clearly against that because we feel that a publicly funded, publicly

delivered service is most cost effective way to look after our nation’s health”.

99 Health- Strict Diet to reduce Type 2 Diabetes
Updated: 06 Jan 2014

The Express has news that GPs could help millions of patients with Type 2 diabetes reverse their condition through a strict

diet of 800 calories per week. The study that has been tested on 11 patients (yes, you read that right) is part of a new £2.4m

medical trial of almost 300 people with obesity-induced diabetes.

Professor Roy Taylor, of Newcastle University, who led the study, told the newspaper: ‘The new study is to see whether GPs

can use this approach to reverse diabetes in their patients and whether it will stay reversed. The evidence is that it will, but

we need a large-scale trial to prove that it works.’ Er, yes you might

100 Health -Public faith in NHS remains stable, survey shows
Updated: 06 Jan 2014

Public faith in NHS remains stable, survey shows

3 January 2014 | By


Trust in NHS services remains stable, shows a new survey.

The NHS Alliance poll of nearly 2,000 UK adults - conducted by YouGov - showed 53% of respondents had not changed their level of trust in the NHS to look after them since the previous year, while 8% said they now trusted services more.

However, for one in five, trust had reduced over the course of the year.

The figures from the first NHS Alliance annual ‘temperature check’ polled respondents on their level of trust that politicians and the media portray NHS in a balanced way, with around nine-in-ten saying they did not.

The figures come after the Government - and especially health secretary Jeremy Hunt - came under fire for repeatedly portraying NHS services, and GPs in particular, in a bad light during 2013. It was also the year where the full details of the horrors that unfolded in the Mid Staffordshire hospital scandal were unveiled with the publication of the Francis report.

But NHS Alliance chair Dr Michael Dixon urged doctors and the public not to put too much emphasis on the negative stories and instead shoulder responsibility for ensuring continued success of the service.

He said: ‘The NHS has been battered and bruised by both the media and politicians this year. In some cases rightly - we should never shy away from confronting care that lacks kindness or efficacy - but it’s too easy to let the negatives get in the way of the extraordinary positives of our health service. I am constantly amazed at the passionate and committed care I see delivered in the hearts of our communities and hospitals and am encouraged that our first annual temperature check shows I’m not alone in those feelings.

101 Health- The Food Chart
Updated: 05 Jan 2014
This chart is awesome!  Everyone can use it.  Please pass it on to others.
 Do share this Chart with everyone
Protects your heart
Prevents constipation
Blocks diarrhea
Improves lung capacity
Cushions joints
Combats cancer
Controls blood pressure
Saves your eyesight
Shields against Alzheimer's
Slows aging process
Aids digestion
Lowers cholesterol
Protects your heart
Stabilizes blood sugar
Guards against liver disease
Battles diabetes
Lowers cholesterol
Helps stops strokes
Controls blood pressure
Smoothes skin
Protects your heart
Quiets a cough
Strengthens bones
Controls blood pressure
Blocks diarrhea
Prevents constipation
Helps hemorrhoids
Lowers cholesterol
Combats cancer
Stabilizes blood sugar
Controls blood pressure
Combats cancer
Strengthens bones
Protects your heart
Aids weight loss
Combats cancer
Protects your heart
Stabilizes blood sugar
Boosts memory
Prevents constipation
Strengthens bones
Saves eyesight
Combats cancer
Protects your heart
Controls blood pressure
Combats cancer
Prevents constipation
Promotes weight loss
Protects your heart
Helps hemorrhoids
Saves eyesight
Controls blood pressure
Lowers cholesterol
Combats cancer
Supports immune system
Saves eyesight
Protects your heart
Prevents constipation
Combats cancer
Promotes weight loss
Protects against Prostate Cancer
Combats Breast Cancer
Strengthens bones
Banishes bruises
Guards against heart disease
Protects your heart
Combats Cancer
Ends insomnia
Slows aging process
Shields against Alzheimer's
Promotes weight loss
Protects your heart
Lowers cholesterol
Combats Cancer
Controls blood pressure
Chili peppers
Aids digestion
Soothes sore throat
Clears sinuses
Combats Cancer
Boosts immune system
Promotes weight loss
Helps stops strokes
Lowers cholesterol
Combats Cancer
Controls blood pressure
Protects your heart
Boosts memory
Protects your heart
Combats Cancer
Supports immune system
Aids digestion
Battles diabetes
Protects your heart
Improves mental health
Boosts immune system
Lowers cholesterol
Controls blood pressure
Combats cancer
Kills bacteria
Fights fungus
Protects against heart attacks
Promotes Weight loss
Helps stops strokes
Combats Prostate Cancer
Lowers cholesterol
Saves eyesight
Conquers kidney stones
Combats cancer
Enhances blood flow
Protects your heart
Green tea
Combats cancer
Protects your heart
Helps stops strokes
Promotes Weight loss
Kills bacteria
Heals wounds
Aids digestion
Guards against ulcers
Increases energy
Fights allergies
Combats cancer
Protects your heart
Controls blood pressure
Smoothes skin
Stops scurvy
Combats cancer
Protects your heart
Controls blood pressure
Smoothes skin
Stops scurvy
Combats cancer
Boosts memory
Regulates thyroid
Aids digestion
Shields against Alzheimer's
Controls blood pressure
Lowers cholesterol
Kills bacteria
Combats cancer
Strengthens bones
Lowers cholesterol
Combats cancer
Battles diabetes
Prevents constipation
Smoothes skin
Olive oil
Protects your heart
Promotes Weight loss
Combats cancer
Battles diabetes
Smoothes skin
Reduce risk of heart attack
Combats cancer
Kills bacteria
Lowers cholesterol
Fights fungus
Supports immune systems
Combats cancer
Protects your heart
Straightens respiration

Prevents constipation
Combats cancer
Helps stops strokes
Aids digestion
Helps hemorrhoids
Protects against heart disease
Promotes Weight loss
Combats Prostate Cancer
Lowers cholesterol
Strengthens bones
Relieves colds
Aids digestion
Dissolves warts
Blocks diarrhea
Slows aging process
Prevents constipation
Boosts memory
Lowers cholesterol
Protects against heart disease
Protects your heart
Battles diabetes
Conquers kidney stones
Combats cancer
Helps stops strokes
Combats cancer
Protects your heart
Boosts memory
Calms stress

Sweet potatoes
Saves your eyesight
Lifts mood
Combats cancer
Strengthens bones

Protects prostate
Combats cancer
Lowers cholesterol
Protects your heart

Lowers cholesterol
Combats cancer
Boosts memory
Lifts mood
Protects against heart disease
Promotes Weight loss
Combats cancer
Conquers kidney stones
Smoothes skin

Protects prostate
Promotes Weight loss
Lowers cholesterol
Helps stops strokes
Controls blood pressure
Wheat germ
Combats Colon Cancer
Prevents constipation
Lowers cholesterol
Helps stops strokes
Improves digestion
Wheat bran
Combats Colon Cancer
Prevents constipation
Lowers cholesterol
Helps stops strokes
Improves digestion
Guards against ulcers
Strengthens bones
Lowers cholesterol
Supports immune systems
Aids digestion
102 Health - A Message from the National Health Action Party
Updated: 28 Dec 2013

Working to

Reinstate, Protect

and Improve your


Thursday 26th December 2013

Christmas and New Year message from the


National Health Action Party

NHS heads for a winter of discontent, but the National Health Action Party will continue to defend the NHS and provide solutions to restore and improve it

2013 has already been a very difficult year for the NHS, and pressures are only going to increase this winter. Ongoing austerity at a time of massive NHS reorganisation is clearly taking its toll with service cuts, staff shortages, bed shortages, hospital closures and management chaos, leading to crises in emergency care and social care, rising waiting lists, and intense pressure on GP services. Of course this was all predicted by the leaked version of the NHS Risk Register 3 years ago, which not surprisingly, the Government still refuses to publish.

The Government's costly and unwanted top down reorganisation was designed to dismantle and increasingly privatise the NHS, and this is happening at an alarming rate with £2.5 billion worth of NHS contracts given to the private sector since the new Health Act became law in April this year. The privatisation process will accelerate if NHS services are included in the EU/US Free Trade Agreement, which will irreversibly open the door to global private healthcare companies to bid for NHS contracts. As the first political party to raise this as an issue, we will continue to fight hard for the NHS to be exempted from this Free Trade Agreement.

NHS austerity is set to continue for at least another 5 years so that the funding gap could be between £44-54 billion by 2020-21. Worse still, the Treasury has clawed back £5bn of the NHS budget over the last 3 years, whilst still trying to claim that NHS spending has not fallen in real terms. The NHS will not be able to cope with this level of cuts and service failure is inevitable. It is already happening in places and that is precisely what this Government wants to happen to allow their privatisation plans to flourish.

Successful public services “crowd out” the private sector, whereas “failing” public services are seen as ripe for privatisation. NHS failures such as the Mid Staffs scandal have undermined public confidence in the NHS. The right wing media is constantly denigrating the NHS to soften up the public to swallow the privatisation pill.

Whilst we must accept that the NHS is far from perfect and there have been unacceptable patches of poor care in the system, we need to expose the real reasons for the problems in the NHS: chronic underfunding, constant re-disorganisations, and 30 years of a failed market in healthcare with the purchaser-provider split, which has separated General Practice from Hospital care and massively increased administration costs gulping up to 10% of total NHS budget.

The NHS needs restoring and improving, not dismantling and privatising. In early 2014 we will launch our new 12 point plan for the NHS, which will keep it in public hands, reverse privatisation, increase accountability, increase the focus on public health, and reject economic austerity, which is so damaging to the health of our economy and population. We will also be announcing our plans for the European elections in May 2014.

Meanwhile, here is some information about what our NHS does for the nation, which will help to put all the bad news stories in context:

  • The NHS manages over 1 million patients every 36 hours
  • The NHS deals with 15 million admissions per year (41,500 patients admitted every day)
  • The NHS performs over 10 million operations per year
  • There are over 300 million GP consultations per year
  • The NHS deals with 21.7 million Accident and Emergency cases per year (61,000 patients per day)
  • The NHS ranks as one of the most cost effective, equitable and efficient health services in the world
  • The NHS is amazing

The NHAP exists to defend the NHS as a public service and will never give up on it. It was a precious gift to our nation following the war effort, and it would be a travesty to lose it. Our committee and staff are absolutely committed and continue to fight hard, but we need your help and continued support if we are going to make a real difference.

Please help us by forwarding this e-mail and encouraging your friends and colleagues to join us, or at least follow us on social media. DONATE if you can. Please spread the word about the National Health Action Party and help us help the NHS.

We wish you a very Happy Christmas and New Year

The Executive Committee of the NHAP

103 Heath - Damaging NHS Reforms Must be Stopped
Updated: 24 Dec 2013

Kathryn Anderson:

'The damaging reforms to our NHS need to be stopped'

18 December, 2013

The reforms are considered by many to be a guise for the privatisation of our health service, says Kathryn


How can we possibly provide safe care when there isn’t the right skill mix or number of nurses available?

I recently overheard a nurse saying, “NHS reform - that’s a good thing, isn’t it?” to a colleague. I was concerned

to discover that neither of them appeared to understand much about how these reforms would affect them or,

most importantly, their patients. So what are the reforms about? That’s the billion pound question. Or, in the

case of the NHS budget, the £109bn question.

So, what do we know about the NHS reforms and how they will affect you, me - all of us? Regardless of whether

we work in the NHS or we are users of the NHS, we will all be affected.

Let’s start with a definition: reform is to make changes in (something) in order to improve it, according to the

Oxford dictionary. That sounds reasonable enough. However, if the NHS needs to be improved, these reforms

are not the answer.

The NHS was created on 5 July 1948 under minister for health Aneurin Bevan. Without doubt, there have been

many reforms of the NHS since that time, most of them needed to ensure the services provided to the population

of the UK remained relevant, appropriate and current. Numerous articles, books and theories have been

published about the pros and cons of each of these changes. However, never has there been such an incredible

out cry of dissent about NHS reform than there is at this point in its long history.

What is it about the latest round of reforms under the Health and Social Care Act 2012, which came into force

fully on 1 April that has caused so many learnt and knowledgeable people to be so concerned?

In short, it is because these reforms are considered by many to be a guise for the privatisation of our National

Health Service. Did you know that with the implementation of the act the health secretary no longer has a “duty

to provide” comprehensive national health services, only a “duty to promote”? This is something so

fundamental that it effectively amounts to the abolition of the NHS.

The removal of the “duty to provide” healthcare is only the beginning. Most telling is the recent article published

in doctors’ journal The Lancet, whose author writes “one might be forgiven for thinking that the current coalition

government views the NHS as a failing bank or business. This stance is one of the most cynical, and at the same

time cunning, ways by which the government abdicates all responsibilities for running a healthcare system that

has patient care and safety at its heart” (17 August). Call me old fashioned, but when a restrained journal like The

Lancet uses such language, we should all be worried.

What then does this mean to you and, most importantly, your patients? As a clinical nurse and a manager, my

priority is always my patients, with my team members coming a very close second. The first thing that is obvious

to me is the reduction in qualified nursing staff in clinical areas. According to Nursing Times (1 March) around

4,000 nurses have lost their jobs in the NHS since the coalition came to power. How can we possibly provide

safe care when there isn’t the right skill mix or number of nurses available? Clearly, we cannot.

The NHS reforms will continue apace and the changes will become more dramatic. Before 1948, people lived in

constant fear that they or their children would become ill. Unless these damaging reforms are stopped or

reversed, those days we thought were gone forever will return.

If you do nothing else, please read, learn and understand what’s happening to our NHS.

Kathryn Anderson is lead nurse at a Foundation Trust and executive member of the National Health Action Party

104 Health- Stop Hunt Closing Hospitals
Updated: 19 Dec 2013


FROM Andrew Tobert - 38 Degrees TO You
38 Degrees Logo



The NHS is one of the best things about Britain. Together 38 Degrees members have worked hard to protect it. But there will be a lot more to do in 2014.

Can you chip in a small regular donation to help campaign on issues like saving our NHS?

Dear Giles,

It’s December, and cold - but a crowd of 50 people made a colourful splash against the grey of the Department of Health on Monday morning. They were there to deliver the 142,053-strong petition you signed to the health minister Jeremy Hunt, telling him to scrap his bid to get new powers to close more hospitals, more easily.

The petition was started by Dr Louise Irvine, a 38 Degrees member. Yours and the tens of thousands of names on the petition prove something important: that 38 Degrees members haven’t given up on our NHS. And we never will.

The NHS is one of the best things about Britain. It cares for everyone, regardless of wealth. It saves lives. It’s not perfect, but the ideals at its heart are worth defending. Together 38 Degrees members have worked hard to protect it. But there will be a lot more to do in 2014.

38 Degrees campaigns are funded entirely by small donations from individual members, never big business or government. We're a people-powered movement, and that's how we can acheive great things on a small budget. But to help us work together, some core costs do need covering.

Can you chip in a small regular donation, the price of a cup of coffee, to help fund the change you want to see for our NHS in the year to come?

In 2013, 38 Degrees members raised money to take Jeremy Hunt to court, twice. And won. We’ve taken to the streets in our thousands, to stop closures and cut-backs. And all across the country, 38 Degrees members have come together to push for change within their local NHS.

We’ve won some fights, and we’ve lost others. But throughout 2013, 38 Degrees members up and down the country have stood by our NHS. We need to do the same together in 2014, and every year beyond.

Just £2 or £3 a week would help ensure that together, we can protect our NHS. Direct debits pay for long-term costs, like the website platform and the backroom staff who support it. Knowing that money will keep coming in means that more support can be given to members like Louise as they set up, run and win brilliant campaigns on our site.

Please can you start a direct debit now, to make sure that in 2014 we do everything we can on issues like the NHS?

Doctors have accused Jeremy Hunt of forcing these “changes through the back door”. [1] And thanks to 38 Degrees members, his plans to grab more powers have been attracting newspaper coverage - he won’t be able to sneak this through unnoticed. [2]”.

And that’s just the start - next year, we can do even more. Together, we can make an even bigger noise to stand up for our NHS. We can fight the relentless downgrades and cut-backs. Because these are our hospitals. Together as a movement, we can protect them. And we will.

Huge thanks, and a merry Christmas

Andrew, Susannah, Maddy and the rest of the 38 Degrees team.

[1] London Evening Standard, Hospital reforms 'rushed through':
[2] Financial Times, Health secretary seeks powers to close hospitals more easily:

105 Health - Strokes and Apples - More than an Advertising Stunt ?
Updated: 19 Dec 2013

If everyone over 50 had just one apple a day, 8,500 stroke deaths a year could be avoided in the UK, reports the

BBC this morning.

Researchers said: ‘The Victorians had it about right when they came up with their brilliantly clear and simple

public health advice,

‘An apple a day keeps the doctor away.

106 Health - GP Weekend Opening proving popular with patients
Updated: 18 Dec 2013

Thousands of patients flock to pilots of GP weekend opening

17 December 2013 | By , Christina Kenny


Around 7,000 patients have accessed GP services at the weekend in the first 11 weeks of one CCG’s groundbreaking trial, prompting GP commissioners to hail it as a success as NHS England prepares to unveil further details of national pilots.

The scheme, which cost North Durham CCG £1.2m of ‘winter money’ and is aimed at reducing pressure on emergency services, could be extended beyond its 31 March cut-off date, while in another pilot of seven-day opening in Manchester, one practice has seen 90 patients per weekend in the first two weeks of the trial.

The first statistics from the new pilots of weekend opening come as NHS England prepares to publish details of how GPs across the country can apply for a share of a £50m fund announced by Prime Minister David Cameron in October to allow nine areas to trial expanded seven-day access.

Board papers published by NHS England said: ‘NHS England will commission pilots across England during 2014/15 to set up improved access to general practice for at least 500,000 people; and [e]valuate these pilots to identify the most effective ways to improve access to routine primary care – and support a more a integrated approach to urgent care services – in 2015/16.’

GP leaders have previously criticised the Government’s plans for seven-day opening because of the extra funding it would require.

But unveiling the first statistics from its scheme, North Durham CCG said 7,000 patients had been seen on Saturdays since 1 October, including 800 referred via 111.

Dr Neil O’Brien, chief clinical officer at North Durham CCG, said there was ‘definitely a need for the scheme’.

As part of the trial, practices are offering pre-booked appointments to patients on Saturday as well as operating an alternative service taking referrals from emergency services where appropriate.

This includes patients being diverted from A&E, as well as patients being referred for an appointment after calling 111. Nurses are also on site to offer services like flu jabs at weekends.

A Pulse analysis of year-on-year hospital statistics from the area found that total A&E attendances were down 9% for the first week of December, although this covered the whole of the County Durham, Darlington and NHS Foundation Trust area, not just North Durham.

The CCG said it lacked reliable statistics on the number of patients diverted from A&E to date. However, it added that this option had been underused due to an IT issue that meant A&E staff could not access GP appointments systems and which had now been corrected.

Dr O’Brien said: ‘You want patients to come through 111 and not actually clog up the A&E. There have been some diversions from A&E but we had some initial problems with the software to get them booked in with the practices. That has now been resolved so that should increase over the next few weeks.’

Dr O’Brien said he ‘would like to’ put the reduction in A&E attendances down to the scheme, but said he could not claim that without conducting further analysis.

He said: ‘I would like it to be, and I hope it is, but we haven’t as yet got that full analysis of the impact of the scheme. I really hope that it has caused that reduction, because that is what it is intended to do. A&E performance has always been a struggle in Durham, certainly over the last few years, and we are working very hard as a commissioning group to try and improve that. This was primary care’s role in reducing winter pressures.’

The CCG has also allocated £2m to the County Durham and Darlington NHS Foundation Trust as part of the bid to improve services over winter.

Elsewhere, weekend opening is now partly up and running some areas of Greater Manchester as part of the Manchester demonstrator project. Spring Lane Surgery is one of the practices taking part in the trials in Radcliffe, forming part of a six-practice federation with shared IT systems and sharing of patient records. So far, it has averaged around 90 patients per weekend in the first two weeks of the trial.

Dr Ajay Kotegaonkar, a GP at the practice, said: ‘Our demonstrator bid started on 2 December so we have done two weekends. The demand is not yet great because it has not yet been well publicised. We anticipate that this will go up as patients understand what services are being provided and when they realise that we are a very good alternative to A&E, walk-in centres and out-of-hours cover services.’

In Central Manchester, one practice in one of the four hub areas, began offering Saturday opening two weeks ago. CCG clinical director Dr Ivan Benett said the CCG was hoping to have Saturday opening in all four locations from the New Year.

He said: ‘It is still early days so it is just picking up activity, but we have got the IT working to support the scheme.’

Seven-day opening in Manchester was accidentally hailed by Conservative leaders as a success during the party’s conference earlier in the autumn, but is only now getting under way.

Note: This article was updated at 11.33 to clarify that patients were seen on both Saturdays and Sundays

Key facts on the North Durham CCG weekend opening scheme

What it does: Provides patients registered on GP lists in Durham, Derwentside and Chester-le-Street areas with GP appointments on Saturdays and Sundays.

How it works: Not all practices are open at the same time - they cross-cover for one another. Some are open on Saturdays, some on Sundays, but patients in the area can always access a GP appointment on the weekend because patients registered with any practice in the CCG area will be diverted to their nearest open surgery. This includes pre-booked appointments as well as emergency appointments coming via referral from 111. The practices also accept referrals of patients from A&E. More than 25,000 additional GP appointments will be available for the duration of the scheme and 15 of the 30 practices also offer nurse appointments. 

Purpose: To improve access to general practice, reduce pressure on emergency services and offer continuous care for patients with long-term health conditions.

Duration of scheme: 1 October - 1 March.

Practices taking part: 30 out of 31 member practices of North Durham CCG.

Funding: £1.2m.

Future: May be extended beyond March 2014 pending a full evaluation.

Source: North Durham CCG

107 Health - Weekend Care Plan must not Patient Care in Other Areas of the NHS
Updated: 17 Dec 2013

Without significant new funding,

Keogh’s weekend hospital plan will hit patient care in other areas of NHS,

says NHA Party

Posted in Press Releases |
Response of Dr Clive Peedell, co-leader of National Health Action Party to Keogh plan for weekend hospital care

“The National Health Action Party supports the principle of increasing and improving service provision at the

weekends in the NHS. However the NHS is having to make unprecedented 4% efficiency savings per year at

present, so under the current financial circumstances the government is not being realistic or honest with the

public by claiming the money for this plan can be found from within the NHS.

“This Government is obsessed with the idea that the NHS can continue to do more for less. It’s plain to see that

the NHS is already being stretched beyond its limits as evidenced by the crises in A&E, midwifery and social

care. Unless significant new funding can be made available, Professor Keoghs’s plans will struggle to get off the

ground and hit patient care in other areas of the NHS, which will have to suffer further cuts as money is diverted

to the weekend service.

“In addition, there are many practical  problems related to increasing 24/7 service provision. It’s not just

consultants that need to be available at weekends, it’s also all the support staff required to help safely manage

the service, from nurses to physiotherapists. And unless extra staff are recruited to the NHS, there will be

problems with the EU Working Time Directive for the excessive hours needed to manage the extra weekend


“Also, there are issues around the maintenance of clinical equipment, such as CT scanners, which is often done

at weekends. Life-saving equipment will be at increased risk of breakdown and needing repairs if overused and

not adequately checked and maintained. Once again, this all comes down to cost.”

108 Health- Care Bill Privatisation Vote in Commons
Updated: 17 Dec 2013


Union urges MPs to vote against ‘hijacker’ Hunt’s power-grab

by - 16th December 2013, 7.45 GMT

Unite NHS HuntUnite is today urging MPs to vote against a clause inserted into the Care Bill that will make it

easier to close or privatise hospitals.

The union has accused health secretary Jeremy Hunt of using ‘a Parliamentary sleight of hand’ to increase his

powers, despite rebuffs by two of the highest courts in the land. It says he has changed the Bill after failing to

implement cuts to the emergency and maternity units at Lewisham Hospital in south east London.

Unite was highly critical of the £200,000 that Jeremy Hunt had squandered in legal bills – money that could have

been better spent on frontline services, such as hip replacements.

Unite head of health Rachael Maskell said: “What Jeremy Hunt is attempting to do is to achieve by a

Parliamentary sleight of hand what he failed to do through the courts.

“It is clear that the health secretary is hijacking the Care Bill by tacking on this clause which has no relevance to

the rest of the bill.

“It shows scant respect to Parliamentary traditions and this country’s judicial process built up over many

centuries. Parliament should be in tune with judicial decisions, not trying to overturn them.

“We are urging to MPs to throw out the clause at the Bill’s second reading today, as we believe that this is a

dangerous move which will put thousands of lives at risk, by removing clinical decision-making from NHS


“Jeremy Hunt was inept and wasteful in his failed legal challenges – but more generally, he has failed in his remit

which is to improve and retain the NHS for the benefit of the many and not just a few private healthcare


“And he continues to demoralise staff as they brace themselves for the winter crisis which is already beginning

to engulf A&E units across England.”

Despite massive local protests, ministers tried to fast-track the closure of Lewisham’s A&E and maternity

services, in order to redirect patients and money to neighbouring hospital trusts. This was in context of the large

private finance initiative (PFI) debts to pay off.

Rachael Maskell added: “The Care Bill is being used to drastically reduce the rights of the public to have ‘a say’

in decisions affecting their local hospitals.

“Unite believes that it is totally wrong to use the fast track ‘failure regime’ as a tool to reconfigure hospital

provision more widely.

“If services need redesigning, the law must ensure this is done with proper and extensive consultation with local

people and that decisions are based on clinical needs; not on political interference and dogma.”

109 Health- Public Against NHS use of Private Providers
Updated: 16 Dec 2013

Public turns against NHS use of private providers

13 December 2013 | By Christina Kenny

The public is turning against the NHS’s use of private providers to deliver care, even when the care remains free

at the point of delivery, a recent poll has found.  

Ipsos Mori asked 1,009 people if they agreed with the statement: ‘As long as health services are free of charge, it

doesn’t matter to me whether they are provided by the NHS or a private company.’

It found that 47% of people disagreed with this statement, an increase of 11 percentage points on the number of

people who disagreed when asked in February 2011.

However, it also found that people are less likely to be against external providers who are charity or voluntary


Anna Quigley, the head of health research at Ipsos Mori said that private providers still have some way to go

before they are a fully accepted part of the UK’s health system on par with state-run services.

She said: ‘The Government are keen to ensure the NHS is able to meet the demands placed on it, but they must

be careful that in reforming the NHS and introducing new providers into the mix, they take account of public

opinion and don’t leave the public behind.’

110 Health - Assisted Dying
Updated: 16 Dec 2013

Assisted dying




Assisted dying is when a terminally ill, mentally competent adult, making the choice of their own free will and

after meeting strict legal safeguards, takes prescribed medication which will end their life.


A matter of facts

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111 Health - Take the Alzheimer's Test
Updated: 16 Dec 2013

Take the Alzheimer's test:

The 21 questions that can reveal if YOU are at risk...

By Fiona Macrae

UPDATED: 13:14, 4 February 2012

Go to Daily Mail link




A quick test that tells if your loved one is at risk of Alzheimer’s disease has been devised by doctors.

The 21-question test distinguishes between normal absent-mindedness and the more sinister memory lapses

that may signal the early stages of dementia.

The questions are designed to be answered by a spouse or close friend.

The Alzheimer’s Questionnaire, which is almost 90 per cent accurate, measures mild cognitive impairment – the

slight memory lapses that can be a precursor of the disease.

Up to 15 per cent of people with MCI develop Alzheimer’s within the next year.

The lack of a cure for dementia means that some may not want to take the test, which was devised by Banner

Sun Health Research Institute in Arizona, which specialises in the disease.

Some questions, including one about making the same statements over the course of a day, known as

repetitiveness, were found to be particularly valuable.

The 21 questions are answered with a simple ‘yes’ or ‘no’. A ‘yes’ is given a score of one or two and a ‘no’ always

scores zero, giving a maximum possible score of 27.

Someone who scores under five is advised that there is no cause  for concern. A score of five to 14 suggests

mild cognitive impairment – or memory lapses that could be the early stages of Alzheimer's.

Any higher than this and the person may already have it. Writing in the journal BMC Geriatrics researcher

Michael Malek-Ahmadi said: ‘As the population ages, the need for a quick method of spotting the disease early

will grow.’

Mr Malek-Ahmadi stressed that it is up to GPs rather than patients to interpret the results of the test. That said,

anyone who scores five or above should seek expert help

112 Health- GP access is essential for those working unsocial hours ?
Updated: 16 Dec 2013

Secondary care services should face government sanctions if they fail to provide seven day access to specialist

consultants and diagnostic services, the Guardian reports.

The announcement was made by Professor Sir Bruce Keogh, who said sanctions could involve a financial

penalty and restrictions on hospitals using junior doctors.

Professor Keogh told the BBC’s Andrew Marr Show: ‘It seems strange in many ways that we should start to

wind down on a Friday afternoon and warm up on a Sunday … and [in the] meantime people are waiting for

diagnosis and treatment.’

113 Health - Better 24 hour care 365 days a year !
Updated: 16 Dec 2013

Warning over NHS weekend care by consultant left disabled by failings

Patients left at risk at weekends warns consultant who was disabled by

poor care

Prof Sir Bruce Keogh, NHS medical director, will next week demand changes to increase the number of senior

doctors working weekends   

By Laura Donnelly, Health Correspondent

10:00PM GMT 13 Dec 2013

Patients are being put at risk at the weekend because too much of their care is being left in the hands of junior

hospital staff, senior consultants have warned.

The group of surgeons spoke out after a retired colleague was left disabled because complications from a hip

operation were not spotted, as he recovered from surgery in hospital over a weekend.

Their intervention comes as the country’s most senior doctor prepares to publish recommendations to put the

NHS on a seven-day footing. It follows increasing concern about worse care and far higher death rates for

patients treated towards the end of the week.  

Prof Sir Bruce Keogh, NHS medical director, will next week demand changes to increase the number of senior

doctors working weekends, after research found that 4,400 lives a year are lost because of inadequate staff


Russell Hopkins, a retired surgeon, and former chairman of the BMA in Wales, was left with nerve and bladder

damage after undergoing hip surgery in June 2011 - on a Thursday - and being left for days without seeing a

consultant, as his condition worsened.

Despite his pleas - and those from his daughter, a hospital consultant - it was not until four days later, on the

Monday, that he was seen by specialists, and complications uncovered, which caused permanent damage to his

bladder and nerves.

Mr Hopkins, 81, a former consultant oral maxillofacial surgeon at the University Hospital of Wales, said he was

left wondering who the NHS would look after, if they could not even attend to the needs of retired staff, who

warned that their recovery was failing.

Earlier this year, a study of four million patients found that those who had surgery on a Friday were 44 per cent

more likely to die following the procedure than those who had the same operations on a Monday - with the risks

steadily increasing as the week went on.

The former surgeon said: “I had the operation on the Thursday and didn’t see any doctor until my daughter -

who is a consultant - finally persuaded them that they needed to get someone to see me. But by then the

damage was done.”

Mr Hopkins is among six retired surgeons and two serving consultants appealing for radical reforms to the way

hospitals are run.

They said the introduction of the European Working Time Directive, limiting surgeons hours, has destroyed a

system which meant senior doctors took responsibility for all patients in their care.

Next week, Sir Bruce will call for changes in the way hospitals are run, to improve care at weekends. But Mr

Hopkins said he was concerned that proposals produced so far from medical royal colleges do not go far

enough to improve safety of patient care.

He said: “My anxiety is that for all the talk of seven-day working, some of the proposals that the colleges have

come up with just aren’t good enough - they suggest that patients could be seen by any type of consultant,

every day of the week, but actually if you have just had hip surgery it’s no good seeing an eye doctor.”

The eight consultants say “catastrophic” failings by the NHS had repaid Mr Hopkins’ lifetime of service with

negligence and long-term disability, and that current systems endanger too many patients.

In the letter, published by The Telegraph, they say many surgeons “yearn to put ethics before directives” and to

take responsibility for the patient on whom they operated.

“Any surgeon who performs an operation needs to be part of a team which shares an understanding of the

possible complications of what they are doing. Surgery is too large and technical for a shift system of junior

staff,” they say.

The letter calls for a return to the system which pre-dated the working time directive, with doctors organised into

firms, each with a named head “with whom the buck stops”.

It says: “No working time directive can absolve surgeons of their responsibily to the patient on whom they have

operated, and this can only be shouldered if shared with their trainees. This relationship was once the bedrock

of training in the craft of surgery. Many surgeons yearn to put ethics before directives and to practise these old-

fashioned, fundamental values. Sadly, the NHS has taken away their teams and split up partnerships. Patients

need to know the name and face of the consultant responsible for their care.”

114 Health- Global Fightback on Dementia
Updated: 12 Dec 2013

As the Government’s much-trailed G8 Dementia Summit gets underway in London today, the Telegraph has

front-page news of a new brain-scan that can rule out Alzheimer’s disease.

According to the paper, Prime Minister David Cameron will announce the brain-scan ‘breakthrough’ and promise

it will be available on the NHS as he pledges to lead a ‘global fightback’ against dementia.

The Independent and the BBC meanwhile focus on the Prime Minister’s pledge to double annual funding for

research into dementia by 2025 – from £66 million a year to £132 million





Scientists are close to developing a blood test that could diagnose

Alzheimer’s disease at an early stage, reports the Telegraph.


The researchers, at Kings College London, said the findings could be

used in clinical trials to develop new drugs for the condition.


115 Health- Ambulance Waiting Times at A&E = Government Cuts in Hospital Beds
Updated: 10 Dec 2013

Statement by co-leader of National Health Action Party, Dr Richard Taylor,

on increasing ambulance waiting times at A&E

Posted in Press Releases |

“These long waits by ambulances are fuelled by the delay in discharging patients from A&E, either onto wards or

into the community. Government cuts to hospital beds and community care are creating this ambulance logjam

because patients have nowhere to go so end up bed blocking.

“There is also a problem with a lack of discharge doctors. More than a decade ago, when I was an MP on the

Health Select Committee, we did an inquiry into the problem of delayed discharges. The Delayed Discharges

report was published in 2001-2002. The main points included: for emergency admissions, planning discharge

must begin at the time of admission and for routine, elective admissions, discharge must be organised before

admission takes place.

“Discharge decisions cannot await consultants’ ward rounds which might only take place twice weekly but must

occur throughout the week and on weekends.”

116 Health - A Healthy Diet costs more and shows Cameron polices are starving the masses
Updated: 09 Dec 2013

A healthier diet costs $1.50 more per day

Eating healthily costs about $1.50 more per day per person, according to the most thorough review yet of the affordability of a healthy diet.

"For many low-income families, an extra $1.50 daily is quite a lot," says Mayuree Rao of the Harvard School of Public Health in Boston, who led the analysis. "It translates to about $550 more per year for one person, and that could be a real barrier to healthy eating."

Rao and her colleagues reached their conclusions after analysing 27 studies from 10 high-income countries, mainly the US, comparing price data for healthy versus unhealthy ingredients and diets. For example, one study compared the cost of a diet rich in fruit and vegetables versus one that was deficient in them. Another compared prices of specific healthy and less healthy items, such as wholegrain versus white bread.

Individual items were closely matched in price. Meats saw the largest difference: healthier options cost an average of 29 cents per serving more than unhealthy options.

Disease risk

Despite this, comparisons of whole diets showed that healthier diets cost on average $1.48 more per day.

This shows that comparisons based on single ingredients don't tell the full story, says Rao. "It tells us that, on average, it doesn't cost more to eat healthier based on one nutrient," she says. "But there's growing evidence that the combination of foods in your diet impacts your disease risk more than any single nutrient, so we think our central finding that healthier diets cost about $1.50 more has the most public health relevance."

Rao and her colleagues conclude that the best way to make healthier foods more affordable is for governments to subsidise healthy foods and tax unhealthy ones, as has been attempted in the US with sugar and sugary beverages.

"These are evidence-based ways to address the price imbalance and nudge people towards a healthier diet," says Rao. "These are strategies our policymakers should be looking at."

Economies of scale

As to why healthier food has become more expensive, Rao says that it may be because the food industry organises itself and the types of food it produces to suit its own economies of scale, rather than what's best for consumers.

"Other research from our group has observed that over the past several decades, the US has developed a complex system of farming, storage, transportation, processing, manufacturing and marketing that favours a lower cost of highly processed foods," she says. "We just don't have the same system to support healthier foods like fruits and vegetables."

"The everyday reality for many in the UK is a struggle to pay bills and put food on the table," says Adrian Curtis, director of the Trussell Trust's Foodbank Network, a charity that provides emergency food for people on a low-income in the UK.

"It is clear that if healthy food is more expensive people will choose the less healthy option to stretch their finances further. We are asking the government to conduct an in-depth inquiry into the reasons why so many people are being referred to Trussell Trust foodbanks for short-term emergency food."

Journal reference: BMJ, DOI: 10.1136/bmjopen-2013-004277

117 Health - NHS Administration (CCG's ) - Implementing Cuts and Privatisation
Updated: 09 Dec 2013

A Guide to Clinical Commissioning Groups (CCGs)

by NHA Party executive member, Dr Bob Gill

CCGs are the latest incarnation of local NHS administration and replaced Primary Care Trusts in 2013. The
Coalition Government justified this change by claiming they were ‘putting frontline staff’ in charge of commissioning or buying services for their patients using local knowledge. There was little interest from most GPs who lack the necessary experience in commissioning. 

Some GPs though were interested,  motivated by a genuine desire to shape services, or towards the end of the careers fancied a different challenge or some who saw potential personal financial gain. Many were already in PCT positions and just shifted across to the new roles.CCGs were allocated less funding and many experienced NHS administrators were lost, and with them went the public service ethos.

CCGs have been tasked to make ‘efficiency savings’ which to me and you means cuts. CCGs also have to sell the myth of improving services while spending less money. Despite the NHS returning £3 billion underspend in 2012/13 to HM Treasury, austerity for the NHS continues. CCGs have to find savings and do this by putting out to tender existing services provided by the NHS for ‘Any Qualified Provider’ to bid. Contracts are awarded to the lowest bid and not based on quality or previous experience of providing a service. 

Different CCG will conduct this work with varying degrees of enthusiasm: those dominated by board members who wish to preserve NHS provision will resist tendering out of services; pro-privatisation CCG boards will forge ahead by avoiding democratic engagement of their fellow GPs and presenting change as an improvement, sticking closely to the Government's pro-market agenda supplied by Management Consultants McKinsey & Co (ref 1).
CCGs are essentially contracting bodies set up to ration care, forced into slicing up NHS provision to the lowest bidder. This race to the bottom will be led by commercial companies interested only in profit and not providing a high quality service. Commercial companies, unlike NHS bodies, have dedicated tendering departments quipped with expertise in putting together impressive bids, promising more than they can or intend to deliver. 
CCGs lack the resources to robustly monitor the delivery of contracted services so private providers have little prospect of being held to account. Contractor failure is no bar to future contracts as we have seen with G4S and the Olympic Game 2012 debacle or more recently the alleged fraud with their Criminal Justice probation contract. The fear of litigation will also prevent many CCGs from taking on the might of companies such as UnitedHealth, Serco, G4S and Virgin. Recent regulations, Section 75, make health service contracting subject to European competition law so CCGs tread carefully to avoid legal challenge for contracts awarded whilst trying to avoid fragmentation of services. The tensions between competition, markets and integration will ultimately be decided in the courts.
GPs have been set up to take the blame for future failures and face the public back lash as the realisation dawns that their NHS is no longer comprehensive, universal or free at the point of need. The diversion of resource away from patient care to contracting, administration, monitoring and litigation is significant and will grow. As GPs explain to patients why previously provided treatments are no longer available on the NHS, the knowledge that vast sums of money are being squandered on transaction costs and profit extraction without any of the promised service improvement will be hard to stomach.

As part of our plan to restore the NHS as a safe, comprehensive, publicly funded, publicly delivered, and publicly accountable integrated healthcare system, the National Health Action Party will reverse the Heath and Social Care Act 2012, reinstate the NHS as the preferred provider of healthcare and remove the requirement to tender out contracts to the private sector.
1. McKinsey & Co 2009: Achieving world class productivity in the NHS: Detailing the size of the opportunity
118 Health -NHS Xmas Number 1 - Download the Song
Updated: 09 Dec 2013

Make the NHS the Xmas Number 1

An NHS tribute song mash-up of Coldplay and Simon &

Garfunkel is being released tomorrow (Monday December 9th)

and is in the running to be the Xmas Number 1.

The song, “A Bridge over You”, is sung by doctors and nurses

in the Lewisham and Greenwich NHS Trust Choir. The choir is

based at Lewisham Hospital which recently won a high court

victory over Jeremy Hunt, preventing the downgrading of the

hospital’s A&E and maternity units.

Dr Louise Irvine, of the National Health Action Party and chair

of the Save Lewisham Campaign said:

“Lewisham and Greenwich Hospital Trust choir’s poignant song

“A Bridge Over You” is not only a beautiful and moving song

but a wonderful celebration of the NHS and the incredible work

of NHS staff.”

“I urge all those who support the NHS to buy this single. What

better tribute to our NHS, and what better way of

demonstrating how much we value our NHS, than to make this

the Christmas number one.”

The mash-up of Bridge Over Troubled Water and Fix You is

accompanied by an emotional video featuring patients, doctors

and nurses.

All profits from the song will be going to charity – to Macmillan

Cancer Support and local health care charities.

The NHS Choir appeared on Gareth Malone’s TV show “Sing

While You Work”.

You can watch the video of the song at:


Please download the song  – and help it reach number one.

119 Health - Hunger in Britain - has become a Public Health Emergency
Updated: 05 Dec 2013

Hunger has reached the level of a ‘public health emergency’ in Britain as a result of austerity and welfare cuts,  

reports the i this morning.

The comments come from doctors and academics writing in the BMJ, who claim the surge in people requiring

emergency food aid, a decrease in the average amount of calories consumed and doubling in the number of

malnutrition cases seen in English hospitals ‘are all signs of a public health emergency that could go

unrecognised until it is too late to take preventative action’

120 Healthy - Professor Hawking warn's against a two tier NHS
Updated: 05 Dec 2013

Statement from co-leader of National Health Action Party,

Dr Clive Peedell on Professor Stephen Hawking’s warning against the

creation of a 2-tier NHS


December 2, 2013 | Posted in News


 “Professor Hawking is right to highlight the risks of increasing commercialisation and privatisation of the NHS.

“The NHS was built on the principles of public provision of care so that all citizens had equal access to

comprehensive healthcare, free at the point of use. Yet this Government is intent on rolling back those principles

and dismantling the NHS as a public service by increasingly privatising and commercialising our healthcare


“They have no democratic mandate for such changes and have ignored public and professional opinion. That is

why we need the National Health Action Party to publicly hold them to account at the next election.”

121 Health- NHS Privatisation - The Vote Loser
Updated: 05 Dec 2013

Poll shows growing disaffection over private healthcare providers

Public opposition to non-NHS providers used by Labour and BMA to claim private companies have fragmented patient care
NHS logo
Public view of non-NHS provision of healthcare services is hardening. Photograph: Dominic Lipinski/PA

The public's attitude has hardened against private providers running healthcare services, a poll has found.

When asked last month whether they agreed with the statement: "as long as health services are free of charge, it

doesn't matter to me whether they are provided by the NHS or a private company", 47% of people said they

disagreed – up from 36% in February 2011. The Ipsos Mori poll for King's College London found the proportion of

people agreeing with the statement had barely changed over the same period, rising from 41% to 42%.

The results were seized upon by Labour and the British Medical Association, with both claiming that use of

private providers had led to fragmentation of patient care.

Dr Mark Porter, chair of the BMA council, said the consistency and quality of care had been adversely affected. "It

has created a shift from an ethos of co-operation to one of competition in the NHS, with providers picking and

choosing what services they can provide at a profit," he said. "Given this, and as the true effects of the NHS

reforms becoming more apparent, it's not surprising that people are increasingly averse to commercial

companies, whose ultimate aim is to turn a profit, operating in our NHS."

Jamie Reed MP, Labour's shadow health minister, said: "People can now see what David Cameron's privatisation

plans have done to the NHS. The next Labour government will repeal Cameron's Health and Social Care Act and

put the right values – collaboration, not competition – back at the heart of the NHS."

The poll showed that people were much more likely to be amenable to healthcare services being delivered by an

external provider if it was a charity or voluntary organisation (54% agreed it would not matter in this case) rather

than a private company.

The slice of the NHS's £100bn a year budget going to non-NHS providers rose from £5.6bn in 2006-07 to an

estimated £8.7bn in 2011-12, according to a study by the Institute of Fiscal Studies and Nuffield Trust health


A department of health spokeswoman said: "The crucial thing is that patients get the best possible services on

the NHS, free to all who need them.

"Other providers, whether they are from the private sector or from a charity, have to comply with exactly the same

quality and safety standards as any NHS provider."

Ipsos Mori interviewed a representative sample of 1,009 adults in Great Britain aged 18 and over by telephone

between 12 and 14 October.

122 Health - NHS Privatisation-Weasel Words from Lansley
Updated: 05 Dec 2013

Lansley denies any rise in NHS private sector contracts

3 December 2013 | By


The number of private sector contracts in the NHS has ‘not increased overall’ since the last election, former health

secretary Andrew Lansley has claimed.

The news comes as the first CCGs have begun putting local enhanced services out to tender through the ‘any

qualified provider’ route, with GP leaders warning this could mean that practices will be ‘unable to compete for

services they have always provided’.

Mr Lansley, who took on the role as leader of the House of Commons after being ousted as health secretary when

Jeremy Hunt was appointed last year, made the statement in a response to a written question by a Labour MP

who had questioned political donations made by private health companies in Parliament.

In response to Oldham East and Saddleworth MP Debbie Abrahams’ question, Mr Lansley said that all contracts

were administered ‘independently and fairly’ and that private provision was not rising in the NHS.

He said: ‘The number of private sector contracts in the NHS has not increased overall since the election.’

From April, under new competition regulations, services will have to be put out to tender - unless commissioners

can prove that they can only be provided by a single provider - in a bid to protect patient choice, although critics

have questioned whether AQP may decrease choice for patients if GP practices are unable to compete effectively

in large-scale tendering processes.

123 Health-A Lack of Basic Care Results in Care Home Deaths-Inspectors or the Lack are Responsible !
Updated: 03 Dec 2013

The Telegraph has revealed that severe dehydration has been a contributing factor in the deaths of more than

1,000 care home residents since 2003.

Responding to a Freedom of Information request, the Office of National Statistics found dehydration contributed

to the deaths of 1,158 care home residents, while a further 318 had died from starvation and 2,815 deaths were

linked to bed sores.

Care minister Norman Lamb said the findings were ‘entirely unacceptable’, adding that new CQC rules would

allow it to intervene more effectively, and ministers would act to make company directors personally responsible

for the care their organisation provides

124 Health - St Helier Hospital A&E Closure Opposed by all the Local GP's
Updated: 03 Dec 2013

GPs vote against closure of local A&E

29 November 2013 | By Christian Duffin

GPs in Surrey have unanimously voted to oppose the closure of A&E services and a maternity unit, following a

ballot organised by local MPs.

Thirty-two GPs in the Sutton area voted against plans to downgrade St Helier Hospital in Surrey, while no GPs came out in favour.

The plans are part of a major review carried out jointly by healthcare organisations including acute trusts, NHS

England local area teams and CCGs. It is investigating options for reconfiguring healthcare services across a

wide area of south and west London, called the Better Services Better Value Review.

This follows the case in south east London, where health secretary Jeremy Hunt’s decision to downgrade the

A&E at Lewisham Hospital was thrown out of the courts, partly because it failed to garner the support of GP


NHS Surrey Downs CCG – one of the CCGs in the region - withdrew its support for the reconfiguration of hospital

services this month following a separate ballot, while Sutton CCG withdrew support after a separate ballot of GPs

came out against the proposals.

The ballot was organised by local Lib Dem MPs Paul Burstow and Tom Brake. Mr Burstow is MP for Sutton,

Cheam and Worcester Park, while Mr Brake’s constituency is Carshalton and Wallington.

Around 90 GPs in the area did not take part in the vote, but Mr Burstow argues that this is partly because some

believed the review plans were on hold following NHS Surrey Downs CCG’s decision.

The consortium behind the review argue that it wants to develop a system allowing patients to experience ‘a

seamless service between different part of the system and to get things right first time more often’.

Dr Brendan Hudson, chairman of Sutton CCG said the CCGs in south west London, told : ‘The BSBV pre-

consultation business case is now invalid and the options put forward are not going to be put to a public

consultation so the MP survey result is not surprising.

125 Health- Whole Patient Care includes access to one's records
Updated: 02 Dec 2013

NHS patients should have right to see records online, says Andy Burnham

Shadow health secretary calls for new patient rights to be added to NHS constitution,
including being cared for at home
Andy Burnham
Andy Burnham has called for 'whole-person care', uniting health and social care and mental health services.
Photograph: Stefan Rousseau/PA

The NHS constitution needs to be expanded to give patients new rights, including a right to see their medical

records online and to be cared for in the home if it is safe, Andy Burnham, the shadow health secretary, has said.

He said the rights would help rebuild the NHS to better provide integrated care which blends health, social care

and mental health services.

"We have to make whole-person care a reality," he told the Guardian, adding he did not believe such a goal was

possible under the coalition's NHS reforms. He predicted his vision of whole-person care would be the dividing

line between parties at the election. "You cannot put the patients and the individual at the heart of the fragmented

system," he said.

Burnham was responding to a pamphlet by the Institute for Public Policy Research thinktank calling for an

integration of health and social care including an alignment of incentives. The pamphlet warns: "The current NHS

system of paying hospitals for activity and paying community-based services under a block contract creates a

financial incentive to treat as many people as possible in hospital and as few as possible in the community."

It also proposes that health and wellbeing boards take responsibility for high-level decisions signing off

investments across health and social care, starting with spending on older people and people with long-term

conditions. The incentive to treat patients in hospitals should be removed by linking payments for more

integrated providers to the outcomes they deliver, rather than paying individual providers for the activities they


The simple guarantees, or rights, would promote the benefits of whole-person care, Burnham believes. He


Each patient should have a single health and care co-ordinator, not necessarily of a clinical background, with authority to get things done. Burnham said: "A single point of contact for patients would remove one of the single greatest frustrations in the NHS."

• Online access to personal health and care records with an ability to share these electronically, sweeping aside some of the data protection rules that prevent co-ordination between organisations. The patients would have a clear right to own their own records.

• A personalised care plan covering health and social care, so care needs are tailored to personal circumstances, and not restricted by service boundaries.

• Access to other people with the same condition who can provide peer support.

The current NHS constitution includes a right to be treated within 18 weeks, the right to choose a hospital, the

right to view personal health records and the right to have a complaint addressed within three days.

Burham has been talking about whole-person care for over a year, but insisted the plans need not cost extra

money. He said: "We know that 30% of beds occupied in the NHS are occupied in an inappropriate way either

because they need not have been admitted or they have no system of care if they go home."

Burnham said he was anxious that whole-person care should not result in another major reorganisation of the


126 Health -The link between obesity and dementia is becoming hard to deny
Updated: 29 Nov 2013

Are Alzheimer's and diabetes the same disease?



The link between obesity and dementia is becoming hard to deny

Editorial: "If diabetes causes Alzheimer's, we can beat it"

HAVING type 2 diabetes may mean you are already on the path to Alzheimer's. This startling claim comes from a

study linking the two diseases more intimately than ever before. There is some good news: the same research

also offers a way to reverse memory problems associated with diabetes – albeit in rats – which may hint at a new

treatment for Alzheimer's.

"Perhaps you should use Alzheimer's drugs at the diabetes stage to prevent cognitive impairment in the first

place," says Ewan McNay from the University at Albany in New York.

Alzheimer's cost the US $130 billion in 2011 alone. One of the biggest risk factors is having type 2 diabetes. This

kind of diabetes occurs when liver, muscle and fat cells stop responding efficiently to insulin, the hormone that

tells them to absorb glucose from the blood. The illness is usually triggered by eating too many sugary and high-

fat foods that cause insulin to spike, desensitising cells to its presence. As well as causing obesity, insulin

resistance can also lead to cognitive problems such as memory loss and confusion.

In 2005, a study by Susanne de la Monte's group at Brown University in Providence, Rhode Island, identified a

reason why people with type 2 diabetes had a higher risk of developing Alzheimer's. In this kind of dementia, the

hippocampus, a part of the brain involved in learning and memory, seemed to be insensitive to insulin. Not only

could your liver, muscle and fat cells be "diabetic" but so it seemed, could your brain.

Feeding animals a diet designed to give them type 2 diabetes leaves their brains riddled with insoluble plaques of

a protein called beta-amyloid – one of the calling cards of Alzheimer's. We also know that insulin plays a key role

in memory. Taken together, the findings suggest that Alzheimer's might be caused by a type of brain diabetes.

If that is the case, the memory problems that often accompany type 2 diabetes may in fact be early-stage

Alzheimer's rather than mere cognitive decline.

Although there is no definitive consensus on the exact causes of Alzheimer's, we do know that brains get

clogged with beta-amyloid plaques. One idea gaining ground is that it is not the plaques themselves that cause

the symptoms, but their precursors – small, soluble clumps of beta-amyloid called oligomersMovie Camera. The insoluble

plaques could actually be the brain's way of trying to isolate the toxic oligomers.

To investigate whether beta-amyloid might also be a cause of cognitive decline in type 2 diabetes, McNay,

Danielle Osborne and their colleagues fed 20 rats a high-fat diet to give them type 2 diabetes. These rats, and

another 20 on a healthy diet, were then trained to associate a dark cage with an electric shock. Whenever the rats

were returned to this dark cage, they froze in fear – measuring how long they stayed still is a standard way of

inferring how good their memory is.

Memory boost

As expected, the diabetic rats had weaker memories than the healthy ones – they froze in the dark for less than

half the time of their healthy counterparts. To figure out whether this was due to the beta-amyloid plaques or the

soluble precursors, Pete Tessier at the Rensselaer Polytechnic Institute in Troy, New York, engineered fragments

of antibodies that disrupt the action of one or the other.

When the plaque-disrupting antibodies were injected into diabetic rats, no change was seen. However, after

receiving antibodies specific for oligomers, they froze for just as long as the healthy rats. "The cognitive deficit

brought on by their diabetes is entirely reversed," says McNay.

Until now, the standard explanation for the cognitive decline associated with type 2 diabetes is that it is a result of

insulin signalling gone awry. One effect is to reduce the hippocampus's ability to transport energy, or glucose, to

neurons during a cognitive task. The fact that amyloid builds up in the brains of diabetic animals – and also in

people, was seen as an unhappy consequence of insulin imbalance.

These experiments suggest oligomers are actually to blame. Previous work from other groups has shown that

the same enzymes break down both insulin and beta-amyloid oligomers – and that the oligomers prevent insulin

binding to its receptors in the hippocampus. So when there is too much insulin around – as there is in someone

with type 2 diabetes – those enzymes are working flat out to break it down. This preferential treatment of insulin

leaves the oligomers to form clumps, which then keep insulin from its receptors, causing a vicious spiral of

impaired brain insulin signalling coupled with cognitive decline.

"We think that our treatment soaked up the amyloid oligomers, so that they could no longer block insulin from

binding to its receptors," says McNay, who presented the preliminary data at the Society for Neuroscience

meeting in San Diego earlier this month. "Everyone thinks of amyloid build-up as a consequence of the events

that cause cognitive impairment in diabetes, but we're saying it's actually a cause." It means, he says, that the

cognitive decline seen in type 2 diabetes may be thought of as early-stage Alzheimer's.

It's a bold claim, and if correct, one with big implications. Given that the number of people with type 2 diabetes is

expected to jump from 382 million now to 592 million by 2035, we might expect to see a similar trajectory for

associated Alzheimer's (New Scientist, 1 September 2012). If beta-amyloid build-up can be stopped in people with

type 2 diabetes and their cognitive impairment reversed – perhaps many of them will never progress to


For the last few years, organisations like the UK's Alzheimer's Society have been backing clinical trials to look for  

diabetes drugs that may have an effect on Alzheimer's patients. "We're saying that this may be not the only way

to think about it," says McNay.

The next step is to repeat the work, and if the results are corroborated, start looking for a drug that would do the

same thing as the group's modified antibodies, without having to inject the drug directly into the hippocampus. It

will also be necessary to work out just how much amyloid the brain can safely do without, since low levels are

important for memory formation.

"The work opens the door to inoculating the most at risk group, people with type 2 diabetes," says Tres

Thompson of the University of Texas at Dallas. There have been plenty of failed attempts to use antibodies to

relieve Alzheimer's in the past. "But these were all in people with advanced stages of the disease. Vaccinating

people much earlier could give better results."

Some researchers are still wary of focusing on beta-amyloid when 20 years of working on a treatment for that

particular aspect of the disease has come to nothing. "I think it's brilliant work – he's using new techniques that

seem to be working, but it's still very beta-centric," says Olivier Thibault at the University of Kentucky in

Lexington. He cautiously agrees that McNay's data do seem to suggest a causative link between beta-amyloid

and impaired insulin signalling but says the group needs to factor in the effect of ageing – both diabetes and

Alzheimer's become more likely as we grow older.

Jessica Smith, spokeswoman for the UK Alzheimer's Society in London welcomes the work. "We need to tease

out the difference between those with type 2 diabetes who develop Alzheimer's and those who don't. If people

were developing the signs earlier than we thought, then perhaps we can intervene earlier, rather than waiting

until they have full clinical Alzheimer's."

Of course, there is another solution to staving off type 2 diabetes and any consequential Alzheimer's that

requires no drugs at all. "Go to the gym and eat fewer twinkies," says McNay.

This article appeared in print under the headline "Eating your way to dementia"

127 Health - Winter Deaths -Social Isolation & the Scrooges of Westminster
Updated: 27 Nov 2013

Energy row erupts as winter deaths spiral 29 per cent to four year high of



Campaigners say Government should be "ashamed" as official figures reveal thousands of over 75 year-olds

perished in Britain during the coldest winter for nearly 50 years

The ONS said temperatures in March were the lowest on record since 1962

10:36AM GMT 26 Nov 2013

Prime Minister David Cameron was tonight urged to spend hundreds of millions of pounds insulating homes

across the UK as official figures revealed 31,000 people died because of the freezing weather last winter.

Official figures revealed so-called "excess winter deaths" rose 29 per cent in 2012-2013 to their highest level for

four years.

Campaigners said Ministers talking about cutting green levies should be "ashamed" at the figure, which is worse

than Sweden and Finland.

More than 80 per cent of the 31,000 were pensioners aged over 75, who suffered from influenza as temperatures in

March fell to levels not seen since 1962.

The Office for National Statistics calculates excess winter deaths by comparing the death rates from non-winter

months to those that occur between December and March.

Overall in March, 1,582 died every single day - 14 per cent higher than average.

Dot Gibson, national secretary of the National Pensioners Convention, Britain's biggest pensioner organisation,

said: "Making sure older people have got a well insulated warm home and the income to pay the fuel bills isn't

green crap. It's what a decent society should do.

"How can colder Scandinavian countries avoid this annual toll while we simply wring our hands? The Government

needs to roll out a more effective programme to insulate homes, build more sustainable properties for older

people, raise the winter fuel allowance and tackle the exessive profits of the Big Six energy companies."

Ed Matthew of the Energy Bill Revolution campaign group said it was mystifying that Germany could "retro fit" a

quarter of a million homes a year while in the UK only 219 homes had been insulated under the Government's

'Green Deal'.

He added the Treasury collected £1.5 billion a year from carbon taxes on power station's which could be used to

fund a wider progrmme.

He told The Daily Telegraph: "We're spending £50 billion on HS2 but we can't spend the money to properly

insulate homes? We should be ashamed."

The figures came a day after Ofgem, the energy industry regulator, said profits at residential supply arms of the Big

Six energy suppliers leapt 75 per cent last year after a near 20 per cent increase in gas and electricity prices.

British Gas earlier this year said it had made more than money expected last winter as customers were forced to

turn up the heating.

The PM's official spokesman said excess deaths rose across Europe last winter and the Government had a "range

of measures" to support vulnerable Britons - such as winter fuel payments. The spokesman added: "This

Government that has maintained the higher level of cold weather payment. These are just some of the things we do

in this area."

But Luciana Berger, Labour's shadow public health minister, claimed that around a third of the excess deaths

were caused by people living in homes that are too cold.

She said: "This winter, David Cameron's failure to stand up to the energy companies will leave too many people

forced to choose between heating and eating.

"Ministers need to take urgent action and back Labour's plans to freeze energy bills."

Campaigners said they feared more people may die this winter, following the recent round of inflation busting price

hikes from the Big Six. Anne Robinson at price comparison website uSwitch said thousands more elderly were

suffering from hypothermia.

A spokesman for Energy UK, the trade association for the energy industry, said: "No one should be afraid to put

their heating on this winter.

"Help is available so contact your energy company if you are worried or call the Home Heat Helpline." He added:

"Energy companies will be spending over £1 billion this year to help support customers in difficulty, especially the

elderly and those on certain benefits."

128 Health - Millions face "Eat or Heat"
Updated: 27 Nov 2013

Millions face 'eat or heat' dilemma as energy bills soar

MILLIONS of households will be forced to ration their heating this winter as price hikes of up

to 10 per cent hit home, campaigners warned last night.

By: Nathan Rao

Published: Fri, October 11, 2013

Deaths of elderly people soar during cold weather

Energy giant SSE “opened the floodgates” by announcing a price rise of 8.2 per cent yesterday.

It will send gas and electricity bills rocketing by more than £100 – and there is expected to be a domino ­effect in the

next few days with other major suppliers also slapping hefty rises on the average dual fuel bill.

Pensioner groups said the ­elderly will be hardest hit, with many forced to decide whether to “eat or heat” as the

weather turns colder. Saskia ­Welman, the spokesperson of the National Federation of Occupational Pensioners,

said: “Any increase in energy prices could come at a huge cost to pensioners. We are extremely worried that

many poorer pensioners may have to make the decision  to ‘eat or heat’, which would have  catastrophic


She said deaths of elderly people soar during cold weather and fuel bill price rises would only “exacerbate an

already alarming problem”.

From November 15 7.3million SSE customers will pay an average of £1,465 a year for gas and electricity, a rise of

141 per cent since 2006.

Tory energy minister Michael Fallon last night called on consumers to boycott SSE and switch to one of its

cheaper rivals. He said: “I would encourage customers to see if they can switch to a cheaper tariff.”

But SSE blamed Government measures including green taxes and subsidising wind farms for the increase.

Will Morris of SSE said: “We’re sorry we have to do this. We’ve done as much as we can to keep prices down, but

buying wholesale energy in global markets, delivering it to customers’ homes, and Government-imposed levies

collected through bills – endorsed by all the major parties – all cost more than last year. We regret this will add to

pressures on household budgets, but there’s a lot we can do to help.”

The rise in energy prices is going to affect the old and the young this winter [GETTY - POSED]

We’re sorry we have to do this. We’ve done as much as we can to keep prices down, but buying wholesale energy

in global markets, delivering it to customers’ homes, and Government-imposed levies collected through bills –

endorsed by all the major parties –

Will Morris of SSE

MP John Robertson, who sits on the energy select committee, said: “It is disgraceful that SSE has decided to hike

prices again. This is nothing to do with wholesale costs, but ripping people off and growing their already inflated

profit margins.”

Energy Secretary Ed Davey played down the impact of Government green policies and levies.

Furious campaigners warned the rise has paved the way for British Gas, Scottish Power, npower, EDF Energy and

E.on, to follow suit.

Mark Todd, co-founder of energyhelpline.com, said an 8.2 per cent (£111) price rise across the board for all energy

firms would push the average gas and electricity bill to around £1,536.

Ann Robinson, director of consumer policy at uSwitch, said: “I am in shock at this crippling price rise which will

have dealt a massive blow to so many people.”

129 Health- It's Never Too Late To Start Exercising
Updated: 27 Nov 2013

It’s never too late to start exercising, say researchers who found even taking up exercise in your sixties will boost

your chance of ageing healthily.

As reported by the Telegraph, the study of around 3,500 people, average age 64, showed people who were already

active and remained consistently so over the eight-year study period were seven times as likely to be classed as a

‘healthy ager’ as those who remained inactive.

But even people who took up exercise during the study were three times as likely to age healthily as inactive


Reporting their findings in the British Journal of Sports Medicine, the researchers wrote: ‘This study supports

public health initiatives designed to engage older adults in physical activity, even those who are of advanced age.

130 Health - £150m for A&E this Winter but what about GP and Geriatrics Services ?
Updated: 27 Nov 2013

NHS managers pump a further £150m

more into emergency services this winter

25 November 2013 | By Christian Duffin


CCGs will receive an extra £150m from NHS England to help hospitals cope with winter pressures in A&E departments.

The money will be in addition to the £500m the Government committed to ‘at-risk’ A&Es in August, which will cover this winter and the following year. It will be up to individual CCGs will decide on how to spend their allocations after consultations within urgent care working groups, the partnerships between hospitals, community and primary care clinicians, an NHS England statement said.

Some CCGs are likely to spend the money on A&E departments themselves, while others could introduce ideas for cutting the numbers of unnecessary visits to A&E, the statement added.

It suggested that some regions could appoint specialists with responsibilities for minimising unnecessary admissions of older people living in care homes, while walk-in centres and pharmacists could extend their opening hours, it said.

NHS England deputy chief executive Dame Barbara Hakin said: ‘This year we started preparing for winter earlier and we are monitoring the situation with great care to see what more might need to be done.’

131 Health - Social Isolation recognised
Updated: 26 Nov 2013

The BBC reports that a five million pound charity scheme to provide lonely older people with 24-hour access to ‘friendship, information and advice’ has launched today.

‘The Silver Line’ is staffed by trained volunteers and aims to support people over 65 who live alone, which can cause serious physical and mental health problems – an earlier trial answered calls from 7,000 older people.

Care and Support Minister Norman Lamb said: “In our busy lives we too easily forget the thousands of older people who often go for days without seeing or speaking to anyone, or rely on the television for company.

“This service will help provide people with the companionship and support they deserve in their older years

132 Health- NHS Complaints are being Gagged
Updated: 17 Nov 2013

NHS complaints review 'will be rendered useless’

The NHS is braced for fresh criticism about the way it handles complaints from patients as safety

campaigners accuse the Government of “legitimising cover-ups” by deciding to limit a new proposed legal

duty of candour.

The NHS is braced for fresh criticism about the way it handles complaints from patients as safety campaigners accuse the Government of “legitimising cover-ups” by deciding to limit a new proposed legal duty of candour.
Ann Clwyd, one of the authors of the report that will call for changes so that complainants who seek the truth
about poor care are given help and truthful information about why care was compromised Photo: RII SCHROER
Laura Donnelly

By , Health Correspondent

8:10AM GMT 27 Oct 2013 

Tomorrow, an independent review commissioned by the Prime Minister in the wake of the Stafford Hospital

scandal will paint a damning picture of the way hospitals deal with the concerns of those who suffer poor care,

and those bereaved as a result of health service failings.

The report on complaint handling in the NHS by Ann Clwyd, a Labour MP who has described how her husband

“died like a battery hen” amid callous treatment from nurses, and by Prof Tricia Hart, one of the advisers to the

public inquiry into Stafford, will call for changes so that complainants who seek the truth about poor care are

given help and truthful information about why care was compromised.

However, patient safety campaigners say the changes will be undermined because ministers have decided to limit

the scope of a new legal duty of candour for hospitals, one of the key recommendations made by Robert Francis

QC, the chairman of the Stafford inquiry in his report in February.

Mr Francis said the duty should be placed on NHS trusts and also on individual staff, which would mean they

were legally obliged to disclose incidents which cause harm, and could be prosecuted for failing to do so.

So far ministers had agreed to introduce such laws covering organisations, but resisted doing so for individuals,

saying they feared it could increase a “blame culture” in the NHS. However, it has now emerged that the

Government intends to limit the scope of the duty on NHS trusts – so that it would only cover incidents which

caused deaths or the most severe cases of harm.

“The Government’s plan would in effect legitimise cover-ups of all but the most severe incidents of harm.”

The disclosure was made by Earl Howe, a health minister, during a debate in the House of Lords. He said

tomorrow’s recommendations “would be rendered useless” if the duty was restricted to only the most serious

cases. This would exclude more than 80,000 incidents of “moderate” harm – any disability from which a person


Mr Walsh said: “A mistake could be made in surgery which leads to you being off work for a year as a result, you

losing your career and being unable to care for dependants during that time, but if it was believed you would

eventually recover, this would be defined as 'moderate harm’ and the mistake would not have to be disclosed to

you.” The NHS has already placed a duty of candour in contracts between hospitals and groups of GPs who hold

health service budgets, which say there should be disclosure of both moderate and serious incidents, but without

legal force, there is little evidence it has changed practices, experts said.

The Action against Medical Accidents charity said that bringing in laws that reduced this scope would “take us

back to the dark ages”.

Mrs Clwyd, chairman of an all-party Parliamentary group on human rights, was asked to lead the review of NHS

complaints after she gave a devastating account of her husband’s treatment in the days before his death last year.

The MP wept in the Commons last December as she described the experiences, asking David Cameron what he

intended to do about nurses who fail to show compassion. She said her husband, Owen Roberts, who suffered

from multiple sclerosis, died because of lack of care and attention, resulting in hospital-induced pneumonia, with

nurses at the University Hospital of Wales, in Cardiff, ignoring pleas for help.

Mrs Clwyd later said: “My husband died like a battery hen. He was 6ft 2 ins. He was cramped, squashed up

against the iron bars of the bed with an oxygen mask that didn’t fit his face. His eye was infected.” When she

begged for him to be moved to intensive care she was brushed aside, she said, by nurses who said there were

“lots of people worse than him”.

Mrs Clwyd said that in the first four months of the review, which began in February, she received more than 2,500

letters and emails from patients, relatives and NHS staff containing “shocking allegations of mistreatment in our


133 Health-Winter is Coming - Is the NHS Ready Doctor or "Crippled" ?
Updated: 16 Nov 2013

The Daily Express meanwhile says senior doctors are warning the NHS could be ‘crippled’ by what is predicted to

be the worse winter for decades. With temperatures as low as -15 degrees, they say it could lead to a crisis on

over-stretched wards and are calling for frail and elderly people to go to their GP or pharmacy at ‘the first sign of

illness’ instead of waiting until they need urgent treatment, particularly for breathing problems.

Professor Mike Morgan, of NHS England, said: ‘My message to the public is simple: look after yourself this winter.

If you know someone who is frail or elderly or has an existing health problem and they are feeling unwell,

encourage them to seek early advice, go to their local pharmacy or GP before one problem leads to another and

they end up in hospital.’

134 Health- Named Doctors for the Elderly -What, No Second Opinion ?
Updated: 16 Nov 2013

“It was this government which introduced intrusive tick-box bureaucracy asking silly, inappropriate questions

 which distracted us from proper care. Finally they’ve seen sense and are letting us get on with caring for our

patients which is all we want to do.

“Giving elderly patients designated GPs is merely a scheme that will formalise and structure what already goes

on, so it’s really nothing new.

“There is no new money on offer and it certainly won’t be feasible to provide 24/7 care . These measures don’t

address the real issues, which are the chronic underfunding of GPs, the lack of beds, and the cuts to social

services and community services. It’s hard to believe, but only 5 new district nurses qualified in London this year.

 We won’t solve the A&E crisis unless there is massive investment in doctors, nurses and community services

and more beds. Many elderly patients have nowhere to go and are stuck in hospital. This had to change.”

Co-leader of the NHA Party, Dr Richard Taylor said:

“Jeremy Hunt’s suggestion of a named GP for everyone over 75 would risk taking GPs away from more deserving

really sick people in younger age groups. But maybe he thinks young people are less likely to vote.

“The Health Secretary should let doctors and nurses get on with their job of looking after patients to the best of

their abilities. He should be supporting those GPs and nurses in areas where they have effective groups working

in the community to review all patients potentially needing hospital admission to decide how they can be looked

after in the community rather than in hospital. In my area, Wyre Forest, such a group runs a ‘Virtual Ward’ out of

hospital that is reducing emergency admissions.

“The Health Secretary should also cancel the tendering process for the 111 phone number to restore it to its

original status of a uniform, national service that would inform patients requiring urgent care exactly which local

health facility is appropriate for them. If this was working properly it would help to reduce unnecessary hospital


“Lastly the Health Secretary should launch a simple, summary care record for every patient that would be

available on a secure internet service for doctors. This is used with great success in Canada and other countries

and shows on a single computer screen demographics and basic details of the patient’s diagnoses, past and

present treatments, allergies and covers everything an emergency doctor needs to know about a patient who is

being seen in an emergency situation with no medical records available”.


135 Health- The Keogh Mortality Review - Hospitals (The Management) listed are under review 142
136 Health - The Keogh Review on the NHS
Updated: 14 Nov 2013

Keogh Review is years overdue and leaves open door to hospital closures

Posted in Press Releases |
Statement from Dr Richard Taylor, co-leader of National Health Action Party on Keogh Review

“This Keogh review is years overdue. I do find it absolutely frustrating and exasperating that I told the House of
Commons exactly what needed doing over 6 years ago and now much of the long-awaited Keogh report lays out
precisely my own proposals regarding the formal classification of emergency services.

“The spiralling crisis in A+E could have been averted had both Labour and coalition governments taken action

years ago”.

“I am concerned though that this government will use the 2 tier A+E classification as an excuse for downgrading

or reconfiguring hundreds of local A+E departments. Keogh has left open the door to local hospital closures.

“We must impose an immediate moratorium on Accident & Emergency departments and hospital closures and

reconfigurations unless there are evidence-based, clinical reasons which have the support of the local population

and the affected professional staff.”

“We are very alarmed at Jeremy Hunt’s attempts to steamroller through hospital closures with a new clause to the

Care Bill. This must be vigorously opposed.

“Keogh has also called for the beefing up of the 111 service and acknowledged there have been problems with it. I

think Jeremy Hunt owes an apology to the thousands of NHS patients who’ve had poor care as a result of the 111

chaos. This should never have been put out to tender with private providers. When I and others, during the last

Parliament, put forward the idea for the 111 number, it was to be a standardised, uniform, nationally provided

service. The coalition’s Health Act made this impossible. This is another disaster of the coalition’s rush to

damaging privatisation of our NHS.

“And Keogh hasn’t properly addressed the issue of improving access to GPs, which is one of the problems

fuelling the A+E crisis. We urgently need more funding for GPs to provide the same day access to primary care that

Keogh is calling for. Surely this would be one use for the year-end NHS underspends which currently are returned

to HM Treasury.”

137 Health - Save the NHS from Greedy Shareholders
Updated: 14 Nov 2013

The NHS future is in our hands

Thursday 14th Nov 2013

The creeping privatisation of the health service will lead to the siphoning of billions of taxpayers money to greedy



When the coalition came into power the NHS had the highest ever patient satisfaction rate. You have to ask

yourselves how it is possible that in just four years the NHS has been brought into life support. I am not a

gambling woman but I know that if the chances of getting run over are 50/50 I wouldn't cross the road.

Yet one in ten senior NHS managers rated their chances of meeting the £20bn so called "efficiency savings" as

50/50 according to a recent survey by the King's Fund.

More than half of managers surveyed identified a high or very high risk of missing the cuts target and nearly a third

reported a detriment to patient care over the past year.

GPs have warned of impending chaos as they struggle to manage on reduced budgets and A&E departments

have given notice of a winter crisis. To make matters worse the government is lining up walk-in centres for closure.

The crisis in health care funding in England is exacerbated by the costly changes introduced by the Health and

Social Care Act, changes that ironically open the floodgates to private sector companies who are accountable to

shareholders and boards intent on making profits.

Unite, together with War on Want and Change to Win, exposed the level of tax evasion by one private sector player

that benefits from NHS income.

In 2007, Alliance Boots left the FTSE 100, went private and is now based in Switzerland. Our research shows that

over six years Alliance Boots has avoided paying £1bn in taxes - despite drawing an estimated 40 per cent of its

British revenue from services it supplies to the NHS.

To understand the scale of what we lost the £1bn equates to more than two years prescription charges for all of

England or 185,000 hip replacements.

Not one of us voted for such dismantling of our NHS that seeks to replace cooperation with competition,

fragmenting services and pitching one health provider against another.

Our NHS is being frogmarched toward the US model, which squanders a huge percentage of expenditure on

complex administration.

Labour in opposition has pledged to repeal the Health and Social Care Act and Unite wants Labour to go further.

There is no place in Britain for a "market" in health care, internal or external.

The vision of Aneurin Bevan was a national health service. Bevan knew that a health service for just the poorest in

society would be a poor health service. So the NHS was established on the principle that "Everyone - rich or poor,

man, woman or child - can use any part of it."

It is this vision and the post-war Labour government's bold economic policy that tackled disease and health

inequalities, built decent homes, schools and universities intended for the many not just the few. And all achieved

with a bigger debt and deficit than Britain faces today following the global economic crisis triggered by casino

style banking in 2008.

That is why Unite is calling for a resurgence of the "Spirit of '45."

It is time to take sides. Unite is for an alternative to austerity that has resulted in health and economic inequalities

not seen in Britain since the depression of the 1930s.

The necessity to defend our NHS in this its 65th year has never been more urgent. The TUC mobilisation that

circled the Tories in Manchester was great but we need more action. Unite has pledged to defend the NHS by any

means possible.

The campaign to defend health services in Lewisham showed what can be achieved when we pull together, trade

unions alongside community organisations.

Gail Cartmail, Assistant General Secretary Unite

138 Health-Cut out Meat to Avoid Diabetes says French Study
Updated: 13 Nov 2013


Sweet Tooth Talking French ?



Cutting out meat is the new way to avoid developing diabetes, says the Daily Mail

The latest advice comes from research showing meat lovers have a higher chance of diabetes even if they eat lots

of fruit and veg, according to the paper.

The study in women showed those who ate the most acid-producing foods – including meat, cheese

and fish – had a 50% higher odds of diabetes than those who ate the least. The effect wasn’t completely

compensated by fruit and vegetables intake – and was surprisingly strongest for slim women.

The French study authors said: ‘From a public health perspective, dietary recommendations should not only

incriminate specific food groups but also include recommendations on the overall quality of the diet, notably to

maintain an adequate acid balance.’

139 Health- 20,000 UK Nursing Shortage due to Government Cuts
Updated: 13 Nov 2013

Front page news on The Guardian this morning is the claim that patients are being put at risk because NHS

hospitals are functioning with 20,000 fewer nurses than they need across England. According to Royal College of

Nursing chiefs, as many as one in six nursing posts at some hospitals are being kept vacant, as managers try to

meet the Whitehall-ordered drive to save £20 billion by 2015.

The figures come from responses to a Freedom of Information request from 61 out of 161 trusts, revealing an

average 6% vacancy rate.

The college’s report concludes understaffing on this scale ‘will have serious consequences for patient safety’

140 Health- A&E's fail to meet waiting time targets
Updated: 13 Nov 2013

Half of London’s A&Es fail to hit waiting targets half the time

12 November 2013 | By Caroline Price

  • More Resources Human and Financial should be put in community and Primary care .
    Primary care is serving 90% of service with only9% total Budget.
    Better Coordinated Links with social services 24hrs not 9 to 5 pm

Over half the capital’s major A&E departments failed to meet the four-hour wait target at least half the time over the

past year, a report has revealed.

The London Assembly report showed 12 out of 22 hospital trusts missed the Government target of 95% of

patients being seen within four hours for at least half the year.

Dr Onkar Sahota, chair of the London Assembly Health Committee, said the findings were ‘extremely worrying’

and called for NHS England to publish – immediately – plans to deal with winter pressures in London to ensure

they are adequate to deal with anticipated demand.

The report revealed six trusts missed the target at least 80% of the time and one – Barking, Havering and

Redbridge University Hospitals Trust – missed it every week.

Only one trust – Chelsea and Westminster – consistently met the target.

Dr Sahota said: ‘Across the capital, A&E departments are struggling to cope with demand and more than half of

trusts have failed to hit the Goverment’s target of dealing with people within four hours at least half the time.’

‘This is extremely worrying and as the winter sets in, with increased costs of heating, we believe emergency

health services will struggle even more and patients in need of urgent care of emergency care will not be seen

quickly enough.’

‘We immediately need to be given much more information on how hospitals and primary care are planning for the

coming months so we can judge if they are adequately prepared.’

According to the report, only 10 trusts in London have been earmarked to receive funding as part of the  

Government’s £500m cash injection for A&E services nationally.

These 10 trusts –  eight of which missed the four-hour target at least half the year – are set to receive £55.4m

between them, while the other four trusts that missed the target at least 50% of the time will not be getting any

additional money.

However, the report stated: ‘Despite assurances to us from NHS England that the plans are now in place and

would be published, they are largely not easily accessible or published at all, so it is not possible to judge whether

they are likely to be adequate to enable A&Es to cope this winter.’

The report also calls for a longer term plan for ‘radical change’, including reform of primary care – which may

involve ‘improving the service GPs can provide’.

The health committee said ‘there is broad agreement that more needs to be done through primary care service –

i.e., GPs – and that reform to primary care in London is crucial for the future of A&E’.

However, RCGP chair Dr Clare Gerada – who is about to take over as NHS England’s lead on primary care reform

in the capital – warned over further extra funds being given to A&E at the expense of primary care.

Dr Gerada said: ‘If we pour money to deal with this winter’s crisis into propping up urgent care or the emergency

departments, even if we get some more investment in general practice, we are going to see a catastrophe in

general practice.’

She said GPs ‘should be the front door of the NHS’ and it would be better to invest in increasing the capacity of

GPs, district nurses and ‘wraparound services’ for elderly and young people instead of A&E.

The committee said it will be addressing changes to primary care – including steps to reduce pressure on A&E –

‘as a priority’, beginning at its next meeting in January

141 Health- Alcohol - Yes or No or Maybe ?
Updated: 12 Nov 2013

Studies claiming health benefits of alcohol may have overestimated effect,

say UK researchers

Posted by: Clinical Blog Fri, 8 Nov 2013

The health benefits of alcohol may have been overestimated in trials because non-drinkers are more likely to have

a long-standing illness, say UK researchers.

Two birth cohorts – one from 1958 and the other from 1970 – were used to identify people who had a long-standing

illness in adulthood.

The researchers from University College London found that having persistent ill health made you 4.5 times more

likely to be a lifetime abstainer from alcohol at 33 years and over 7 times more likely at 42 years.

They conclude that studies comparing the health outcomes of moderate drinkers to lifetime abstainers that do not

account for pre-existing poor health may overestimate the better health outcomes from moderate alcohol


142 Health -Take Up Thy Bed and Walk-Say Labour ( Weather Permitting)
Updated: 12 Nov 2013

Labour considers ‘ambitious’ physical activity targets

8 November 2013 | By Caroline Price 

Labour is looking at introducing an ‘ambitious’ public health target to get half the population taking recommended

levels of exercise, in plans being developed for the next election manifesto, shadow health secretary Andy Burnham has said.

Pulse understands the plans are ‘not fully worked through’, but signal Mr Burnham’s intention to devise an ambitious target on physical activity in time for the next election.

Mr Burnham’s comments were made at a summit on physical activity in London yesterday.

According to the Daily Telegraph, Mr Burnham said increasing physical activity levels will be the ‘cornerstone’ of public health policy if Labour is elected, centred on a new target to get half of Britain taking enough exercise by 2025.

Labour health advisors confirmed to Pulse they were ‘looking at’ the target, based on exercise levels recommended by the chief medical officer, but said it was not yet in the manifesto.

A spokesperson said: ‘It’s not yet a manifesto commitment – it’s not fully worked through. It’s to signal [Mr Burnham’s] intention to come up with some kind of ambitious plan like that in time for the manifesto.

‘We need to do more research and convince people that should be in it. But we do want something that ambitious as a public health physical activity target in there, but whether it is exactly at that level is not decided yet.

143 Health - Salmon leap ahead with their Vitamins
Updated: 09 Nov 2013

The lifter's lunch

Try this muscle-building meal after your next heavy lifting session
the lifter s lunch

The ingredients

200g salmon, cut into chunks
Handful of rice, cooked
1 small carrot, diced
½ sweet potato, diced
Handful of peas
Light soy sauce

The method

Toss all the ingredients into a hot wok and stir-fry for 5-8 minutes to get a bowl of post-workout nutrition at its most complete.

A study presented at the International Society of Sports Nutrition found a combination of 1-5g of creatine, 30-40g of protein, 50-100g of carbs and up to 30g of fat was the best mix of nutrients for creating muscle growth when eaten directly after a brawn-building workout. The salmon gives you the protein, creatine and fat, while the potato, rice and veggies take care of the refuelling carbs

144 Health- Mackerel Rich in Omega 3
Updated: 09 Nov 2013

Protein-packed gourmet recipes

Chicken and mackerel with a courgette twist
protein packed gourmet recipes

Cook to impress

January’s unwelcome combination of extreme weather and extreme recession means the dawn of the new decade isn’t the greatest time to be a foody: even if you make it to that fancy new restaurant, your budget certainly won’t stretch to the specials board. Luckily, spice-meister Schwartz has come up with some rather more appealing contemporary combos. Hole yourself up in a cosy kitchen and attempt these two culinary challenges involving your favourite proteins and the versatile courgette. You're sure to impress your partner with the results far more than your signature “special” spag bol.

Courgette and mackerel salad with mint

“As well as being great for protein, mackerel is rich in omega-3 essential fatty acids, which reduce your risk of heart disease and strokes, as well as being essential for healthy brain function,” says nutritionist Carina Norris. Additionally, the courgettes are a good source of potassium, folate, and vitamins A and C. “And using olive oil rather than a saturated fat (like butter) means the dressing is good for your heart,” adds Norris.

The ingredients (serves 4)
4 medium courgettes
Zest and juice of 2 limes
2 tbs mint
2 tbs extra-virgin olive oil
250g (9oz) tin mackerel fillets, in oil
8-12 anchovy fillets
Extra-virgin olive oil
Ground white pepper
Sea salt

The method
1 Wash the courgettes and slice into ribbons, using a peeler. Set aside in a salad bowl.
2 Mix the zest of 1 lime, reserving the remaining zest for garnish, and the juice of 2 limes together in a small bowl. Stir in the mint, drizzle in the olive oil and season to taste. Add the courgette ribbons and toss to coat evenly.
3 Place the courgette ribbons onto individual plates or bowls. Flake the mackerel and add to the courgettes. Place 2-3 anchovy fillets on each salad, according to preference.
4 Drizzle with any remaining lime dressing and garnish with the remaining lime zest.

Herbes de Provence-marinated chicken with chorizo salsa and courgette purée

“Chicken is a great low-fat protein source and tomatoes are good for vitamin C and lycopene,” says Norris. “Vitamin C is an immune-boosting nutrient, so this is a good recipe for winter.” It’s also fairly high in fat – so try it on your designated no-holds-barred day or tweak it with Norris’ fat-reducing suggestions (see below).

The ingredients (serves 4)

For the chicken
1 tbs Schwartz Herbes de Provence
3 tsp Schwartz Easy Garlic
75ml (3fl oz) extra-virgin olive oil
Zest of 1 lemon
4 boneless, skinless chicken breasts

For the courgette purée
2 tbs olive oil
1 tsp Schwartz easy garlic
3 courgettes, sliced
1 tbs Parmesan cheese, grated
1 tbs butter

For the chorizo salsa
2 tbs olive oil
2 shallots, minced
2 tsp Schwartz Easy Garlic
100g (4oz) chorizo, diced
1 large courgette, diced
4 medium-sized plum tomatoes, seeds removed and diced
½ bunch fresh coriander leaf
Sea salt and black pepper

The method

1 Combine all the ingredients for the marinade in a bowl, add the chicken breasts and coat with the marinade. Cover with cling film and allow to marinade in the refrigerator for 4 hours or, for best results, overnight.
2 For the courgette purée, heat the oil in a frying pan. Add the garlic and courgettes and fry for 4-5 minutes, season to taste. Place in a blender and purée until smooth. Add the Parmesan cheese and butter and blend for a couple of seconds. Refrigerate until ready to use.
3 When ready to cook the chicken, pre-heat the oven to 200°C, 400°F Gas Mark 6. Transfer the chicken to a baking tray and cook for 20-25 minutes or until the chicken is cooked through.
4 For the salsa, heat the olive oil in a frying pan, add the shallots and fry for 2 minutes over a medium-heat. Add the garlic, chorizo, courgette and tomatoes, cook for 4-5 minutes. Add the Coriander Leaf and season to taste.
5 To serve, place some of the purée in the middle of a warm plate, slice the chicken and place on top. Serve with a generous helping of the chorizo salsa.

Some healthy tweaks
To make the recipe above slightly healthier, Norris advises the following:
1 For the chicken marinade, you only need a tablespoon of olive oil. 
2 Take the butter out of the courgette purée.
3 Chorizo is high in fat and salt so cut the quantity down to 50g.
4 Only use a single teaspoon of olive oil to fry the shallots in

145 Health - Pecs Pie and Peas for Extra Calories
Updated: 09 Nov 2013

Pecs, pies and measuring tape

We transform the classic cottage pie into a muscle-building miracle dish
pecs pies and measuring tape

Think-big cottage pie

Ground lean beef packs crucial extra calories and protein into the meat of this muscular offering, and mixing egg yolks in with the spuds means there’s a super-size secret in the topping. ”Yolks are a nutrient dense, antioxidant-rich, vitamin-and-mineral-loaded portion of the egg,” says certified nutritionist Mike Geary, founder of truthaboutabs.com.

And while you may be getting plenty of whites from your protein shakes, according to Geary: "The protein in egg whites isn't as powerful without the yolks to balance out the amino acid profile and make the protein easier for your body to absorb. Plus, free-range egg yolks are loaded with muscle-nourishing omega-3 fatty acids.” Omelette for breakfast too then.
Vital Stats: Per serving 861 calories, 45g fat, 17g sat fat, 47g protein, 43g carbs (serves 3)


1 large onion
2 cloves garlic
1 stalk celery
1 medium carrot
1 sprig thyme
1 tbsp Worcestershire sauce
2 tbsp tomato paste
250ml vegetable stock
Salt, pepper and olive oil
550g ground lean beef
125ml red wine
80ml semi-skimmed milk
4 large potatoes
2 egg yolks


Four steps to oven-baked muscle or pie-powered gut shrinkage

Step 1: The meat
Preheat the oven to 200C. Heat the meat in a large, deep frying pan over a high heat. No oil necessary, just sprinkle on a little salt and pepper, add the thyme and fry until browned. This should take about 10 minutes, but stir frequently to break up the meat. Once browned, transfer to a sieve and leave over the sink to drain off excess fat.

Step 2: The veg
While the beef is ridding itself of the stuff you don’t want in your arteries and the chicken, espresso and gravy granule combo is convincing your other half that she really shouldn’t have let you loose in the kitchen after all, get on with stage two. You need to peel and finely chop the onion, garlic, carrot and celery. Use the sharpest knife you have. Watch those fingers. Give the pan you used to brown the meat a quick wipe, drizzle in a little olive oil with a Mediterranean flourish, then stick the chopped veg. Cook over a medium heat for about 5 minutes until it all softens up. Flamboyant stirring and Gordon Ramsay impersonation optional.  

Step 3: The flavour
Open the wine. You’ll need about half a glass for the pie and the most accurate method of measuring is to pour yourself a full glass and drink the other half. Scientific fact. Return the minced beef back to the pan along with the veg, add the wine and cook until it’s reduced in volume so just half of the liquid remains.

Stick the chicken back in the pan with the veg; add the anchovy paste and fry for a few minutes.  Then add the marsala and let it heat up until it bubbles for a minute. Add the tomato paste, Worcestershire sauce and vegetable stock.  Bring to the boil, then turn the heat down and let everything simmer for 30 minutes. Stir occasionally and wait for the mixture to thicken. Add more salt and pepper to taste.

Step 4: The spuds
While the sauce thickens peel the spuds, chop into 2.5cm chunks and rinse. Then stick them in a pot of salty water and boil over medium high heat for 12 minutes. Drain and mash. Mix the egg yolks into the mash. Transfer the frying pan mixture into a casserole dish, and then add the potato topping a spoonful at a time, working from the edge inwards. Rake some furrows so you’ll get some nice crispy bits and bake for 30 minutes in your pre-heated oven. Enjoy

146 Health - Tuna for Lunch - Fat Free
Updated: 09 Nov 2013

Mexican muscle

A post-workout packed lunch that will pack a punch
mexican muscle

Brown rice

How much: 75g, cooked
Why: Ian Marber, founder of The Food Doctor Clinic in London, thefooddoctor.com says: “Low GI is a perfect base for any meal, let alone one as balanced in fibre, fats and protein as this one. It will help replenish your glycogen stores, which will be depleted after a hard workout.” You’ve been training hard, right?


How much: 200g, tinned, drained
Why: “Canned tuna is a good source of omega-3 fats which are the building blocks for the body’s anti-inflammatory compounds called prostaglandins, so are good post exercise. The tuna’s complete protein supplies the amino acids needed for muscle repair and growth.”

Kidney beans

How much: 200g, tinned, drained and rinsed
Why: “Kidney beans are a low-fat protein that deliver fibre too. Ensure that the beans are in plain water, not sugared or salted.” They’re also high in iron which is good news as you’ll have lost a fair bit through sweating.


How much: ½ cut into chunks
Why: “This will deliver essential fats for energy and also a good dose of vitamin E with its potent antioxidant properties to combat the free radicals naturally created during physical exertion.” Wait until the last minute to chop it up though, otherwise it can discolour.

Green pepper

How much: ½ deseeded and cut into chunks
Why: If you’re training hard, your body will be crying out for vitamin C. “You lose a lot through sweating. Green peppers are stuffed with it, which will help replace what you’ve lost.”


How much: One, deseeded and chopped.

Baby leaf spinach

How much: handful, chopped
Why:  “As well as lycopene, an antioxidant required to protect cells from oxidisation, tomatoes also contain fibre, while spinach, like all green vegetables, is rich in magnesium and potassium, useful in regulating blood pressure.”


How much: deseeded and thinly sliced
Why: Ever wondered why Mexicans love chillies? It’s not just because of the heat. “Chilli peppers contain capsaicinoids that help reduce the ill effects of LDL, the unwanted type of cholesterol. They are also a good source of vitamin D, which helps magnesium uptake, which in turn helps relax muscles.”

The dressing

1 tbsp olive oil
Juice of ½ a lime
½ a clove of garlic, crushed

The method

Cook the brown rice according to the packet instructions and allow to cool. Meanwhile, mix the dressing and combine with all the other ingredients. Stick the rice in your lunch box and layer the tuna mixture on top. Stick it in the fridge at work and try to forget about it until after your workout

147 Health - The Power of Chicken to Repair
Updated: 09 Nov 2013

Stuffed with power

stuffed with power

Eat this after your workout to repair your damaged muscles. These Mediterranean-style chicken breasts are an excellent source of lean protein needed to build muscle and boost strength.

You'll need


5-6 chicken breasts
2 tbsp chopped sun dried tomatoes
2 tbsp crumbled feta cheese
2 tbsp chopped olives
1 tbsp minced garlic
1 tbsp pine nuts
1 tbsp balsamic vinegar
Extra virgin olive oil

How to make it

Preheat the oven to 230°. Toss together the tomatoes, feta cheese, olives, garlic, pine nuts and vinegar. Rub the chicken with olive oil, salt and pepper. Cut a slit along the thick part of each chicken breast, creating a pocket. Add enough stuffing to fill each pocket and transfer the chicken to a baking sheet. Bake for 15 minutes. Makes 2 servings. Eat with mash and spinach

148 Health - Muscle in with Steak
Updated: 09 Nov 2013

Get ripped, with steak

Bulk up your muscles with the MH pepper steak
 Mens Health
get ripped with steak

The muscle-building saucy steak

You don’t need Jake La Motta to tell you steak is a classic muscle-builder. “Red meat is high in zinc which maintains testosterone levels, and testosterone supports muscle growth,” says Chris Aceto author of Understanding Body Building Nutrition and Training (Nutramedia). The trouble with the classic recipe is it’s swimming in cream, and excess dairy reduces your body's ability to absorb that vital zinc. The MH version solves this by using just a few tablespoons of sour cream. On the side, you’ll ditch standard spuds in favour of sweet potatoes. These contain more high-quality low-glycemic carbs, which provide a steady supply of energy, allowing your body to use the steak’s protein to reconstruct muscle tissue more effectively. The only thing we couldn’t sort out is a protein-enriched glass of Malbec.
Vital Stats: Per serving 864 calories, 33g fat, 12g sat fat, 65g protein 89g carbs


½ tbsp of large flake salt (maldonsalt.co.uk)
200g sirloin steak, trimmed
½tbsp black peppercorns
1tsp olive oil spray
½tsp fresh thyme
1 carrot
1 parsnip
1 sweet potato
1 clove garlic
20ml Cognac
20ml beef stock
20ml low-fat sour cream
1 tbsp fresh chives


Four simple steps for a lean cut or extra meat.

Step 1: The tender touch
Sprinkle each side of the steak with half a teaspoon of Maldon salt, which is a better tenderiser than table salt and easier to rinse off. Leave them for 15 minutes and start on the veg.
Preheat the oven to 200C. Peel the carrots, parsnips and sweet potato. Chop the carrots and parsnips into matchsticks, and the sweet potatoes into 4-cm cubes. Toss everything in a roasting tin with the unpeeled garlic, coat lightly with olive oil and bake for 45 minutes.

Step 2: The sear factor
Use the bottom of a pot to crush the peppercorns so they’re chunky, but no whole corns remain. Unless you’re planning on subduing terrorists before dinner, you want to limit the debilitating effects of the spicy pepper dust by putting the peppercorns in a sieve and giving them a shake. Look away, hold your breath, or stick on your scuba gear for the shake down.
Rinse the salt off the steaks under running water then pat them dry with kitchen towel. Now press the crushed peppercorns into both sides of your steak. Preheat a heavy-duty frying pan over high heat. Once it’s hot, add the oil and sear your meat for about 3 minutes each side. When done to your satisfaction, cover with aluminum foil and ‘rest’ for 10 minutes well away from the dog. This allows the steak to reabsorb the juices that leak out during the cooking process, keeping it moist, tender and delicious.
Step 3: The brandy devil
Try to control your Pavlovian drooling with that eau-de-boeuf pervading the kitchen and dump the grease out of the frying pan into a throw-away container. This means it can go in the rubbish when it cools down instead of clogging your drain. And you can enjoy a night’s free entertainment watching the dog desperately trying to eat your bin. Add the Cognac to the pan and boil or, if you’re feeling flamboyant, flambé (set the alcohol on fire…keep a fire extinguisher close) for a few minutes to burn off the boozy edge. Add the beef stock and boil the mixture for 10 minutes, stirring often until it reduces by half. Meanwhile chop the fresh herbs. Stir in the low-fat sour cream, add the herbs and add salt and pepper to taste.

Step 4: The plate and the good
Check that Malbec is breathing nicely. Remove the roasted veg from the oven and stick on the side of a warm plate. Dig out the garlic cloves and squeeze the puree out of the papery skin and over the veg. Lift the steak out of the foil and lay on the plate. Top with the sauce. Show any vegetarians the way out, sharpen your steak knives and tuck in

149 Health- A Difficult Boss can Damage Your Immune System
Updated: 08 Nov 2013

 A story in the Daily Mail which may or may not apply to you - that working for a difficult boss can damage

employees’ immune systems.

Researchers from Ohio State University studied mice and found that chronic stress causes changes in the gene

activity in immune cells. This results in the cells being primed to fight an infection that doesn’t exist, causing

inflammation in the body.

When compared with studies of people living in poor areas, the researchers found their blood samples contained

similarly primed immune cells.

Dr John Sheridan from Ohio State University, who is co-lead author of the study, said: ‘The cells share many of the

same characteristics in terms of their response to stress.’

‘There is a stress-induced alteration in the bone marrow in both our mouse model and in chronically stressed

humans that selects for a cell that’s going to be pro-inflammatory.

‘So what this suggests is that if you’re working for a really bad boss over a long period of time, that experience

may play out at the level of gene expression in your immune system.

150 Health- Motivated to lose weight ?
Updated: 08 Nov 2013

Advice from health professionals

increases motivation to lose weight in obese patients

From: Clinical Newswire

  • 06 November 2013

Motivation to lose weight and weight loss is greater in overweight adults when they have received health

professional advice on weight loss, suggests a recent UK study.

In the study, a cross-sectional survey of 810 overweight and obese adults were asked if they had ever received

health professional advice to lose weight and reported their desire to weigh less, and whether they were

attempting to lose weight.

Only 17% of overweight and 42% of obese respondents recalled ever having received health professional advice

to lose weight. Health professional advice to lose weight was associated with nearly a 4-fold increase in both

wanting to lose weight and weight loss attempts.

The researchers noted that ‘advice to lose weight appears to increase motivation to lose weight and weight loss

behaviour, but only a minority of overweight or obese adults receive such advice’ and advise that better training

for health professionals in delivering weight counselling could ‘offer an opportunity to improve obese patients’

motivation to lose weight’.

BMJ Open, online 4 November

151 Health - Fungus in Your Food poses a Public Health Cancer Risk
Updated: 07 Nov 2013

Fungus in Your Food

Written by Our Correspondent
Print Friendly
Asia Sentinel

Tropical climates, impoverished governments, pose a health risk

Controlling aflatoxins – naturally occurring byproducts of common fungus on grains and other crops in poor,

tropical countries – has become a new crusade for the world’s food scientists. One of the most significant risk

factors of deadly liver cancer, controlling their existence in the world’s food supply is critical.

Scientists believe the aflatoxins, which often appear in common mold, could be responsible for up to 172,000 liver

cancer cases per year, according to a study by the Washington, DC-based International Food Policy Research

Institute, which was released today. They occur mostly in groundnuts and maize (corn). Persistent high levels can

result in childhood stunting, according to the report, which can lead to a variety of adverse health conditions that

last well beyond childhood.

The Eurozone countries and the United States have established strict standards to minimize aflatoxins on crops

consumed in foods or animal foods. However, the IFPRI report said, particularly in tropical countries where food

inspection standards are lax, they are more widespread and meeting such challenges remains difficult.

The IFPRI’s findings are carried in a 62-page report titled “Aflatoxins: Finding Solutions for Improved Food Safety”

and comprising 19 policy briefs connected with the research institute, a member of the CGIAR Consortium, a

global research partnership for food security.

Because the fungi are a pervasive threat to the environment, many different efforts are required to reduce food risk

and move to higher quality food. New efforts must be made to build new market channels and to develop risk


“Aflatoxins pose both acute and chronic risks to health,” the authors note. “Exposure to aflatoxins is particularly

high for low-income populations in the tropics that consume relatively large quantities of staples such as maize or

groundnuts. Consumption of very high levels of aflatoxins can result in acute illness and death.”

As many as 26,000 such deaths occur annually in sub-Saharan Africa although “Other effects of chronic exposure

are less understood due to the difficulties in establishing causality when putative effects are correlated with a

number of adverse health determinants. Chronic exposure is associated with immune suppression and higher

rates of illness.”

The specific role of aflatoxins in causing stunting isn’t known, for instance, although animal studies provide

evidence that high levels in animal feeds have adverse effects for animal health, growth, and productivity.

“These are suggestive of such effects in humans, but animal studies typically involve much higher levels of

aflatoxin exposure than is usually observed in human populations,” the report notes.

Actually discerning aflatoxin contamination is difficult although the presence of mold is a potential, albeit imperfect

indicator. Farmer awareness is far from perfect, as are adequate storage and drying practices. While some moldy

grain is diverted to uses that somewhat reduce direct human exposure, such as for brewing and animal feeds,

paying attention to quality “is still unusual in most developing countries.”

Identification of high-risk elements of the supply chain should help prioritize those areas where market actors can

intervene. The World Food Program’s Purchases for Peace program has a simpler approach: the introduction of

basic grain quality evaluation tools which can be seen as an essential building block, providing the foundation for

quality assessment and evolution toward improved supply chain management. Also changing handling and

processing are important to reduce mold growth and contamination

Actually a wide range of control methods exist, according to the report, including cultivation practices and

postharvest handling but none are in wide use in developing countries due to cost, logistics, and lack of


There are policy initiatives underway, along with regional approaches to setting standards or to biocontrol

registration, which can reduce the costs of individual country action and may promote regional trade.

Development of new detection and diagnostic tools that are cheaper, more reliable, and more easily used in the

field is also underway, the report caus.

But while concern is growing about aflatoxin issues in tropical environments, little is definitively known about their

public health risks or about effective market and technology solutions. “There is thus a continued need for

multidisciplinary and comprehensive research to inform policy and to test potential solutions. Such research can

use the tools of risk analysis to better inform policymakers about the scope of public health risks

152 Health- Only A&E is a 24hour service & the savage Tory Cuts are the main cause of the crisis
Updated: 07 Nov 2013

All the papers report this morning on the crisis in A&E, with The Mirror citing ‘savage Tory cuts’ as the main cause

of what emergency doctors are warning could plunge the health service into its worst winter crisis ever. According

to a report from the College of Emergency Medicine, patients could die because of overcrowding of emergency

departments, says The Guardian.

The College says it is 600 consultants short of the 2,000 it needs to provide a fully manned service at every

hospital for at least 16 hours a day.

It urges NHS England to make a list of changes, including ways to make emergency medicine more attractive to

young doctors, while The Independent picks up on the call for GPs as well as social care services and NHS walk-in

centres need to be open longer hours to take pressure of casualty wards.

Dr Chris Moulton, vice president of the College, told the paper: ‘GP out-of-hours tend not to be as comprehensive

in the type of patients they will see and are often appointment-based. Most walk-in centres and minor injury

centres tend to be open 12 hours a day, maybe five or six days a week. The only 24-hour service is A&E.’

153 Health- Depression is now the second biggest cause of disability in the world
Updated: 07 Nov 2013

The BBC reports depression is now the second biggest cause of disability in the world, after back pain.

This news comes from experts writing in the journal PLoS Medicine, who compared the amount of disability

caused by over 200 diseases and injuries. Depression came out in the number two spot as a global cause of

disability, although its impact varied, with the burden of depression tending to be higher in low- and middle-income

countries and lower in high-income countries.  In the UK it ranked third for the number of years it caused people to

live with a disability.

Lead author Dr Alize Ferrari from the University of Queensland said: ‘Depression is a big problem and we definitely

need to pay more attention to it than we are now.’

154 Health- What GP's think of Jeremy Hunt's GP Reform's ?
Updated: 07 Nov 2013

In full: What do GPs think of Jeremy Hunt's GP reforms?

6 November 2013



Read the full results of Pulse’s survey of 700 GPs on the changes the health secretary wants

to see in the GP contract.


Jeremy Hunt has said he wants to see ‘profound reform’ of general practice by next April, and has set out a series

of changes he intends to make to the GP contract.

Which measures do you support?


Introducing ‘named’ GPs with 24/7 responsibility for vulnerable patients

Oppose – 71%

Support – 10%

Not sure – 19%


Reducing ‘tick-box’ medicine through shrinking the QOF

Oppose – 7%

Support –  73%

Not sure – 20%


Increasing the overall proportion of GP funding going into primary care

Oppose – 3%

Support –  87%

Not sure – 10%


Expanding the GP workforce by recruiting at least 2,000 additional GPs

Oppose – 3%

Support –  86%

Not sure – 11%


Widening online access for patients

Oppose – 26%

Support –  34%

Not sure – 40%


What is your overall impression of the measures taken as a whole

Oppose - 44%

Support - 9%

Not sure - 47%


Source: Pulse survey of 690 GPs

If ministers and the GPC are again unable to reach agreement on the GP contract, and the Department of Health

imposes contract changes as they did this year in England, would you support industrial action?

Yes – 62%

No – 22%

Don’t know – 16%

Source: Pulse survey of 734 GPs

155 Health - Do You Eat Breakfast ? - "Grave Danger" if Not
Updated: 06 Nov 2013

Did you have breakfast today?

If not you may be putting yourself in ‘grave danger’ according to the Daily Mail.

A Harvard School of Public Health study found that men who don’t have breakfast are 27% more likely to suffer

heart attacks or heart disease, as missing the meal put an ‘extra strain’ on the body.

The article goes on to list the best things to eat for breakfast (porridge with honey, boiled egg and toast), dispel a

few myths (having breakfast doesn’t mean you’ll eat less for lunch though) and looks at the link between morning

hunger and genes

156 Health- Colchester Cancer Cover Up - NHA Press Release
Updated: 06 Nov 2013

Statement from co-leader of National Health Action Party, Dr Richard Taylor on Colchester Hospital Cancer Unit


“This is a very serious matter requiring serious investigation.

“If true, it’s concerning on many levels: that cancer patients had delayed treatment which may affect their

outcomes, that staff falsified data to cover up delays, and that staff felt bullied into taking such dreadful action.

“If proven this is a very worrying example of what can happen when staff are pressurised by management to put

centrally imposed targets ahead of honesty, accuracy of reports and, inevitably, quality of care.

“It is appalling that NHS staff can be put under these sort of pressures when the Health Secretary talks about the

needs for honesty and openness in the NHS.”


For press enquiries please contact

Giselle Green, Head of Press, NHA party

Mob: 07767 612311

157 Health - Hospital Closure Clause -Sign the Petition
Updated: 06 Nov 2013

Jeremy Hunt should resign and take his hospital closure clause with him

To: Jeremy Hunt, Secretary of State for Health

of 1,000 signatures
Campaign created by Louise Irvine Icon-email

Dear Secretary of State for Health,

After a further legal defeat in the Court of Appeal when the three judges
(upholding the case of Lewisham Council and Save Lewisham Hospital Campaign) found
against the Government with unprecedented speed we, the undersigned, call
upon you to seriously consider your position and resign.

We also call upon you or your ministerial colleagues to withdraw the new
Chapter 4 and clause 118 of the Care Bill as this was not only introduced
by amendment in the Lords with unseemly haste but is in effect a  “hospital
closure clause”  that will make it possible to close neighbouring viable hospitals
 without proper consultation.

Why is this important?

We call on the government to withdraw the Hospital Closure Clause (Clause
118),which they are seeking to rush through the Commons this month as part
of the Care Bill.This Clause, added as a late amendment to the Care Bill,
scraps the law that protected Lewisham’s A&E. The Clause will allow the
government to close or downgrade any hospital in the country, with barely
any consultation of local people, if there is a Trust in financial difficulties
anywhere nearby. They will be able to appoint an administrator to one Trust
who will be able to take decisions to fast-track the closure of hospitals
in another area - no matter how successful or popular those hospitals are -
using the 'unsustainable provider' legislation that was designed only for
insolvent Trusts. If it becomes law, this Clause means that *no* hospital
will be safe, no matter how successful.

As well as signing the petition, please also write to directly your MP
urging them to take action - check out this link
http://www.opendemocracy.net/ournhs/stop-hospital-closure-clause for more information and tips on how to do that. We suggest you write open letters to your MP and send them to your local paper to help raise awareness of this issue. This needs to be done quickly as the Bill may go through parliament very soon.

We will update you on further campaign actions you can get involved in. Please share on Twitter and Facebook.
158 Health - Stop Hunt's Hospital Closures Clause Via the Back Door
Updated: 06 Nov 2013


The government is trying to quietly rush through a law making it much easier to close our hospitals. It’s time to

make our voices heard!

There is very little time to act to stop the government making it much easier and quicker to close local

hospitals with hardly any consultation. Please act now – there are several things you can do to help protect your

local hospitals.

First, you can sign the petition for Hunt to go, and to take the hospital closure clause with him. His attacks on

hospitals have gone too far already,

Second, if you have time, please write to your local MP and your local newspaper. You can use the text below.

Please amend it to:

a) address your MP directly

b) refer to your local hospitals, and

c) put in any other personal experience or thoughts you’d like to include.

You can find and write to your MP very easily by using this site www.writetothem.com

(If you use this site, make sure to copy and save the text yourself too, for your records).

It can be very effective to send an ‘open’ letter to your MP, by marking on the bottom you are copying it to your

local paper and then sending it to the Editor.

Lastly, watch out for more action over the hospital closure clause very soon – we’ll keep you updated!

For more information see here and here.

An open letter to MPs 

The government is trying to quickly change the law to make it much easier and faster to close local hospitals and

A&Es without any proper consultation of local people.

The law change will be debated and voted on in the Commons in November as part of the Care Bill, which has

already been through the Lords. Clause 118, the hospital closure clause, would allow any hospital be closed

down, or lose its A&E, maternity or other services, with hardly any local consultation. MPs must ensure this

dreadful Clause does not become law.

Currently the law allows such undemocratic and fast-track closures to happen only at hospitals that are in such

serious financial or clinical difficulties that they are taken into ‘Administration’.

But the hospital closure clause would change the law. It allows fast-track closures – or privatisations – to happen

to any hospital, however high quality, popular and solvent, if it has a more struggling hospital nearby. And given

the cuts currently being inflicted on the NHS, there will be few hospitals in the country that aren’t somewhere near

a struggling hospital.

Why would anyone want to close down a popular, well-run A&E, maternity unit, or whole hospital? Especially

when our hospitals are already full to overflowing?

Ask the people of Lewisham. There the government tried to fast-track the closure of Lewisham’s A&E and

maternity services, to redirect patients (and money) to a different Hospital Trust that had large Private Finance

Initiative debts to pay off to the banks.

The courts found that the government had broken the law. So now the government is trying to change the law.

If they succeed, no hospital will be safe.

This is a very dangerous move which will put thousands of lives at risk.

The government should think again. We urge MPs from every party to work to scrap this Clause of the Care Bill –

and not to vote for the Bill unless it is dropped. The Bill has already had its first reading in the Commons, and the

signs are the government is going to try and rush it through in the next month or so.

MPs can, as a first step, sign the Early Day Motion 656 ‘Closure of NHS services’ which has been laid down, and

already signed by a MPs from different parties – including Labour front benchers.

We would hope that every MP would be concerned that the Care Bill is being used to drastically reduce the rights

of us, their constituents, to have a say in decisions about our local hospital provision. The hospital closure clause

could be used to threaten hospital provision in any area. It is totally inappropriate to use the fast track ‘failure

regime’ to reconfigure hospital provision more generally.

If services need redesigning the law must ensure this is with proper and extensive consultation with local people.

This process cannot be rushed. Decisions should not be based on the needs of investment banks. What

happened to the government promises that in the NHS there would be ‘no decision about me, without me’?

159 Labour Pledge on Mental Health Services
Updated: 02 Nov 2013

Labour pledges to give right to psychological therapies on NHS

31 October 2013 | By Caroline Price


Labour will give patients the right to receive psychological therapies under the NHS constitution if elected, shadow

health secretary Andy Burnham announced today (Thursday).

The move comes as Labour accused the Government of trying to hide the scale of cuts to mental health services

by scrapping the annual review of mental health expenditure in the NHS.

Speaking at a mental health conference hosted by the University of Chester Centre for Psychological Therapies in

Primary Care, Mr Burnham said despite progress in removing the stigma of mental health problems, the NHS still

had much to do to achieve equality of care for mental and physical problems envisaged when it was first set up by

Aneurin Bevan.

Burnham said the NHS constitution needed to be changed to empower patients to gain access to appropriate

talking therapies, rather than ‘just pills’ as currently is their right through the inclusion of NICE approved


He said: ‘We need to empower people, individuals to get what they need. One of things we are saying is, could we

strengthen the NHS – and give people the right to counselling or to talking therapy because currently the only right

in this regard is a right to pills. There is a right to NICE-approved technologies but there isn’t a right to

[psychological] support.’

Speaking to Pulse, Burnham said he was proud to have played a part in the Government’s Improving Access to

Psychological Therapies, but admitted it was failing to deliver in some areas, with long waiting times.

He said: ‘Certainly we will carry on funding talking therapies – I think it’s the beginning of a journey not the end of

it. It’s true there can be very wide variation in services, particularly waiting times.’

‘But I’m also thinking of a new vision for general practice of “whole-person” care.’

He added: ‘I’ve shadowed GPs lately and I’ve seen people come in who are very similar to some of the people who

come into my surgery. They are often people for whom the “blockage” in their health is often to do with

bereavements, relationships, housing, benefits. I’ve often been with GPs when they’ve prescribed antidepressants

– and I’ve asked them, if you’d been able to refer them for bereavement counselling, would that have been better –

and they say “absolutely”.’

‘I’d like to see NHS money spent prescribing social rather than medical interventions – wouldn’t that help to

empower general practice.

160 New NHS Boss Simon-Who wasted $billions of Health money
Updated: 02 Nov 2013

How the new NHS boss has helped ruin health services on two continents


Nov 2013 Friday 1st

posted by Morning Star in Features SOLOMON HUGHES introduces new NHS chief executive Simon Stevens – a

man with a dubious history of undermining public health on both sides of the pond


In the past, interviews for top jobs were all about what school tie you wore.

Middle management positions were decided on funny handshakes and golf club membership. For rank-and-file

jobs, turning up was half the battle.

But competition for jobs has got fiercer. The concept of human resources has expanded. Interview panels are

more complicated, wrestling with lists of “essential qualities for candidates.”

So what happened at the interview for the new head of the NHS?

Did the panel have a piece of paper reading: “Wasted billions of health money — Desirable. Lobbied against public

health care in the US — Essential.”?

Because they have appointed a man who did that and more.

The new NHS chief executive Simon Stevens has screwed up the health service on two continents.

He successfully fought off the growth of public health care in the US, killing a key component of “Obamacare.”

While in Britain he fought to get a slice of the NHS pie stuffed into the gobs of private health firms, wasting billions

in the process.

Stevens was health adviser to both Labour health secretary Alan Milburn and prime minister Tony Blair. He was

intimately involved in Blair’s privatisations.

He is the main author of the “NHS Plan” launched in 2000. The plan took NHS-funded operations out of NHS

hospitals, handing them over to private companies.

This was a bonanza for health companies and private equity firms behind them. It built a whole industry of firms

sucking up NHS cash. Paying their profits wasted NHS cash and resources.

For example, under Stevens’s plan the NHS gave up buying its own MRI scanners. It paid a private company to do

the scans from the back of lorries in hospital car parks instead.

A company called Alliance Medical was paid for all the scans in the contract, even though it only did 80 per cent of

the work. The Royal College of Radiologists and the NHS Clinical Guardian didn’t trust the quality of the work, so

hospitals had to duplicate many of the scans anyway.

The same plan meant the NHS bought hundreds of thousands of minor operations from private clinics called

“independent-sector treatment centres” (ISTCs).

Under Stevens’s plan, the NHS paid private firms like Care UK 15 per cent above the NHS rate to encourage the

growth of a “market.”

It also paid firms whether the operations was done or not. Estimates by Professor Allyson Pollock, an academic

critic of the scheme, suggest that up to £1.6 billion may have been wasted on phantom operations.

The NHS was stuck with training costs and “difficult” cases, while the private sector creamed off easy work and


Still, Stevens’s old boss Milburn has a new job with private equity firm Bridgepoint Capital, which owned Alliance

Medical and now owns Care UK — the companies profiting from the crazy scheme.

Stevens was central to one of the worst NHS financial disasters. He helped to run the 2002 Prime Minister’s

Seminar on NHS Information Systems which launched Connecting for Health.

This NHS-wide computer system was supposed to create electronic patient records. It has cost between £12bn

and £20bn pounds but basically doesn’t work.

Newspapers usually write the Connecting for Health story as a “wasteful Labour government in computer cock-

up” tale.

But Connecting for Health was actually driven by new Labour’s determination to hand over NHS cash to private


Stevens’s record of the seminar says: “The key was to use stronger central direction to accelerate the pace of

change and make more use of partnerships with the private sector.”

So Stevens helped Labour centrally direct the NHS to sign partnerships with IT firms. The result was a disastrous

waste of cash.

Connecting for Health was actually a double privatisation. First, it meant handing over NHS money to the IT


Second, the whole system was designed to hand over operations to the private sector.

Transferring electronic patient records was meant to make transferring NHS patients to private hospitals easier.

In 2004 Stevens left Britain to join private US health firm UnitedHealth, becoming executive vice-president at a firm

winning NHS work from his NHS Plan.

There is a persistent link between Stevens and computers and funny business with money.

In 2009 UnitedHealth, the firm Stevens helped to lead, paid a $350 million court settlement.

UnitedHealth used a computer database to systematically cheat its customers.

The American Medical Association said UnitedHealth’s payments database was a “corrupt system” and

“intentionally manipulated” and “rigged.”

Patients who went to see a doctor outside UnitedHealth’s business associates were deliberately given less of their

UnitedHealth insurance money for medical treatments, leaving patients with bigger bills.

Stevens wasn’t satisfied with just working for a scandal-hit US health firm. 

He worked to screw up the US national health system as well. In Britain Stevens tried to make the NHS more like

the private health system that fails so many US citizens. 

In the US President Barack Obama made tentative steps towards a European-style health system. So Stevens did

all he could to obstruct Obamacare.

Obama’s scheme offers private health-care plans for most people in the US, with some government backing.

However, in 2008 he also proposed a “public option.” In the original Obamacare, a small publicly run health

insurance scheme would compete with private firms like UnitedHealth.

The public option would curb private insurance profiteering. The idea of having to compete with the public option

was too much for Stevens, who ran UnitedHealth’s political lobbying in the US, and he organised a pincer

movement against it.

First, in 2009 UnitedHealth sent its staff to the town hall meetings where Tea Party types attacked Obama’s reforms

as “socialist.”

UnitedHealth mobilised advocacy specialists, priming staff with “talking points” like: “A government-run health

plan would be a roadblock to meaningful health-care reform.”

UnitedHealth staff were mobilised during working hours to attack Obama’s reforms.

While Stevens sent his staff to join the barmy right-wing town hall meetings alongside crazy Republicans, he

personally lobbied right-wing Democrats — known as “Blue Dog Democrats” — to kill the public option. Stevens’s

campaign won and the public option of Obamacare died.

So having introduced profiteering into the NHS, Stevens then fought to keep the government out of health care in

the US.

By putting Stevens in charge of the NHS, the government has put a self-destruct mechanism in the centre of our

health service

161 Tracking fitness -Measuring Energy Expended- through your SmartPhone
Updated: 01 Nov 2013

Ditch the pedometer – the AI in your phone is better


FORGET Fitbits, Fuelbands and other pedometers. Your smartphone and its built-in sensors can do a better job of  

measuring the energy you expend during the day.

Amit Pande of the University of California, Davis, designed an activity tracking algorithm for smartphones. It works

by training a neural network, which functions like a simplified human brain, to recognise features in the data

gathered by the phone's accelerometer and barometer. The system also takes account of variables like age,

gender, height and weight to estimate energy expenditure.

The team compared their system to the Fitbit and Nike's Fuelband, the leading activity monitors on the market, as

well as a professional, wearable calorimeter. It was more accurate than the commercial devices and closely

matched the calorimeter.

Fitbit and Fuelband tested particularly badly on stairs. In trial runs up and down four flights of stairs, the

commercial devices estimated that more energy was expended going down than up – clearly untrue. In contrast,

the smartphone performed better thanks to its barometer, which measures the tiny changes in atmospheric

pressure that tell the device when someone is going up and down stairs.

"This is a new market, so in the beginning people are not so worried about accuracy," Pande says. "But we want

accurate data so that physicians can use it to improve their understanding of human beings."

Pande and colleagues will demonstrate the system at the Wireless Health conference in Baltimore this week.

Pande is not alone in taking the smartphone-only approach to monitoring human activity. Health data start-up

Ginger.io also relies on activity traces from your smartphone's sensors, as well as your text and phone activity, to

make predictive health insights and alerts.

Mike Brown of the National University of Singapore says he is impressed with Pande's work, but notes that there

are some obvious downsides to phone-only activity sensing. "iPhones and Androids need to charge at least once

a day. Fitbit and Nike Fuelband can work for seven to nine days on a single charge," he says." And ever try to run

a marathon carrying a phone?"

This article appeared in print under the headline "Ditch the Fitbit – track fitness with your phone"

162 Mental Health -The poor relation of the NHS
Updated: 01 Nov 2013

Labour would include the right to counselling for mental health patients in the NHS constitution, shadow health

secretary Andy Burnham will announce today.

In a speech at a mental health conference, Mr Burnham will attack the Government for long waits for talking

therapies on the NHS and for the lack of existing data on spending on mental health in England, the Guardian


163 Lewisham Victory -We Are Saving the NHS - Utter Humiliation for the Little Hunt
Updated: 30 Oct 2013

Statement from co-leader of the NHA Party, Dr Richard Taylor , on Court of Appeal throwing out Jeremy Hunt’s

attempt to downgrade Lewisham Hospital

“Today’s Appeal Court ruling stops the downgrading of Lewisham hospital and represents an important victory

for the people of Lewisham and utter humiliation for Jeremy Hunt, who has wasted thousands of pounds of tax-

payers’ money on a court case that was thrown out in just ten minutes. But this is just one battle in the war against

the coalition government’s attempt to downgrade our whole health service.”

“It is clear that in order to achieve their £50 billion of NHS austerity savings by 2020, the Government wants to

close hospitals. This ruling is a blow to that aim, but they are going to change the law in the Care Bill to give the

Trust Special Administrator new powers to close hospitals. This is yet another scandalous attack on the NHS.”

164 Digging the Dirt -is good for over 60's
Updated: 30 Oct 2013

There is slightly more cheery news for the over-60s this morning though, at least for those who don’t fancy the gym. 

New research shows daily activities such as gardening and DIY are just as good as other forms of exercise at

warding off vascular disease.

The study from Sweden of nearly 4,000 people aged 60 years and over showed daily gardening or DIY cut their risk

of heart attacks and stroke and prolonged their life by as much as 30%, reports The Guardian.

Even elderly people who trained for marathons were at no less risk than the potterers.

Authors of the study, which is published in the British Journal of Sports Medicine, said their findings are important

because people in this age group tend to spend more of their active day performing these kinds of activities ‘as

they often find it difficult to achieve recommended exercise intensity levels’.  

165 Patient Complaints -NHS Administrators- "Delay, Deny and Defend" + Deceit
Updated: 30 Oct 2013

Patient complaints are met with an attitude of ‘delay, deny and defend’ in the NHS, according to a damning

parliamentary report.

Co-author and Labour MP Ann Clwyd said a defensive approach to patient concerns is

‘deeply entrenched’, The Times reports.

The review of 2,500 submissions detailed cases of failures to communicate, ‘slapdash’ care and ‘pompous and

condescending doctors and nurses’.

It found patients were sometimes scared to complain because of fears or reprisals, or put off by confusing


Mrs Clwyd, who has complained about the poor care her husband received when he died in hospital last year,

called for an end to the culture of denial.

She said: ‘When I made public the circumstances of my own husband’s death last year, I was shocked by the

deluge of correspondence from people whose experience of hospitals was heart-breaking.’

‘The days of delay, deny, and defend must end, and hospitals must become open, learning organisations.’

166 Lewisham Hospital Closures - Jeremy Hunt, acted illegally - He should pay our costs
Updated: 30 Oct 2013
Tue, 29 Oct 2013 at 17:50
Tue, 17:50


FROM Robin Priestley - 38 Degrees TO You
38 Degrees Logo

Dear Friend
Great news just in. Health Minister Jeremy Hunt has been beaten in court ... AGAIN!

In August, a judge ruled that Hunt had acted illegally by deciding to cut A&E and maternity services at Lewisham hospital. Hunt appealed the decision, and today he lost again. The court of appeal ruled that he does not have the power to implement cuts at the successful hospital. [1]

It’s the result we’d all been hoping for, and is wonderful news for the people of Lewisham and the 38 Degrees members who chipped in to help fund the legal challenge.

When the Save Lewisham Hospital campaign decided to take Jeremy Hunt to court, thousands of us from all across the UK stepped in to help. Together, chipping in whatever we could afford, we raised the £20,000 they needed to launch their legal challenge. [2]

This isn’t just great news for Lewisham though, it’ll show Hunt he can’t break the law and get away with it. If he’d have got away with cutting services here, then no hospital would have been safe.

Rosa Curling from law firm Leigh Day, who represented the Save Lewisham Hospital Group said: "We are absolutely delighted with the Court of Appeal's decision today. It confirms what the Save Lewisham Hospital campaign has been arguing from the start - that the Secretary of State did not have the legal power to close and downgrade services at Lewisham Hospital."

"This expensive waste of time for the government should serve as a wake up call that they cannot ride roughshod over the needs of the people.” [3]

So lets make sure we remember the Save Lewisham Hospital campaign’s victory and everyone who’s given a helping hand along the way. This is an exciting day for our campaign to save our NHS. And while the battle’s not over yet, it’s important to celebrate the victories we have.

It’s moments like this that make it even more important that we stop the government from silencing ordinary people with the gagging law. It reminds us of the important role that campaign groups and charities play, keeping the government in check and campaigning on issues that are important. That's why we're so focussed on defeating it! [4]

But we’re still keeping you under observation Jeremy!

Thank you for everything you do

Robin, Blanche, Ian and the 38 Degrees team

PS: Why not forward this email to your friends, it’s great to spread the good news. Today’s victory shows that people power works, and that’s an incredibly important story to tell.

You can share the news on Twitter and Facebook using the links below:
Tweet about the victory - https://secure.38degrees.org.uk/lewisham-appeal-tweet
Post the story on Facebook - https://secure.38degrees.org.uk/lewisham-appeal-facebook

[1] BBC - Lewisham Hospital: Appeal Court overrules Jeremy Hunt http://www.bbc.co.uk/news/uk-england-24729477
[2] 38 Degrees blog: Update: Jeremy Hunt and the Lewisham court case: http://blog.38degrees.org.uk/2013/07/18/update-jeremy-hunt-and-the-lewisham-court-case/
[3] Leigh Day Solicitors - Victory for people of Lewisham as Government appeal dismissed http://www.leighday.co.uk/News/2013/October-2013/Victory-for-people-of-Lewisham-as-Government-appea
[4] 38 Degrees Blog - The gagging law http://blog.38degrees.org.uk/tag/gagging-law/

167 "NHS Complaints Process needs reforming" say NHA
Updated: 29 Oct 2013


Complete reform of NHS complaints process is essential and urgent,

says NHA Party

October 28, 2013 | Posted in News, Press Releases |
National Helth Action
Statement from NHA Party co-leader, Dr Richard Taylor on  NHS Complaints Review

‎”Complete reform of the NHS complaints process is essential and urgent. At the moment it is toothless and not

helpful from the patient’s or their relatives’ points of view.

“Even when I was an MP assisting constituents with complaints, I failed to achieve satisfaction on occasions as

‘independent’ experts appeared to be only on the side of the NHS. ‎

“Patients need expert, independent help to make effective complaints and this independent help must be easily

and generally available early in the process and long before legal action is considered. This must always be the

last resort.‎

“But even more important is the need to avoid complaints. This can be achieved by improving communication

between NHS staff and their patients as with open information sharing and discussion most complaints can

become unnecessary.”


168 Health - UK Death Rates show "Mystery Rise"
Updated: 27 Oct 2013

Death rates show 'mystery rise'

25 July 2013 Last updated at 10:55

There has been an unexplained rise in the number of people dying in England and Wales, according to a report.

The document, seen by the Times newspaper and the Health Service Journal, reported 600 more people died each

week last year than the average.

The increase was highest in the elderly, particularly those over 80.

Public Health England said death rates were currently in line with expectation.

About 10,000 people die a week normally, but last year's figures were about 5% higher than average.

The increase has not been explained although suggested contributory factors include flu, a levelling off of life

expectancy and council cuts.

A Public Health England representative said it "uses data on weekly all-cause death registrations in England and

Wales provided by the Office for National Statistics to establish a baseline of the expected number of deaths

registered in each week".

"Allowing for variation, we can then determine if the number of deaths are higher than expected," the

representative said.

"As acknowledged in Public Health England's annual influenza report, the number of deaths during 2012-13 was

high, especially amongst those 85 years and older and in deaths recorded as resulting from respiratory causes.

"We are currently undertaking further work to understand why there was a rise in mortality rates during the earlier

months of this year and the causes behind this.

"The weekly number of deaths are currently within levels expected for this time of year."

169 Health - The Inverse Care Law -Save the NHS
Updated: 26 Oct 2013

The Inverse Care Law

The Lancet:  Saturday 27 February 1971


Glyncorrwg Health Centre, Port Talbot, Glamorgan, Wales 


The availability of good medical care tends to vary inversely with the need for the population served.  This inverse

care law operates more completely where medical care is most exposed to market forces, and less so where such

exposure is reduced.  The market distribution of medical care is a primitive and historically outdated social form,

and any return to it would further exaggerate the maldistribution of medical resources.

Interpreting the Evidence

The existence of large social and geographical inequalities in mortality and morbidity in Britain is known and not

all of them are diminishing.  Between 1934 and 1968, weighted mean standardised mortality from all causes in the

Glamorgan and Monmouthshire valleys rose from 128% of England and Wales rates to 131%.  Their weighted

mean infant mortality rose from 115%  of England and Wales rates to 124% between 1921 and 1968.1[1] The

Registrar General’s last Decennial Supplement on Occupational Mortality for 1949-53 showed combined social

classes I and II (wholly non-manual), with a standardised mortality from all causes ­18% below the mean, and

combined social classes IV and v (wholly manual) 5% above it. Infant mortality was 37% below the mean for social

class I (professional) and 38% above it for social class V unskilled manual).

A just and rational distribution of the resources of medical care should show parallel social and geographical

differences, or at least a uniform distribution. The common experience was described by Titmuss in 1968: “We

have learnt from 15 years’ experience of the Health Service that the higher income groups know how to make

better use of the service; they tend to receive more specialist attention; occupy   more of the beds in better

equipped and staffed hospitals; receive more elective surgery have better maternal care, and are more likely to get

psychiatric help and psychotherapy than low-income groups- particularly the unskilled.”[2]

These generalisations are not easily proved statistically, because most of the statistics are either not available (for

instance, outpatient waiting-lists by area and social class, age and cause specific hospital mortality rates by area

and social class the relation between ante-mortem and postmortem diagnosis by area and  social class an hospital

staff shortage by area) or else described essentially use-rates.  Use-rates may be interpreted either as evidence of

high morbidity among high users, or of disproportionate benefit drawn by them from the National Health Service. 

By piling up the valid evidence that poor people in Britain have higher consultation and referral rates at all levels of

the N.H.S., and by denying that these reflect actual differences in morbidity Rein[3] ,[4] has tried to show that

Titmuss’s opinion is incorrect, and that there are no significant gradients in the quality or accessibility of medical

care in the N.H.S. between social classes.

Class gradients in mortality are an obvious obstacle to this view.  Of these Rein says: “One conclusion reached …

is that since the lower classes have higher death rates, then they must be both sicker or less likely to secure

treatment than other classes…it is useful to examine selected diseases in which- there is a clear mortality class

gradient and then compare these rates with the proportion of patients in each class that consulted their physician

for treatment of these diseases… ”

          He cites figures to show that high death-rates may be associated with low consultation-rates for some

diseases, and with high rates for others, but, since the pattern of each holds good through all social classes, he

concludes that a reasonable inference to be drawn from these findings is not that class mortality is an index of

class morbidity but that for certain diseases treatment is unrelated to outcome.  Thus both high and low

consultation rates can yield high mortality rates for specific diseases.  These data do not appear to lead to the

compelling conclusion that mortality votes can be easily used as an area of class related morbidity.”

This is the only argument mounted by Rein against the evidence of mortality differences, and the reasonable

assumption that these probably represent the final outcome of larger differences in morbidity. Assuming that

“votes” is a misprint for “rates”, I still find that the more one examines this argument the less it means.  To be fair, it

is only used to support  the central thesis that “the availability of universal free-on-demand, comprehensive

services would appear to be a crucial factor in reducing class inequalities in the use of medical care services”. It

certainly would, but reduction is not abolition, as Rein would have quickly found if his stay in Britain had included

more basic fieldwork in the general practitioner’s surgery or the outpatient department.

Non-statistical Evidence

There is massive but mostly non-statistical evidence in favour of Titmuss’s generalisations. First of all there is the

evidence of social history.  James[5] described the origins of the general-practitioner service in industrial and

coalmining areas, from which the present has grown:

“The general practitioner in working-class areas discovered the well-tried business principle of small profits with a

big turnover where the population was large and growing rapidly; it paid to treat a great many people for a small

fee.  A waiting-room crammed with patients, each representing 2s. 6d. for a consultation … not only gave a

satisfactory income but also reduced the inclination to practise clinical medicine with skilful care, to attend clinical

meetings, or to seek refreshment from the scientific literature.  Particularly in coalmining areas, workers formed

themselves into clubs to which they contributed a few pence a week, and thus secured free treatment from the

club doctor for illness or accident.  The club system was the forerunner of health insurance and was a humane

and desirable social development.  But, like the ‘cash surgery’, it encouraged the doctor to undertake the

treatment of more patients than he could deal with efficiently.  It also created a difference between the club patients

and those who could afford to pay for medical attention … in these circumstances it is a tribute to the profession

that its standards in industrial practices were as high as they were.  If criticism is necessary, it should not be of the

doctors who developed large industrial practices but of the leaders of all branches of the profession, who did not

see the trend of general practice, or, having seen it, did nothing to influence it.  It is particularly regrettable that the

revolutionary conception of a National Health Service, which has transformed the hospitals of the United Kingdom

to the great benefit of the community, should not have brought about an equally radical change in general

practice.  Instead, because of the shortsightedness of the profession, the N.H.S. has preserved and intensified the

worst features of general practice.

This preservation and intensification was described by Collings[6] in his study of the work of 104 general

practitioners in 55 English practices outside London, including 9 completely and 7 partly industrial practices, six

months after the start of the N.H.S. Though not randomly sampled, the selection of practices  was structured in a

reasonably representative manner.  The very bad situation he described was the one I found when I entered a

slum practice in Notting Hill in 1953, rediscovered in all but one of five industrial practices where I acted as locum

tenens in 1961, and found again when I resumed practice in the South Wales valleys. Collings said:

“the working environment of general practitioners in industrial areas was so limiting that their individual capacity

as doctors counted very little.  In the circum­stances prevailing, the most essential qualification for the industrial

G.P. . . . is ability as a snap diagnostician-an ability to reach an accurate diagnosis on a minimum of evidence . . .

the worst elements of general practice are to be found in those places where there is the greatest and most urgent

demand for good medical service…. Some conditions of general practice are bad enough to change a good doctor

into a bad doctor in a very short time.  These very bad conditions are to be found chiefly in industrial areas.”

In a counter-report promoted by the British Medical Association, Hadfield[7] contested all of Collings’ conclusions,

but, though his sampling was much better designed, his criticism was guarded to the point of complacency, and

most vaguely defined.  One of Collings’ main criticisms – that purpose-built premises and ancillary staff were

essential for any serious up-grading of general practice – is only now being taken seriously; and even the present

wave of health-centre construction shows signs of finishing almost as soon as it has begun, because of the

present climate of political and economic opinion at the level of effective decision.

Certainly in industrial and mining areas health centres exist as yet only on a token basis and the number of new

projects is declining. Aneurin Bevan described health centres as the cornerstone of the general practitioner

service under the N.H.S., before the long retreat began from the conceptions born in the 1930s and apparently

victorious in 1945. Health-centre construction was scrapped by ministerial circular in January, 1948, in the last

months of gestation of the new service; we have had to do without them for 22 years, during which a generation of

primary care was stunted.

Despite this unpromising beginning, the N.H.S brought about a massive improvement in the delivery of medical

care to previously deprived sections of the people and areas of the country. Former Poor Law hospitals were

upgraded and many acquired fully trained specialist and ancillary staff and supporting diagnostic departments for

the first time. The backlog of untreated disease dealt with in the first years of the service was immense, particularly

in surgery and gynecology. A study of 734 randomly sampled families in London and Northampton in 1961

[8] showed that in 99% of the families someone had attended hospital as an outpatient, and in 82% someone had

been admitted to hospital. The study concluded:

“When thinking of the Health Service mothers are mainly conscious of the extent to which services have become

available in recent years. They were more aware of recent changes in health services than of changes in any other

service. Nearly one third thought that more money  should be spend on health services, not because they thought

them bad but because ‘they are so important’, because ‘doctors and nurses should be paid more’ or because ‘

there shouldn’t be charges for treatment’. Doctors came second to relatives and friends in the list of those who

had been helpful in times of trouble.”

Among those with experience of pre-war services, appreciation for the N.H.S., often uncritical appreciation, is

almost universal -so much so that, although  most London teaching-hospital consultants made their opposition to

the new service crudely evident to their students in 1948 and the early years, and only a courageous few openly

supported it, few of them appear to recall this today. The moral defeat of the very part-time, multi-hospital

consultant, nipping in here and there between private consultations to see how his registrar was coping with his

public work, was total and permanent; lip-service to the N.H.S. is now mandatory.    At primary-care level, private

practice ceased to be relevant to the immense majority of general practitioners, and has failed to produce evidence

of the special functions of leadership and quality claimed for it, in the form of serious research material. On the

other hand, despite the massive economic disincentives to good work, equipment, and staffing in the N.H.S. until a

few years ago, an important expansion of well-organised, community-oriented, and self-critical primary care has

taken place, mainly through the efforts of the Royal College of General Practitioners, the main source of this vigour

is the democratic nature of the service – the fact that it is comprehensive and accessible to all, and the fact that

clinical decisions are therefore made more freely than ever before.  The service at least permits, if it does nor yet

really encourage, general practitioners to think and act in terms of the cure of a whole defined community, as well

as of whole persons rather than diseases.  Collings seems very greatly to have underestimated the importance of

these changes and the extent to which they were to over shadow  the serious faults of the service – and these

were faults of too little change, rather than too much. There  have in fact been very big improvements in the quality

and accessibility of care both at hospital and primary care level, for all classes and in all areas.

Selective Redistribution of Care

Given the large social inequalities of mortality and morbidity that undoubtedly existed before the 1939-45 war and

the equally large differences in the quality and accessibility of medical resources to deal with them, it was clearly

not enough simply to improve care for everyone:some selective redistribution was necessary, and some has

taken place.  But how much, and is the redistribution accelerating, stagnating, or even going into reverse?

Ann Cartwright’s study of 1370 randomly sampled adults in representative areas of England, and their 552 doctors

[9] gave some evidence on what had and what had not been achieved. She confirmed a big improvement in the

quality of primary care in 1961 compared with 1948 but also found just the sort of class differences suggested by

Titmuss.  The consultation-rate of middle class patients at ages under 45 was 53% less than that of working-class

patients, but at ages over 75 they had a consultation-rate 62% higher; and between these two age-groups there

was stepwise progression. I think it is reasonable to interpret this as evidence that middle-class consultations had

a higher clinical content at all ages, that working-class consultations below retirement age had a higher administr­

ative content, and that the middle-class was indeed able to make more effective use of primary care. Twice as

many middle-class patients were critical of consulting-rooms and of their doctors, and three times as many of

waiting-rooms, as were working-class patients yet Cartwright and Marshall [10] in another study found that in

predominantly working-class areas 80% of the  doctors’ surgeries were built before 1900 and only 5% since 1945;

in middle-class areas less than 50% were built before 1900, and 25% since 1945. Middle-class patients were both  

more critical and better served.  Three times as many middle class patients were critical of the fullness of

explanations to them about their illnesses; it is very unlikely that this was because they actually received less

explanation than working-class patients, and very likely that they expected, sometimes demanded, and usually

received much more.  Cartwright’s study of hospital care showed the same social trend for explanations by

hospital staff.[11] The same study looked at hospital patients’ general practitioners, and compared those working

in middle-class and in working-class areas: more  middle-class area G.P.s had lists under 2000 than did working-

class area G.P.s, and fewer had lists over 2500; nearly twice as many had higher qualifications, more had access

to contrast-Media X-rays, nearly five times as many had access to physiotherapy, four times as many had been to

Oxford or Cambridge, five times as many had been to a London medical school, twice as many held hospital

appointments or hospital beds in which they could care for their own patients, and nearly three times as many

sometimes visited their patients when they were in hospital under a specialist.  Not all of these differences are

clinically significant; so far the record of Oxbridge and the London teaching hospitals compares unfavourably

with provincial medical schools for training oriented to the community.  But the general conclusion must be that

those most able to choose where they will work tend to go to middle-class areas, and that the areas with highest

mortality and morbidity tend to get those doctors who are least able to choose where they will work. Such a

system is not likely to distribute the doctors with highest morale to the places where that morale is most needed. 

Of those doctors who positively choose working-class areas, a few will be attracted by large lists with a big

income and an uncritical clientele; many more by social and family ties of their own.  Effective measures of

redistribution would need to take into account the importance of increasing the proportion of medical students

from working-class families in areas of this sort; the report of the Royal Commission on Medical Education[12]

showed that social class I (professional and higher managerial), which is 2.8% of the population, contributed

34.5% of the final-year medical students in 1961, and 39.6% of the first-year students in 1966, whereas social class

iii (skilled workers, manual and non-manual), which is 49.9% of the population, contributed 27.9% of the final-year

students in 1961 and 21.7% of the first-year in 1966.  The proportion who had received State education was 43.4%

in both years, compared with 70.9% of all school-leavers with 3 or more A-levels.  In other words, despite an

increasing supply of well­qualified State-educated school-leavers, the over­representation of professional families

among medical students is increasing.  Unless this trend is reversed, the difficulties of recruitment in industrial

areas will increase from this cause as well, not to speak of the support it will give to the officers/other ranks’

tradition in medical care and education.

The upgrading of provincial hospitals in the first few years after the Act certainly had a geographical redistributive

effect, and, because some of the wealthiest areas of the country are concentrated in and around London, it also

had a socially redistributive effect.  There was a period in which the large formerly local­ authority hospitals were

accelerating faster than the former voluntary hospitals in their own areas, and some catching-up took place that

was socially redis­tributive.  But the better-endowed, better-equipped, better-staffed areas of the service draw to

themselves more and better staff, and more and better equipment, and their superiority is compounded.  While a

technical lead in teaching hospitals is necessary and justified, these advantages do not apply only to teaching

hospitals, and even these can be dangerous if they encourage com­placency about the periphery, which is all too

common.  As we enter an era of scarcity in medical staffing and austerity in Treasury control, this gap will widen,

and any social redistribution that has taken place is likely to be reversed.

Redistribution of general practitioners also took place at a fairly rapid pace in the early years of the N.H.S., for two

reasons.  First, and least important, were the inducement payments and area classifications with restricted entry to

over-doctored areas.  These may have been of value in discouraging further accumulation of doctors in the Home

Counties and on the coast, but Collings was right in saying that “any hope that financial reward alone will attract

good senior practitioners back to these bad conditions is illusory; the good doctor will only be attracted into

industrial practice by providing conditions which will enable him to do good work”.  The second and more

important reason is that in the early years of the N.H.S. it was difficult for the increased number of young doctors

trained during and just after the 1939-45 war to get posts either in hospital or in general practice, and many took

the only positions open to them, bringing with them new standards of care.  Few of those doctors today would

choose to work in industrial areas, now that there is real choice; we know that they are not doing so.  Of 169 new

general practitioners who entered practice in under-doctored areas between October, 1968, and October, 1969,

164 came from abroad. [13] The process of redistribution of general practitioners ceased by 1956, and by 1961 had

gone into reverse; between 1961 and 1967, the proportion of people in England and Wales in under-doctored

areas rose from 17% to 34%.[14]

Increasing List Size

The quality and traditions of primary medical care in industrial and particularly in mining areas are, I think, central

to the problem of persistent inequality in morbidity and mortality and the mismatched distri­bution of medical

resources in relation to them.  If doctors in industrial areas are to reach take-off speed in reorganising their work

and giving it more clinical content, they must be free enough from pressure of work to stand back and look at it

critically.  With expanding lists this will be for the most part im­possible; there is a limit to what can be expected of

doctors in these circumstances, and the alcoholism that is an evident if unrecorded occupational hazard among

those doctors who have spent their professional lives in industrial practice is one result of exceeding that limit. 

Yet list sizes are going up, and will probably do so most where a reduction is most urgent.  Fry[15]   and Last[16]  

have criticised the proposals of the Royal Commission on Medical Education[17] for an average annual increase

of 100 doctors in training over the next 25 years, which would raise the number of economically active doctors per

million population from 1181 in 1965 to 1801 in 1995.  They claim that there are potential increases in productivity

in primary care, by devolution of work to ancillary and para­medical workers and by rationalisation of administra­

tive work, that would permit much larger average list sizes without loss of intimacy in personal care, or decline in

clinical quality.  Of course, much devolution and rationalisation of this sort is necessary, not to cope with rising

numbers, but to make general practice more clinically effective and satisfying, so that people can be seen less

often but examined in greater depth. If clinically irrelevant work can be devoluted or abolished, it is possible to

expand into new and valuable fields of work such as those opened up by Balint and his school,[18] and the

imminent if not actual possibilities of presymptomatic diagnosis and screening, which can best be done at

primary-care level and is possible within the present resources of general practice.[19]But within the real political

context of 1971 the views of Last, and of Fry from his experience of London suburban practice which is very

different from the industrial areas discussed here, are dangerously complacent.

Progressive change in these industrial areas depends first of all on two things, which must go hand in hand:

accelerated construction of health centres, and the reduction of list sizes by a significant influx of the type of

young doctor described by Barber in 1950[20]

“so prepared for general practice, and for the difference between what he is taught to expect and what he actually

finds, that he will adopt a fighting attitude against poor medicine-that is to say, against hopeless conditions for the

practice of good medicine.  The young man must be taught to be sufficiently courageous, so that when he arrives

at the converted shop with the drab battered furniture, the couch littered with dusty bottles, and the few rusty

antiquated instruments, he will make a firm stand and say “Iwill not practise under these conditions; I will have

more room, more light, more ancillary help, and better equipment.’”

Unfortunately, the medical ethic transmitted by most of our medical schools, at least the majority that do not have

serious departments of general practice and community medicine, leads to the present fact that the young man

just does not arrive at the converted shop; he has more room, more light, more ancillary help, and better

equipment by going where these already exist, and no act of courage is required.  The career structure and

traditions of our medical schools make it clear that time spent at the periphery in the hospital service, or at the

bottom of the heap in industrial general practice, is almost certain disqualification for any further advancement. 

Our best hope of obtaining the young men and women we need lies in the small but significant extent to which

medical students are beginning to reject this ethic, influenced by the much greater critical awareness of students

in other disciplines.  Some are beginning to question which is the top and which the bottom of the ladder, or even

whether there should be a ladder at all; and in the promise of the Todd report, of teaching oriented to the patient

and the community rather than toward the doctor and the disease, there is hope that this mood in a minority of

medical students may become incorporated into a new and better teaching tradition.  It is possible that we may get

a cohort of young men and women with the sort of ambitions Barber described, and with a realistic attitude to the

battles they will have to fight to get the conditions of work and the ­buildings and equipment they need, in the

places that need them; but we have few of them now.  The prospect for primary care in industrial areas for the next

ten years is bad; list sizes will probably continueand the pace of improvement in quality of primary care is likely to


Recruitment to General Practice in South Wales

Although the most under-doctored areas are mainly of the older industrial type, the South Wales valleys have

relatively good doctor/patient ratios, partly because of the declining populations, and partly because the area

produces an unusually high proportion of its own doctors, who often have kinship ties nearby and may be less

mobile on that account. (In Williams’ survey of general practice in South Wales 72% of the 68 doctors were born in

Wales and 43% had qualified at the Welsh National School of Medicine[21] ) On Jan. 1, 1970, of 36 South Wales

valley areas listed, only 4 were designated as under-doctored. However, this situation is unstable; as our future

becomes more apparently precarious, as pits close without alternative local employment, as unemployment rises,

and out-migration that is selective for the young and healthy increases, doctors become subject to the same

pressures and uncertainties as their patients. Recruitment of new young doctors is becoming more and more

difficult, and dependent on doctors from abroad.  Many of the industrial villages are separated from one another by

several miles, and public transport is withering while as yet comparatively few have cars, so that centralisation of

primary care is difficult and could accelerate the decay of communities. These communities will not disappear,

because most people with kinship ties are more stubborn than the planners, and because they have houses here

and cannot get them where the work is; the danger is not the disappearance of these communities, but their

persistence below the threshold of viability, with accumulating sickness and a loss of the people to deal with it.

What Should Be Done ?

Medical services are not the main determinant of mortality or morbidity; these depend most upon of standards of

nutrition, housing, working environment, and education, and the presence or absence of war. The high mortality

and morbidity of the South Wales valleys arise mainly from lower standards in most of these variables now and in

the recent past, rather than from lower standards of medical care.  But that is no excuse for failure to match the

greatest need with the highest standards of care.  The bleak future now facing mining communities, and others

that may suffer similar social dislocation as technical, change blunders on without agreed social objectives,

cannot be altered by doctors alone; but we do have a duty to draw attention to the need for global costing when it

comes to policy decisions on redevelopment or decay of established industrial communities.  Such costing would

take into account the full social costs and not only those elements of profit and loss traditionally recognised in


The improved access to medical care for previously deprived sections under the N.H.S. arose chiefly from the

decision to remove primary-care services from exposure to market forces.  The consequences of distribution of

care by the operation of the market were unjust and irrational, despite all sorts of charitable modifications.  The

improved possibilities for con­structive planning and rational distribution of resources because of this decision are

immense, and even now are scarcely realised in practice.  The losses predicted by opponents of this change have

not in fact occurred; consultants who no longer depend on private practice have shown at least as much initiative

and responsi­bility as before, and the standards attained in the best N.H.S. primary care are at least as good as

those in private practice.  It has been proved that a national health service can run quite well without the profit

motive, and that the motivation of the work itself can be more powerful in a decommercialised setting.  The gains

of the service derive very largely from the simple and clear principles on which it was conceived: a comprehensive

national service, available to all, free at the time of use, non-contributory, and financed from taxation. Departures

from these principles, both when the service began (the tripartite division and omission of family-planning and

chiropody services) and subsequently (dental and prescription charges, rising direct contributions, and relative

reductions in financing from taxation), have not strengthened it.  The principles themselves seem to me to be

worth defending, despite the risk of indulging in unfashionable value-judgments.  The accelerating forward move­

ment of general practice today, impressively reviewed in a symposium on group practice held by the Royal

College of General Practitioners,[22]is a movement (not always conscious) toward these principles and the ideas

that prevailed generally among the minority of doctors who supported them in 1948, including their material

corollary, group practice from health centres.  The doctor/patient relationship, which was held by opponents of the

Act to depend above all on a cash transaction between patient and doctor, has been transformed and improved by

abolishing that trans­action.  A general practitioner can now think in terms of service to a defined community, and

plan his work according to rational priorities.

Godber[23] has reviewed this question of medical priorities, which he sees as a new feature arising from the much

greater real effectiveness of modern medicine, which provides a wider range of real choices, and the great

costliness of certain forms of treatment.  While these factors are important, there are others of greater importance

which he omits.  Even when the content of medicine was overwhelmingly palliative or magical -say, up to the 1914-

18 war- the public could not face the intolerable facts any more than doctors could, and both had as great a sense

of priorities as we have; matters of life and death arouse the same passions when hope is illusory as when it is

real, as the palatial Swiss tuberculosis sanatoria testify.  The greatest difference, I think, lies in the transformation

in social expectations.  In 1914 gross inequality and injustice were regarded as natural by the privileged,

irresistible by the unprivileged, and inevitable by nearly everyone.  This is no longer true; inequality is now

politically dangerous once it is recognised, and its inevitability is believed in only by a minority.  Diphtheria

became preventable in the early 1930s, yet there were 50,000 cases in England and Wales in 1941 and 2400 of

them died.[24]   I knew one woman who buried four of her children in five weeks during an outbreak of  diphtheria

in the late 1930s.  No systematic national campaign of immunisation was begun until well into the 1939-45 war

years, and, if such a situation is unthinkable today, the difference is political rather than  technical.  Godber rightly

points to the planning of hospital services during the war as one starting-point of the change; but he omits the

huge social and political fact of 1945: that a majority of people, having experienced the market distribution of

human needs before the war, and the revelation that the market could be overridden during the war for an agreed

social purpose, resolved never to return to the old system.

Perhaps reasonable economy in the distribution of medical care is imperilled most of all by the old ethical concept

of the isolated one-doctor/one-patient relationship, pushed relentlessly to its conclusion regardless of cost-or to

put it differently, of the needs of others.

The pursuit of the very best for each patient who needs it remains an important force in the progress of care; a

young person in renal failure may need a doctor who will fight for dialysis, or a grossly handicapped child one

who will find the way to exactly the right department, and steer past the defeatists in the wrong ones.  But this

pursuit must pay some regard to humane priorities, as it may not if the patient is a purchaser of medical care as a

commodity.  The idealised, isolated doctor/patient relationship, that ignores the needs of other people and their

claims on the doctor’s time and other scarce resources, is incom­plete and distorts our view of medicine.  During

the formative period of modern medicine this ideal situa­tion could be realised only among the wealthy, or, in the

special conditions of teaching hospitals, among those of the unprivileged with “interesting” diseases.  The

ambition to practise this ideal medicine under ideal conditions still makes doctors all over the world leave those

who need them most, and go to those who need them least, and it retards the development of national schools of

thought and practice in medicine, genuinely based on the local content of medical care.  The ideal isolated

doctor/patient relation has the same root as the 19th-century preoccupation with Robinson Crusoe as an

economic elementary particle; both arise from a view of society that can perceive only a con­tractual relation

between independent individuals.  The new and hopeful dimension in general practice is the recognition that the

primary-care doctor interacts with individual members of a defined community.  Such a community-oriented

doctor is not likely to encourage expensive excursions into the 21st century, since his position makes him aware,

as few specialists can be, of the scale of demand at its point of origin, and will therefore be receptive to common-

sense priorities.  It is this primary-care doctor who in our country initiates nearly every train of causation in the use

of sophisticated medical care, and has some degree of control over what is done or not done at every point.  The

commitment is a great deal less open-ended than many believe; we really do not prolong useless, painful, or

demented lives on the scale sometimes imagined.  We tend to be more interested in the people who have diseases

than in the diseases themselves, and that is the first requirement of reasonable economy and a humane scale of


Return to the Market ?

The past ten years have seen a spate of papers urging that the N.H.S. be returned wholly or partly to the operation

of the market. Jewkes,”[25] Lees,[26] Seale,[27] and the advisory planning panel on health services financing of

the British Medical Association[28] have all elaborated on this theme.  Their arguments consist in a frontal attack

on the policy of removing health care from the market, together with criticism of faults in the service that do not

necessarily or even probably depend on that policy at all, but on the failure of Governments to devote a sufficient

part of the national product to medical care.  These faults include the stagnation in hospital building and senior

staffing throughout the 1950s, the low wages throughout the service up to consultant level, over-centralised

control, and failure to realise the objective of social and geographical equality in access to the best medical care.

None of these failings is intrinsic to the original principles of the N.H.S.; all have been deplored by its supporters,

and with more vigour than by these critics.  The critics depend heavily on a climate of television and editorial

opinion favouring the view that all but a minority of people are rich enough and willing to pay for all they need in

medical care (but not through taxation), and that public services are a historically transient social form, appropriate

to indigent populations, to be discarded as soon as may be in favour of distribution of health care as a bought

commodity, provided by competing entrepreneurs.  They depend also on the almost universal abdication of

principled opposition to these views, on the part of its official opponents.  The former Secretary of State for Social

Services, Mr. Richard Crossman, has agreed that the upper limit of direct taxation has been reached, and that “we

should not be afraid to look for alternative sources of revenue less dependent on the Chancellor’s whims. . . . I

should not rule out obtaining a higher proportion of the cost of the service from the Health Service

contribution.”[29] This is simply a suggestion that rising health costs should be met by flat-rate contributions

unrelated to income – an acceptance of the view that the better-off are taxed to the limit, but also that the poor can

afford to pay more in proportion.  With such opposition, it is not sur­prising that more extravagant proposals for

substantial payments at the time of illness, for consultations, home visits, and hospital care, are more widely

discussed and advocated than ever before.

Seale[30] proposed a dual health service, with a major part of hospital and primary care on a fee paying basis

assisted by private insurance, and a minimum basic service excluding the “great deal of medical care which is of

only marginal importance so far as the life or death or health of the individual is concerned.  Do those who want

the Health Service to provide only the best want the frills of medical care to be only the best, or have they so little

understanding of the nature of medical care that they are unaware of the existence of the frills?” Frills listed by

Seale are: “time, convenience, freedom of choice, and privacy”. He says that ” it is precisely these facets of

medical care-the ‘middle class’ standards-which become more important to individuals as they become more

prosperous “. Do they indeed? Perhaps it is not much that they (and other frills such as courtesy, and willingness

to listen and to explain, that may be guaranteed by payment of a fee) become more important as that they become

accessible.  The possession of a new car is an index of prosperity; the lack of one is not evidence that it is not

wanted.  Real evidence should be provided that it is possible to separate the components of medical care into frills

that have no bearing on life, death, or health, and essentials which do. Life and happiness most certainly can hang

on a readiness to listen, to dig beneath the presenting symptom, and to encourage a return when something

appears to have been left unsaid.  And not only the patient-all patients value these things; to practice without them

makes a doctor despise his trade and his patients.  Where are the doctors to be found to undertake this veterinary

care? It need not be said; those of us who already work in industrial areas are expected to abandon the progress

we have made toward universal, truly personal care and return to the bottom half of the traditional double


This is justified in anticipation by Seale:

“some doctors are very much better than others and this will always be so, and the standard of care provided will

vary within wide limits . . . the function of the state is, in general, to do those things which the individual cannot do

and to assist him to do things better. It is not to do for the individual what he can well do for himself …I should like

to see reform of the Health Service in the years ahead which is based on the assumption of ­individual

responsibility for personal health, with the State’s function limited to the prevention of real hardship and the

encouragement of personal responsibility.”

Lees[31] central thesis is that medical care is a commodity that should be bought and sold as any other, and

would be optimally distributed in a free market.  A free market in houses or shoes does not distribute them

optimally, rich people get too much and the poor too little, and the same is true of medical care.  He claims that the

N.H.S. violates “natural” economic law, and will fail if a free market is not restored, in some degree at least, and that

in a free market “we would spend more on medical care than the government does on our behalf “. If the “we” in

question is really all of us, no problem exists; we agree to pay higher income tax and/or give up some million-

pound bombers or whatever, and have the expanding service we want. But if the “we” merely means “us” as

opposed to “them”, it means only that the higher social classes will pay more for their own care, but not for the

community as a whole.  They will then want value for their money, a visible differential between commodity-care

and the utility brand; is it really possible, let alone desirable, to run any part of the health service in this way?

Raymond Williams[32] put his finger on the  real point here:

“we think of our individual patterns of use in the favourable terms of spending and satisfaction, but of our social

patterns of use in the unfavourable terms of deprivation and taxation.  It seems a fundamental defect of our society <