Skin cells 'turned into neurons'

26 May 2011 Last updated at 19:25 GMT By Neil Bowdler Science reporter, BBC News An image of neurons in the brain. The researchers claim such cells can be made from skin cells A Californian team say they have managed to convert human skin cells directly into functioning brain cells.

The scientists manipulated the process by which DNA is transcribed within foetal skin cells to create cells which behaved like neurons.

The technique had previously been demonstrated in mice, says the report in Nature.

It could be used for neurological research, and might conceivably be used to create brain cells for transplant.

Reprogrammed skin

The scientists used genetically modified viruses to introduce four different "transcription factors" into foetal skin cells. These transcription factors play a role in the "reading" of DNA and the encoding of proteins within the cell.

Continue reading the main story

We showed that it is possible to convert human skin cells directly into cells which look and behave like nerve cells”

End Quote Marius Wernig Stanford University They found the introduction of these four transcription factors had the effect of switching a small portion of the skin cells into cells which functioned like neurons.

Unlike other approaches, the process did not involve the reprogramming of the skin cells into stem cells, but rather the direct transformation of skin cells into neurons.

Marius Wernig, an assistant professor of pathology at Stanford University School of Medicine in California, was one of the researchers.

"We showed that it is possible to convert human skins cells directly into nerve cells which look and behave like nerve cells which usually only exist in the brain," he told BBC News.

"It was known that it was possible to change a specialised cell back into a stem cell, what's called an induced pluripotent stem cell (iPS), but it was not known whether a specialised cell could be pushed into another direction, other than backwards."

Professor Wernig conceded that there were examples, some dating back many years, where specialised cells have been switched into similar cell types, but he believes this is the first example of where cells have undergone such radical conversion.

He believes the immediate application will be in modelling diseases, whereby skin cells from a patient with a known neurological condition could be used to produce new brain cells for research.

"It is very very difficult to look into the brain. There is a big skull which protects the brain very well and therefore it's difficult to image," he said.

"Everything that can be done at a cellular level is only possible after a patient has died, by which time the disease is usually in the final stages and you have no chance of seeing how the disease develops."

Future treatments

The technique might one day also be used to create new brain cells which could be transplanted into patients with neurological disorders, he said.

Created from the patient's own skin, these cells would be an exact match for the patient, although there would be many obstacles to overcome, not least the challenge of producing enough of the right type of brain cells.

Commenting on the study, Jim Huettner, an associate professor at Washington University School of Medicine, said the research was "convincing and important".

"They have shown similar things in mice before but in humans they've discovered some subtle differences which often turn up when moving from mice to humans," he said.

"But the work solidifies the idea that this kind of transition is possible and that it's not just some fluke in the mice model."

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Alarm over elderly patient care

26 May 2011 Last updated at 00:24 GMT By Dominic Hughes Health correspondent, BBC News The Care Quality Commission carried out 100 unannounced inspections Serious concerns have been raised by the NHS care regulator about the way some hospitals in England look after elderly patients.

The Care Quality Commission said three had failed to meet legal standards for giving patients enough food and drink and treating them in a dignified way.

They were Alexandra Hospital, Redditch, the Royal Free, in London, and Ipswich.

The CQC, which carried out unannounced inspections, also raised concerns about three other NHS hospitals.

The commission has published the first 12 results of 100 such inspections, called for by the health secretary Andrew Lansley after a long campaign by the Patients Association, which highlighted poor care for the elderly.

While its inspectors said there had been many examples of people being treated with respect and given excellent care, in other cases people had not been helped to eat and drink, "with their care needs not assessed and their dignity not respected".

All six hospitals about which concerns were raised must now say how and when they will improve.

The worst three offenders will have to improve or face action from the regulator.

Continue reading the main story This is the first report of the Care Quality Commission's Dignity and Nutrition programmeIt covers 12 hospitals and by September the full picture of the rest for the country will be revealedOf the 12 that were looked at, three were found to be failing essential standardsAnother three had less serious failings, the regulator saidAll six have been told to come up with plans to rectify the situationThe programme was started following a request by Health Secretary Andrew Lansley following concerns raised by the Patients AssociationPrescribing water The inspections looked at nutrition and found cases of patients not being helped to eat, poor monitoring of patients' weight and people not being given enough to drink, with water being out of reach for long periods of time.

In one case, a member of staff at Worcestershire Acute Hospitals NHS Trust said they had to prescribe water on medical charts to ensure patients got enough to drink.

Inspectors also looked at dignity and respect, noting that elderly patients were sometimes not involved in their own care and were given no explanation of the treatment they were to receive or asked for consent.

Staff also treated people in a disrespectful way, spooning food into their mouths without engaging them.

One man told inspectors that staff "talk to me as if I'm daft".

Chief Executive John Rostill, Worcestershire Acute Hospitals: "This is a real wake up call"

The reports acknowledge examples of excellent care where treatment was explained in a way patients could understand and they were treated with respect and dignity.

Jo Williams, chair of the CQC, said the inspections had built a detailed picture of the care being received by elderly patients in NHS hospitals in England.

"Many of these reports describe people being 'cared for' in the truest sense. Sadly, however, some detail omissions which add up to a failure to meet basic needs - people not spoken to with respect, not treated with dignity, and not receiving the help they need to eat or drink.

"These are not difficult things to get right - and the fact that staff are still failing to do so is a real concern. These are the basics that help ensure every patient is treated like an individual - not a nuisance to be ignored or a task that must be completed.

"This is what we expect for ourselves and for our own families, and what every patient should expect from the people who care for them."

Enforcement powers

Health Secretary Andrew Lansley said that everyone admitted to hospital deserved to be treated as an individual, with compassion and dignity.

"The inspection teams have seen some exemplary care, but some hospitals are not even getting the basics right. That is unacceptable.

Continue reading the main story

What the inspectors observed on that day was not acceptable and it has been something we have taken very seriously indeed”

End Quote Helen Blanchard Worcestershire Acute Hospitals NHS Trust "Where the inspections uncovered appalling levels of care, the CQC will be able to use its enforcement powers to ensure that real improvements are made."

One of the hospitals found to have problems was the Royal Free Hampstead NHS Trust.

In a statement the hospital said it was disappointed by the CQC report, but that it took the findings very seriously.

"Following the CQC's concerns, we immediately implemented an action plan to make sure we comply with both the letter and the spirit of the standards," it said.

"As part of the action plan, we are rolling out a programme of 'nurse rounding' which ensures that every patient is reviewed by a nurse at least once an hour to ensure their comfort and needs are met.

"We will continue to ensure that all measures are taken to respect patients' privacy, dignity and confidentiality and patients are put at the centre of communication about their care."

Siobhan Jordan, director of nursing at the Ipswich Hospital NHS Trust, said: "The trust was disappointed by, but responsive to, the findings of the review team. Much work is under way within the trust, particularly focusing on meeting the needs of the older person.

"The trust recognises the value of the regulator's unannounced visit and continues to focus on improving care at the hospital."

Worcestershire Acute Hospitals NHS Trust said it was "extremely disappointed" by the findings and had already shown "significant improvements".

Apology

Director of nursing and midwifery Helen Blanchard said: "I'd like to apologise to the patients and their families that were affected by the care that this report refers to.

"What the inspectors observed on that day was not acceptable and it has been something we have taken very seriously indeed."

She said the findings were an unpleasant surprise because service on the wards concerned had been traditionally "very good".

The trust would continue to carry out its own unannounced ward visits to monitor standards, she added.

More CQC reports will be published over the summer with the findings of the programme of inspections released in the autumn.

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Less childhood sleep has fat risk

27 May 2011 Last updated at 06:34 GMT Lack of sleep when young can lead to higher weight and attendant health risks Children who get insufficient sleep at night are more likely to become overweight, according to researchers in New Zealand.

A study, published on the BMJ website, followed 244 children between the ages of three and seven.

It said more sleep was linked to a lower weight, which could have important public health consequences.

UK experts said there was "no harm" in drawing attention to the link between reduced sleep and ill health.

The children were seen every six months when their weight, height and body fat were measured. Their sleeping habits and physical-activity levels were recorded at ages three, four and five.

The researchers found that those children who had less sleep in their earlier years were at greater risk of having a higher Body Mass Index at age seven.

This link continued even when other risk factors, such as gender and physical activity, were accounted for in their research.

'Health risk'

Suggested reasons for the link include simply having more time to eat and changes to hormones affecting appetite.

In an accompanying analysis, Professors Francesco Cappuccio and Michelle Miller, from the University of Warwick, said future research should "explore and validate new behavioural, non-drug based, methods to prolong children's and adults' sleeping time.

"In the meantime it would do no harm to advise people that a sustained curtailment of sleeping time might contribute to long-term ill health in adults and children."

Dr Ian Maconochie, from the Royal College of Paediatrics and Child Health said: "Children under five generally average at least 11 hours sleep at night and in daytime naps.

"However, 20% of children at this age experience problems sleeping, and we already know that inadequate sleep has a significant impact on attention, memory, behaviour, and school performance. This paper is a useful addition to our knowledge of children's sleep patterns."

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Measles outbreak prompts jab plea

27 May 2011 Last updated at 10:12 GMT By Philippa Roxby Health reporter, BBC News Dr Mary Ramsay: "You're never too old to get vaccinated".

Parents in England and Wales are being urged to have their children vaccinated after a tenfold rise in measles cases in the first four months of the year.

The Health Protection Agency reported 334 cases compared with 33 in the similar period last year.

The outbreak is thought to be linked to an epidemic in France, where 7,000 cases have been reported since January - more than in the whole of 2010.

The HPA says it is "crucial" that those at risk are fully immunised.

It says the latest cases are mainly among unvaccinated people under 25 years old and are centred on "small clusters in universities, schools or families or associated with travel abroad".

Worst-hit are London and the South East, with 104 and 102 confirmed cases respectively in the first quarter of this year.

Recently the Health Protection Agency sent out letters to some primary schools and further education colleges in London warning of the risks of taking children who are not fully immunised to mainland Europe.

'Potentially dangerous' Dr Mary Ramsay, head of immunisation at the Health Protection Agency, warned parents and young adults of the importance of immunisation.

"Although MMR coverage has improved over the last few years, we cannot stress enough that measles is serious and in some cases it can be fatal.

"Measles is a highly infectious and potentially dangerous illness which spreads very easily.

"Whether you stay here in the UK or travel abroad, it is crucial that individuals who may be at risk are fully immunised."

Continue reading the main story How safe is it to take children to mainland Europe who have had two doses of the MMR vaccine?

It gives 99% protection against the measles virus.

What if they have had only one dose of MMR?

One dose is better than none, but two doses is better than one. If you are concerned about travelling to an outbreak area you can bring forward the second MMR dose. Speak to your GP about it.

What if my children are not vaccinated at all?

The advice is to go to your GP and arrange for them to be immunised as soon as possible before you travel. Measles is a dangerous viral illness which can be fatal.

BBC Health - Measles

In the UK, two doses of the MMR vaccine are usually given, the first at around 12 months and the second around the time of starting school.

The HPA advises parents to contact their GP as soon as possible if their child is over a year old and has never had the MMR jab.

Two doses of the MMR vaccine are required to provide the greatest protection against measles.

HPA figures show that the number of toddlers getting the MMR vaccination is climbing steadily, but is still far from the 95% uptake rate needed to stop the spread of the disease in the community.

In December 2010, 89.4% of two-year-old children in the UK had received their first dose of the MMR vaccine.

For five-year-olds, the uptake rate had risen to 92.8%.

Continue reading the main story It is a highly infectious viral illnessIt causes a fever, coughing and distinctive red-brown spots on the skinMeasles is contracted by breathing in tiny droplets created when an infected person coughs or sneezesPossible complications include pneumonia, ear and eye infections and croupSerious complications include inflammation of the brain (encephalitis), which can be fatalMeasles in pregnancy can cause miscarriage, premature labour or a baby with low birth weightThe most effective way of preventing measles is the measles, mumps and rubella (MMR) vaccineThere is no link between the MMR vaccine and autismControversial research The vaccination rate had been well below 95% for several years, ever since The Lancet published controversial research about the MMR vaccine in 1998.

The study has since been discredited, but confidence in the combined measles, mumps and rubella vaccine has been slow to return.

In Scotland, there have been 12 confirmed cases of measles between January and April, compared with no cases at all for the same time last year.

Since the start of 2011 Northern Ireland has had one confirmed case of measles.

In France, the figure of 7,000 cases so far this year already exceeds the 5,090 recorded in the whole of 2010.

The World Health Organization said France was taking immediate steps to control the outbreaks by vaccinating infants at nine months and offering the vaccine to all unimmunised or under-immunised people over that age.

Other European countries reporting an increase in cases of measles are Belgium, Denmark, Finland, Germany, Norway, Romania, the Russian Federation, Sweden and Switzerland.

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Future model?

26 May 2011 Last updated at 22:28 GMT Hinchingbrooke hospital staff will remain employed by the NHS In his first major speech on the NHS on Thursday, Nick Clegg made the case for competition where it could improve services for patients.

One NHS hospital is due to have its management taken over by a social enterprise after a competative tendering process, an approach that could be tried with other struggling hospitals, as health correspondent Branwen Jeffreys reports.

Hinchingbrooke hospital, near Huntingdon, in Cambridgeshire, will be run by Circle on a 10-year contract expected to be finalised soon.

Health unions say such takeovers open up the NHS to another form of competition.

It will be the first time a "social enterprise" has taken over the management of an NHS trust in this kind of deal. NHS managers say Circle will have to meet health service standards and pay off the hospital's debt.

The contract awarded to Circle is a fresh approach for NHS hospitals struggling to make their finances work. Under the deal, the hospital buildings will remain in public ownership and the staff will continue to be employed by the NHS.

Hinchingbrooke has a debt of around ?40m on an annual turnover of ?90m. Circle will have the power to make changes, including hiring and firing staff. It will be paid NHS prices to meet NHS standards.

The social enterprise will have to repay the hospital's debts through finding cost savings. Only then can it make any profit, leaving some to privately describe the challenge as a tall order.

'Future model'

Dr Stephen Dunn, from the East of England Strategic Health Authority, says the choice of Circle was not ideological. NHS trusts were also invited to bid to take over the hospital in the efforts to avoid it closing.

He said the final decision was pragmatic: "We wanted the best deal for patients, the public and the taxpayer. I think it will be a model for the future; the NHS faces major challenges in terms of efficiency. "

Circle's flagship hospital in Bath

The process of putting the managment of Hinchingbrooke out to tender was mainly conducted under the last government. Under the coalition's plans for the NHS in England, all hospital trusts will have to meet strict financial standards by 2014 or find another solution. That could involve being taken over by another NHS Foundation Trust, or the approach being tried in Hinchingbrooke.

Circle describes itself as a social enterprise which is co-owned by its clinicians. Ali Parsa, the chief executive, is a former Goldman Sachs banker turned healthcare entrepreneur. Already Circle is treating more than 100,000 NHS patients a year at a treatment centre in Nottingham.

Its flagship hospital is just outside Bath, where it competes with local NHS trusts for routine surgery. Designed by award-winning architects, its lobby feels more like a smart hotel than a hospital. Unlike an NHS hospital there are no emergency services, but Mr Parsa insists they are up to the challenge of running a full district hospital.

It is likely they will cut management costs substantially at the NHS trust in Huntingdon, as Circle plans to divide the hospital into units led by senior doctors and nurses. Mr Parsa described their core philosophy.

"We believe that it should be doctors and nurses - healthcare professionals - that run hospitals. We don't think they should be slaves of the state. We think they should run services for the benefit of their patients."

Every patient treated by Circle is asked what needs to be improved. The company says it aims to make changes within three months of a problem being identified. Acheiving that in a bigger hospital could be harder.

Karen Jennings, assistant general secretary of Unison, told me the union was prepared to work with Circle at Hinchingbrooke, but was wary of this approach being tried elsewhere in the NHS.

"The long-term consequences are another matter. Circle will learn everything it can about running a district general hospital and it will then move in to compete with the NHS."

It is not clear how many in the local community share those concerns. In 2006, when Hinchingbrooke hospital's future looked much less certain, many people joined a campaign to safeguard its future, turning out for marches and rallies. The campaign was supported by David Cameron, as then Opposition leader.

Now that campaign has dwindled. Local patients, and many in the NHS, will be watching Hinchingbrooke carefully to see if this is a model which can work.

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Woman's treatment 'was degrading'

26 May 2011 Last updated at 17:02 GMT The watchdog recommended better training and monitoring of care A Scottish hospital has been severely criticised over the care of an 80-year-old woman with dementia.

BBC Scotland has learned that the hospital involved was Ninewells in Dundee.

Before her death, the woman was given dozens of sedative doses over 16 days in ways the Mental Welfare Commission deemed distressing and unnecessary.

NHS Tayside said the treatment was "woefully inadequate" and said it had begun a programme of improvements.

The woman, known as Mrs V, has not been named to protect her family's identity.

Mrs V was admitted to a ward for the elderly at Ninewells in December 2008 after she developed a chest infection, which meant she had difficulty swallowing. She also had dementia.

Continue reading the main story

Our investigation revealed that nursing attitudes, medical decision-making and monitoring of medication were poor”

End Quote Dr Donald Lyons Mental Welfare Commission for Scotland Over 11 days she was given no food and became increasingly agitated because she could not understand why people around her were eating.

She was given sedatives rectally 57 times and by injection 29 times, an amount described in a report as "astonishing".

Eventually, when she was allowed to eat small amounts, she became calmer and did not need as much sedation. The woman later died in hospital.

The Mental Welfare Commission for Scotland, which examined the case, said her treatment was degrading, unnecessary, and may have breached her human rights.

The commission's report, Starved of Care, said Mrs V was given repeated, uncomfortable and undignified administrations of sedative medication.

'Not typical'

Dr Donald Lyons, chief executive of the commission, said: "We found this to be a wholly inappropriate way to treat a person with severe dementia and life-threatening physical illness.

"Our investigation revealed that nursing attitudes, medical decision-making and monitoring of medication were poor, and that there was a complete lack of a shared view on the best way to manage people with dementia who become physically ill."

Several recommendations for improvement and better training have been made and subsequent visits to the hospital found care had been improved.

Continue reading the main story

Since this event we have initiated a number of service improvement programmes for dementia patients”

End Quote Dr Margaret McGuire NHS Tayside The recommendations to the NHS board involved included training on the management of delirium and use and misuse of medication, along with risk assessment guidance and triggers for advice from mental health specialists.

The commission added that visits to a range of general hospitals suggested the case was not typical of the care which people with dementia receive.

Dr Margaret McGuire, NHS Tayside director of nursing, said: "The standards of care received by this patient were woefully inadequate, wholly inappropriate and utterly unacceptable.

"Since this event we have initiated a number of service improvement programmes for dementia patients.

"As part of these improvements, we have appointed a nurse consultant in dementia care who is leading improvements in care for our dementia patients and ensuring all members of staff who care for dementia patients have appropriate training and education."

Ms McGuire added that the Mental Welfare Commission had revisited the hospital twice since the case and had acknowledged the improvements.

A Scottish government spokesman also branded the care given as "unacceptable".

He said: "Many of the issues the report identifies are already being addressed through the national dementia strategy published last summer. Work is well under way at national and local level to make these improvements and we expect that to continue over the coming months.

"For example, the strategy - Scotland's first ever for dementia - was clear that general care in acute hospitals needs to get better at identifying and supporting people who have dementia."

Standards of care for people with dementia are due to be published next week.

A spokeswoman from the Scottish Human Rights Commission said: "The possible infringements of core human rights principles as highlighted in the report - the right to dignity and to be free from degrading treatment - need to be taken seriously and lessons learned by all."

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Apology over NHS cutback figures

27 May 2011 Last updated at 14:06 GMT An economist has apologised to the Welsh Government for an error over figures about cuts in health spending.

Health think tank King's Fund says the correct figure over three years should have been a fall of 8.3% rather than a reported figure of nearly 11%.

The Welsh Government has accepted the correction, stating that 40% of its budget will be spent on health and social services.

Economist John Appleby has apologised to Health Minister Lesley Griffiths.

Continue reading the main story

More than 40% of the overall Welsh budget will be invested in providing health and social services for the people of Wales”

End Quote Welsh Government spokesperson "In his letter to the minister, Prof Appleby has apologised for an error that exaggerated the real change in Wales' NHS spending.

"Ahead of the publication of the report, the Welsh Government had queried the four-year forecasts released by the King's Fund. This error was acknowledged by Prof Appleby on Wednesday morning."

Writing for the British Medical Journal (BMJ), Mr Appleby said the NHS in Wales is set for a budget cut of nearly 11% over three years, but that figure has since been revised to -8.3%.

The new figure is still considerably bigger than the 0.9% cut for England and 2.2% cut by 2014/15 in Northern Ireland.

A Welsh Government spokesperson said: "The health service has, and will, continue to be a priority for the Welsh Government - despite the financial constraints imposed on us by the UK Government.

"This commitment is demonstrated by the ?77m investment in Ysbyty Glan Clwyd announced yesterday - and the fact that more than 40% of the overall Welsh budget will be invested in providing health and social services for the people of Wales."

In Scotland, NHS spending will be cut in real terms by around 3.3% this year, with no plans yet made for spending in subsequent years.

For the UK NHS as a whole, funding will be cut in real terms by 2014/15.

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NHS overhaul

26 May 2011 Last updated at 17:12 GMT By Nick Triggle Health correspondent, BBC News The NHS changes affect only England The NHS listening exercise is drawing to a close, but still the criticisms keep coming.

The British Medical Association has now weighed in, suggesting the health bill for England may even need to be withdrawn.

This is despite the government spending the last six weeks trying to get critics on board.

More than 200 listening events have been held with thousands of doctors, nurses and patients.

Health Secretary Andrew Lansley has himself been to 30 - about one for every working day.

He has been joined by both the prime minister and deputy prime minister at times.

Submissions have also been made via the internet, while leading organisations have written to David Cameron personally.

So what now?

Officially, the government is saying no decisions will be made until the report of the NHS Future Forum, the group which led the listening exercise, is in.

The forum has been chaired by Professor Steve Field, the former leader of the Royal College of GPs.

He will spend the next week or so writing his report after the completion of the final listening events over the next few days. It is expected to make a wide range of recommendations about how the plans need to be altered.

Professor Field has already made it clear greater clarification is needed over the issue of competition. Under the current proposals, there is a duty on the economic regulator, Monitor, to promote competition.

Whether this goes completely - as some critics have called for - remains to be seen, but there is likely at least to be a change in tone with more emphasis placed on collaboration between the NHS, private sector and charities.

Professor Field is also known to be looking at whether primary care trusts - the management bodies Mr Lansley wants to scrap - should stay on in some form to support GP consortia.

A combination of poor election results and the fall-out from the tuition fees row has meant the Lib Dems have come out fighting on the NHS.

Nick Clegg has made it clear he wants to see changes, particularly to the role of Monitor.

His positioning has meant clear divisions have begun to open up in the coalition for arguably the first time.

He has talked about being a moderating influence in the government, much to the annoyance of many in the Tory party.

In many ways, the listening event has changed the nature of the coalition - and both parties need to adjust to that. And quickly.

Mr Lansley faced perhaps his more difficult day of the last two months when he visited the Royal College of Nursing conference in Liverpool before Easter.

On the morning of his visit delegates gave him a vote of no confidence. He then faced a meeting of more than 60 nurses amid claims he was running scared of the full conference hall.

And, of course, the BMA has now set out its concerns.

Without warmer words from groups such as the BMA and RCN in the coming months, it will be difficult for the government to get the reforms back on track.

It seems whatever concessions are made need to answer their criticisms.

With so many vested interests, those on the front-line in the NHS have begun to voice fears the pause could lead to a series of cobbled together, contradictory concessions.

This would be the worst outcome. Almost all those involved in the NHS believe change is necessary to deal with the demands of the ageing population, cost of new drugs and lifestyle changes, such as obesity.

If there is not a clear vision for the future, the NHS could find itself struggling to just maintain standards never mind improve them.

Officials have already talked about giving themselves a few weeks once Professor Field has submitted his report before announcing what concessions will be made.

The prime minister, deputy prime minister and health secretary have all talked about substantial changes.

The challenge is making them in a coordinated way that convinces those working in the health service and the public that relies on it that the government has got it right this time. It promises to be a tricky balancing act.

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Charities urge NHS bill revision

27 May 2011 Last updated at 00:58 GMT By Adam Brimelow Health Correspondent, BBC News The NHS changes affect only England A group of 40 charities says the government's plans for health changes in England must be revised to give a voice to the most vulnerable patients.

They say the current proposals fail to ensure that patients will be properly consulted in the planning of services.

The charities have issued a statement setting out six "much-needed" changes.

The coalition government says there will be substantive changes, and describes feedback from organisations such as these as "invaluable".

This statement has a long and impressive list of signatories, including the Alzheimer's Society, the Patient's Association and the National Autistic Society.

The charities set out a series of demands designed to ensure that the public, patients and carers have a say - especially those least able to speak up for themselves.

"Seeking out views"

That means requiring GP consortia - which will handle most of the NHS budget - to be proactive in seeking out their views.

They also call for changes to improve the links between health and social care, a stronger system of patient advocacy, and better access to specialised services for people with complex needs.

The statement says the uncertainty surrounding the NHS does not help anyone, but it welcomes the government's listening exercise.

"The Department of Health needs to use this time to substantially improve the Health and Social Care Bill," it says.

Continue reading the main story

The Patients Association have raised the concerns of patients regarding the proposed changes to the NHS ever since they were announced last July. Patients think the changes are happening too fast and do not feel they have been consulted”

End Quote Katherine Murphy Patient's Association Patient Association chief executive Katherine Murphy said the organisation was constantly hearing on its helpline from people who were worried about the changes.

"Patients are worried about GP commissioning - will GPs deviate from the clinical to the commercial? Will they be referred on to the best services or those that are going to make their GP more money? Will the changes mean shorter appointment times with GPs as they have to focus on balancing the books?"

Mencap's chief executive, Mark Goldring, said it was vital to ensure that the health system worked for the most vulnerable patients.

"It is essential that the government keeps patients at the heart of NHS reforms and ensure that the most vulnerable in our society, such as those with a learning disability, have access to the good quality healthcare they need."

'Greater clarity'

National Autistic Society chief executive Mark Lever called for greater clarity.

"We need a clearer indication from the Department of Health about exactly what the future will look like for NHS services", he said.

The charities' intervention comes just a day after Deputy Prime Minister Nick Clegg said that the right kind of reform came "from the patients' point of view".

In a statement a Department of Health spokesperson said: "We agree that patients need to be at the heart of modernising the NHS - this has always been the central aim of our plans. But we recognise that there have been some concerns, and feedback from organisations such as these is invaluable to make sure we get this right.

"The health secretary has been clear that there will be substantive changes to the bill if they deliver improvements for patients. We await the recommendations from the NHS Future Forum, expected next month."

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Beauty for Ashes

27 May 2011 Last updated at 06:04 GMT Melanie with her sons Leo, 1, and William, 3 Melanie Grimsley has not had an easy life.

Aged just two she was severely burned in a car fire which killed her older sister, and left her needing weekly operations on her injuries.

A lesser person may not have had the strength to survive the prejudice and bullying which accompanied her throughout her youth, to say nothing of the grief of losing a beloved sibling.

But at the age of 25, Melanie is happily married, working part time and has two children of her own. She has also learned to play the violin in spite of her fire damaged hands.

Now the County Fermanagh woman is writing her life story, and she has spoken to the BBC about her experiences.

"I had only just turned two at the end of March. The accident happened at beginning of April. I was very young - I don't remember the details of it," she said.

Many readers may well remember the story of the unexplained car fire outside a shop in Enniskillen in April 1988.

Melanie's mother had just gone into the shop to buy milk, and minutes later passers-by were struggling to pull her two young toddlers from a blazing vehicle.

Tragically, three-year-old Amanda did not survive the fire, while Melanie escaped with third-degree burns.

The exact cause of the fire remains a mystery, but Melanie has been living with the consequences ever since.

Serendipity Even now, 23 years later, Melanie is still bumping into people who played a part in saving her life that day.

"I always feel very moved and honoured when I meet anybody who comes up to me and says, 'I was there that day,' or, 'I was the fireman,' or, 'I drove you to the hospital.'

"It is moving for me that they played a part in the day that changed my life," she said.

Some of those people, who were drawn into her life by pure chance in the first instance, she has met again through similar coincidence.

"I do a few talks locally about my own life story, and that's how I met one of the firemen. He just came up to me and said 'I was there that day.'

"Another time we met the paramedic who drove me to hospital after the accident. My little son loves ambulances, and one day we stopped to look at this lovely big ambulance, and we met the paramedic there."

'True bravery'

However, among all the people who touched her life that day, one in particular stands out.

Oliver Quinn was the man who risked his own life to pull Melanie and her sister from the fire.

The pair have been in contact ever since, and Melanie said that of all the events of the day, his action stands out as the most important.

"Whenever I think of Oliver, I just think none of us, me and my boys, none of us would be here at all without him.

"I'm just in awe of people that can forget all thoughts of themselves and do something for somebody else with little or no regard for their own safety. It is true bravery," she said.

Indeed, when her youngest son Leo, now 16 months, was born, Melanie chose to name him Oliver in honour of the man who saved her life.

'Not ashamed' Melanie suffered third degree burns in the accident 23 years ago

Melanie said she lays no blame upon her mother for leaving her in the car that day.

Indeed, she attributes much of her inspirational success to the strength and courage of her parents.

In particular, she recalls a statement that they gave to a local newspaper shortly after the accident: "We're not ashamed of her and we're not going to hide her away," they said.

It is such an attitude that has encouraged Melanie to live a normal life, to step out into the world rather than shy away from it.

"It's because of my parents' strength and courage that I am the way I am now," she said.

"I owe everything that I am and everything that I have to my mum and dad."

Melanie's book, Beauty for Ashes, is due to be published later this year.

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Drug lifeline

27 May 2011 Last updated at 06:37 GMT By Helen Briggs Health editor, BBC News website Follicular non-Hodgkin's lymphoma makes white blood cells grow into tumours Patients with a rare blood cancer have learned a new drug that can prolong remission is to be made available on the NHS in England and Wales. Here, one man explains the realities of living with the cancer.

When Andy Barton went to the doctor with a lump in the groin, he expected to be told it was a hernia and nothing to worry about.

But a few weeks later, the 49-year-old had been diagnosed with cancer and was facing an agonising wait to see if it would spread.

"I must have had this for several years without knowing about it," says Andrew, a project manager from Wirral, Cheshire.

"It was harder to spot having a lump in the groin. Typically, it appears in the neck, where it is more obvious."

The cancer, called follicular non-Hodgkin's lymphoma, makes white blood cells known as B-cell lymphocytes grow into tumours.

Watch and wait

Andrew's was quite advanced - and had spread to other parts of his body.

Continue reading the main story

It's always there in the back of my mind, but there are people worse off than me ”

End Quote Andrew Barton Living with cancer But since this type of cancer is generally slow-growing, and there may be long periods where there is little or no change, doctors often take the approach of watching and waiting.

"It's not going to kill you tomorrow or next week or next month," Andrew says. "But it's hard to get a grip when you're told you've got cancer and we're not going to do anything about it.

"It's cancer, and unless something else gets me, it will kill me."

After about six months, Andrew started waking at three in the morning, drenched in sweat. Night sweats - and other symptoms such as unexplained weight loss - are hallmark signs of the cancer.

He was given a cocktail of drugs, including chemotherapy, steroids and monoclonal antibodies.

When this course finished - in July last year - he faced a dilemma.

Andrew was told he could benefit from an extra course of monoclonal antibodies, used on their own in an attempt to prolong his remission.

Continue reading the main story More than 9,700 people in the UK are diagnosed with one of the many different types of non-Hodgkin's lymphoma (NHL) each yearNHL is a cancer of the lymphatic system, which forms a network around the body and helps circulate white blood cellsFollicular NHL is the name used when the cancer cells are grouped togetherHe needed to start this by October to have the best chance of success - but the drugs were unavailable on the NHS.

Fortunately for Andrew, he was able to fund them through medical insurance.

"If not, we would have had to think about selling the house or getting some money from elsewhere," he said. "They cost ?1,500 or more a go.

"When you are faced with a choice of, 'You must start your treatment in October,' you do what you can to get the treatment you need."

The drug, known as rituximab, is given by intravenous infusion once every two months.

It works by targeting a specific protein found on B-cell lymphocytes, thereby killing defective cells, while allowing normal white blood cells to survive and expand.

Long road ahead

The drug has just been given the green light for use on the NHS in England and Wales by the National Institute for Health and Clinical Excellence (NICE).

NICE said evidence presented to the committee suggested it could keep a patient's cancer in remission for longer, after they had had chemotherapy.

Andrew says: "I welcome NICE's decision - it's the right thing to do.

"Not everyone has access to Bupa or the ability to sell a house to buy the drug themselves. This is what the NHS is for."

Lymphoma Association chief executive Sally Penrose says patients with the cancer often face a long and challenging journey, with repeated cycles of treatment, remission and relapse.

The new treatment gives them a chance of longer periods of first remission, she says, "giving them greater peace of mind and, in turn, helping to restore normality to their daily lives".

Andrew says his approach is to remain stoical.

When he was first diagnosed he started a blog, Still My Turn This Year, charting the ups and downs of his illness.

"It's always there in the back of my mind, but there are people worse off than me - you have to get on with life."

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Human brain's 'bat sight' found

26 May 2011 Last updated at 08:09 GMT Bats use sound to hunt The part of the brain used by people who can "see like a bat" has been identified by researchers in Canada.

Some blind people have learned to echolocate by making clicking noises and listening to the returning echoes.

A study of two such people, published in PLoS ONE, showed a part of the brain usually associated with sight was activated when listening to echoes.

Action for Blind People said further research could improve the way the technique is taught.

Bats and dolphins bounce sound waves off their surroundings and by listening to the echoes can "see" the world around them.

Continue reading the main story

[They] use echolocation in a way that seems uncannily similar to vision”

End Quote Dr Lore Thaler University of Western Ontario Some blind humans have also trained themselves to do this, allowing them to explore cities, cycle and play sports.

Brain scan

Researchers looked at two patients who use echolocation every day. EB, aged 43, was blinded at age 13 months. LB, 27, had been blind since age 14.

They were recorded echolocating, while microphones were attached to their ears.

The recordings were then played while their brain activity was being recorded in an fMRI machine.

Increased activity in the calcarine cortex was discovered.

Dr Lore Thaler, from University of Western Ontario, said: "This suggests that visual brain areas play an important role for echolocation in blind people."

The study looked at only two people so cannot say for certain what happens in the brains of all people who learn the technique, but the study concludes: "EB and LB use echolocation in a way that seems uncannily similar to vision."

Susie Roberts, rehabilitation officer at Action for Blind People, said: "This research into brain activity and echolocation is very interesting and improves our understanding of how some visually impaired people may be processing information to help them navigate safely.

"Further investigation may help to improve the way the technique is taught to people in the future, potentially improving their mobility and independence."

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Tory MP declares NHS 'red lines'

27 May 2011 Last updated at 08:13 GMT The NHS changes affect only England Conservative MPs are preparing to oppose changes that Nick Clegg wants to make to the government's NHS overhaul in England, the BBC has learned.

One MP, Nick de Bois, who sits on the parliamentary committee looking at the NHS bill, has set out a series of "red lines" from which he says his fellow Tories should not retreat.

Some of them appear to clash directly with proposals from the deputy PM.

The NHS bill is currently on hold while ministers consider objections to it.

In an e-mail sent to all Conservative MPs, Mr de Bois says there has been talk of "concerning change" to the Health and Social Care Bill from the Lib Dems.

'Reclaim the debate'

He says critics of the bill have so far "made their voices the loudest", and calls on his fellow Tories to set out their own red lines - "the principles on which we will not budge".

"I am determined that we reclaim the debate over the future of the National Health Service from those who seek to use the bill as a political tool," he says.

He tells MPs the red lines should include:

The declaration that any qualified provider, including private companies and charities, should be able to provide care. Mr de Bois said: "Government should do nothing that stands in their way", but Mr Clegg said earlier on Thursday there would be "no sudden, top-down opening up of all NHS services to any qualified provider"A clear date - April 2013 - "when statutory responsibility must transfer from the top-down bureaucracy to GP consortia". Mr de Bois said this was "a very reasonable period of time", but Mr Clegg said there should be "no arbitrary deadline"The requirement for all GPs to take on these new responsibilities, right across England. Mr de Bois said "there must be no two-tier NHS", but Mr Clegg said this change should be introduced in a "planned, phased way"

Mr de Bois, thought to represent the views of a number of his colleagues, also says Conservatives should insist upon competition within the NHS to drive up standards, and push for the creation of an independent regulator, Monitor, "to ensure that patients' choices are not being restricted".

He told the BBC the voices of Tory MPs must be reflected as the proposals are scrutinised again and said he was surprised at the Lib Dems' position given they supported the bill during its initial passage through Parliament.

"While I accept there may be some changes on the fringes of the bill, the core principles and pillars of the bill need to remain in place," he told Radio 4's Today programme.

The focus must be on improving choices for patients, he stressed, and not getting "bogged down" in other arguments.

"I believe it is right we maintain the need for qualified, willing providers to join effectively the supply chain in the health service so that we can drive up choice, and through competition of provider, drive up better quality of care to patients."

But fellow Conservative MP and GP Sarah Wollaston said ministers should be listening to what NHS professionals were saying rather than setting out their own boundaries.

"I think this is a shame if we see this as a debate between Conservative and Liberal Democrat," she told Today.

"I don't see it as that. This is a very broad-based listening exercise and let's do the listening.

"The point is that the voice that matters is the voice out in the country - what patient groups and professionals are saying."

'Not thought through'

Mr Clegg said on Thursday he thought the bill should be sent back to MPs to reconsider.

Repeating the bill's committee stage could delay the timetable of reforms scheduled for 2012 and potentially risk the billions of pounds of savings that have to be made by the NHS by 2014.

Mr Clegg said earlier this month he would oppose any regulator which promoted competition, and insisted that Monitor's focus should be on collaboration.

The toughening of his stance on the NHS plans has been widely viewed as a response to the Lib Dems' poor results in the local elections earlier this month.

Prime Minister David Cameron has said that "sticking with the status quo" on health is "simply not a serious option" but he has promised "never to take risks" with the health service's core principles.

Labour have questioned whether the proposed bill in its original form can continue, calling it "expensive, bureaucratic, and not properly thought through".

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Can indulging in the Arts improve your health?

24 May 2011 Last updated at 10:46 GMT Culture linked to good health Trips to the theatre, concerts, art galleries and museums have been linked to better health and wellbeing, according to researchers in Norway.

A report, published in the Journal of Epidemiology and Community Health, showed the more often people engaged in cultural activities the greater their health benefits.

The authors suggest culture could be used to promote good health.

The study interviewed 50,797 adults from Nord-Trondelag County in Norway.

They were asked about their health, and satisfaction with life, as well as levels of anxiety and depression.

They were also questioned about their involvement in two cultural fields: "creative culture" when the person does something such as play an instrument, paint or sing, and "receptive culture" including going to galleries and concerts.

Both types of cultural activity were linked with good health, wellbeing, low stress and low depression even when other factors, such as social background and wealth, were taken into account.

In men the effect was most pronounced in those who preferred to get their dose of culture as an observer rather than doing something more hands on.

The authors said: "The results indicate that the use of cultural activities in health promotion and healthcare may be justified."

The study, however, cannot say that culture improves health. It could be the case that healthier people are more likely to take part in cultural activities.

Professor Alan Maryon-Davis, spokesperson for the UK Faculty of Public Health, said: "It's interesting research, probably working through the release of hormones, like endorphins, increasing the feeling of wellbeing and reducing anxiety and depression."

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Monthly misery

21 May 2011 Last updated at 03:17 GMT By Caroline Parkinson Health editor, BBC News website Many women experience debilitating heavy periods Around a quarter of women of reproductive age suffer from heavy bleeding which blights their lives every month.

A report by experts at the Royal College of Obstetricians and Gynaecologists has found significant variations in the care they are offered.

Sarah, now 44, has experienced severe, prolonged, bleeding ever since she started her periods at the age of 13.

"We had a register for PE and were excused showers if we were on our periods. But because my name was down on the register for the previous week, I was made to go into the communal showers, even though I was bleeding.

"I've suffered on and off from anaemia, and so had to take iron tablets, all my life."

She saw her first specialist at the age of 17, but that was to be the first of many appointments which failed to find a solution.

Sarah, who lives in Cornwall, said: "I particularly remember seeing a male consultant when I was very young. He was really awful, and had no time for me at all. I came out in floods of tears."

She has had two surgical procedures to try to ease her symptoms, one in her early 30s to have polyps and fibroids removed, and a second five years ago to remove the damaged lining of her womb - a procedure called endometrial ablation.

On both occasions, her symptoms abated - but then came back as bad as they had been before.

'I'm 100% ready'

Sarah was recently told she has severe endometriosis (where small pieces of the womb lining are found outside the womb) and adhesions caused by her previous surgery.

She says she is now "100% ready for a hysterectomy".

"My bleeding affects my sleep because I have to get up to go to the toilet in the night, I get chronic diarrhoea, migraines.

"And it affects me at work.

"I've had to take in plastic bags to put on my chair in case I leak through. Sometimes I've taken in changes of clothes too."

Sarah has been told she needs an exploratory procedure to assess exactly how surgeons would carry out her hysterectomy, but she hopes to have had it by the end of the year.

The RCOG investigation found significant regional variations in surgical rates.

Between 2003 and 2006, the proportion of women having surgery who underwent endometrial ablation (a less invasive surgical procedure) ranged from 46% to 75% within the 10 strategic health authorities in England.

The rest had hysterectomies.

After April 2006, the proportion varied from 64% in the east midlands to 82% in the north east.

Professor Allan Templeton, from the RCOG, said: "We don't know why there is this variation, and are carrying out further work to investigate further.

"But it is possible that patients' expectations are different, that the range of care and treatments offered are different in different areas.

"What we really want to find out is what women think of their care. Are they satisfied? Do they think they are being offered all of the options? Are people taking their problems seriously? And is their quality of life improving?

"With the regional variations, it is possible that the quality of care does vary throughout the country."

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Wanted: Brides

23 May 2011 Last updated at 00:19 GMT Sreeja has struggled to come to terms with Haryana's patriarchal society A shortage of women in Haryana has led some Indian men to seek wives from other states, but the "imported" brides often struggle to adapt, writes the BBC's Soutik Biswas.

On the face of it, Sreeja leads a contented life with her husband, two children and a pet dog in a cosy two-room brick and cement village home in this northern state.

But prod her a little, and she begins speaking openly about life in a society steeped in patriarchy.

"Men here don't allow their women to go out and work. They just dominate."

She sits in her tiny, unkempt garden in Sorkhi in Hissar district, drinking black tea and munching on banana chips and local sweets laid out on a plastic chair.

Her husband, Birbal Singh, who owns five acres of land and drives a small delivery van for a living, smokes a hookah and looks at her amusedly.

Sreeja continues, happy to have found a listener.

"So all you do is farm work and chores at home. There is this dreariness of work in the boiling heat. There is no relief. It hardly rains in these parts.

"That's not all. Safety is a concern. Women are not safe here - they are harassed and sometimes attacked. Where I come from, women can walk around safely.

"Hindu married women here wear veils. Why? Back home only Muslims women wear veils. Here, they abort and kill their girls. Then they complain about a lack of girls and bring them from other states to marry."

Illegal abortions

Sreeja travelled more than 2,000km (1,240 miles) from her parents' home in Kerala in southern India to set up home with her husband in Haryana. He had tired of waiting to find a local bride so he used connections to make contact with her family.

Ajit Singh was on his own for more than 10 years before he married Omna, who comes from Kerala

Inter-state marriages are rare in rural India. Yawning differences in language, food, cultural habits, weather, attitudes to women and even names easily conspire to make such alliances unworkable.

But Birbal was unable to find a bride in Haryana, which has the most unbalanced sex ratio in the country, with 877 women for every 1,000 men. Among under sevens, that ratio drops to just 830 girls for every 1,000 boys.

Experts say Haryana's situation is the result of illegal sex-selective abortions, female infanticide, parental neglect and discrimination against girl children.

The good news is that both ratios are slightly higher than the rate in the 2001 census, thanks to moves against antenatal sex-determination clinics and a gender awareness drive.

The bad news is that the ratios are still way behind India's average - 914 girls for every 1,000 boys under seven, and that gap itself has widened since 2001.

In contrast, Kerala has a laudable 1,084 women for every 1,000 men, according to the 2011 census, considerably higher than the national average of 940 women for every 1,000 men.

Renamed wife

Birbal and Sreeja are not the only couple in Sorkhi from different Indian cultures.

Men in Haryana, unable to find a bride at home, are willing to pay up to 100,000 rupees ($2,222) to marry an "imported" girl from states like West Bengal, Jharkhand, Bihar or Madhya Pradesh.

With fewer women the "marriage market" has taken an interesting turn.

Usually, a bride's family pays a large dowry to the groom's family. But these days prospective grooms in areas short on women often need to have substantial amounts of land and a secure government job if they are to win a wife.

In Sorkhi, the "imported" brides have adapted to life in this alien land, giving up their jobs and learning the local Hindi dialect.

Rambir gave his wife a new name that he found easier to pronounce

Ajit Singh, a Sorkhi-based farmer, says he spent 12 years looking for a bride without success before he married Omna, a 35-year-old woman from Kerala.

"The girls from Kerala eat rice, we eat flattened bread. They use coconut oil for cooking, we don't use that. They are non-vegetarian, we are vegetarian. I made all this very clear to her before we got married," says Ajit Singh.

Across the street, Rambir, a mechanic, has been married to Thangkamma, also from Kerala, for three years.

His first wife died 13 years ago, and he struggled to find a new bride - and when he did, he found he could not pronounce her name, so he promptly renamed her Radhika.

Of her marriage, Sreeja says: "We live in two worlds in our minds, but we manage. But when I go home to my parents, I don't feel like coming back."

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Smallpox decision deferred again

24 May 2011 Last updated at 13:03 GMT The viral disease was eradicated over 30 years ago A decision on when to destroy the last known stocks of live smallpox virus has been put off for another three years.

The World Health Organization (WHO) agreed to resume the discussion in 2014, following debate this week at its annual meeting.

Countries were divided on the issue at the 64th World Health Assembly.

Iran led opposition to a plan backed by the US and Russia to set a date for destruction in 2016.

Continue reading the main story Caused by the variola virusThe virus originated over 3,000 years ago in India or EgyptSymptoms include fever, muscle pain, headache, tiredness and the distinctive rashIt killed 30% of those infectedMore than 300 million people were thought to have died from smallpox in the 20th century aloneUp to 80% of survivors were marked with deep pitted scars, mostly on the faceThere has been a lot of discussion around the smallpox issue," Pierre Formenty of the WHO told a news briefing in Geneva.

"Three years from now, we will resume the discussion."

The issue was first discussed at the Assembly in 1986 and has been the source of debate ever since.

Destroying the remaining stocks of variola, or small pox virus, is seen by some countries as the final chapter in eradicating the disease to prevent the risk of accidental release.

Others, including the US and Russia, argue for more research in case smallpox returns, possibly as a biological weapon.

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Ash-cloud health 'reassurance'

24 May 2011 Last updated at 10:07 GMT By Michelle Roberts Health reporter, BBC News Poor air quality can trigger breathing problems Experts are reassuring people with lung conditions like asthma that the ash cloud travelling to the UK from Iceland should pose no real health treat.

The International Volcanic Health Hazard Network, which is monitoring the situation, expects very little ash to fall on Britain.

Air quality should remain good and not trigger breathing problems.

But medics are advising those who might be susceptible to carry their medication as a precaution.

The Gromsvotn volcano began erupting on Saturday.

But scientists believe it will not be as disruptive as last year's eruption in Iceland of a different volcano.

Continue reading the main story

We know that volcanic ash can trigger asthma symptoms like coughing, wheezing and shortness of breath. However, as the ash is very high in the atmosphere it does not pose an immediate problem”

End Quote Erica Evans of Asthma UK The Eyjafjallajokull volcano's unusual ash size distribution, combined with unusual weather patterns, made life difficult across Europe during the late spring and early summer of 2010.

'Relatively tame'

About 20 countries closed their airspace and it affected hundreds of thousands of travellers.

But even then, it had little impact on the health of people in the UK. The International Volcanic Health Hazard Network found almost no traces of ash on UK soil.

Even in areas of the UK where the fine ash from the eruption fell out of the plume and was deposited on the ground, there were no unusual consequences - most of the ash particles were too coarse and at too low a concentration to have any detectable impact on air quality.

And the impact of the Grimsvotn volcano looks to be tamer than this, according to University of Iceland geophysicist Pall Einarsson.

The ash particles from this eruption are said to be larger than last year and, as a result, should fall to the ground more quickly.

But lung experts are still advising precaution.

Dr Keith Prowse, of the British Lung Foundation, said: "In light of the latest news that ash from the volcanic eruption in Iceland could reach the UK by Tuesday, we would advise people living with a lung condition in affected areas to carry their medication as a precaution."

Erica Evans, of Asthma UK, said: "We know that volcanic ash can trigger asthma symptoms like coughing, wheezing and shortness of breath. However, as the ash is very high in the atmosphere it does not pose an immediate problem. Asthma UK advises people with asthma to monitor the news to see whether the ash cloud moves closer to the UK.

"People with asthma should make sure they maintain their regular asthma medicine and keep their emergency inhaler on them at all times."

Both charities say they can offer advice via a telephone helpline to anyone who may be concerned.

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Debate over weight loss schemes

By Adina Campbell
Newsbeat reporter Debbie Rugg explains how she went from a size 20 to a size 12

The government should continue to refer people onto weight loss programmes, a new report suggests.

Figures from a Slimming World study over five years followed nearly 35,000 people on a 12-week course.

More than two thirds completed the course and each lost around a stone during that period.

However, some health groups have criticised the government for using private weight loss organisations.

Over the last decade the government has formed partnerships with private firms to try to curb worrying obesity levels.

It's estimated the government spends more than ?4m a year tackling obesity.

The Department of Health says it will be looking into the way it tackles obesity over the next few months.

However, ministers insist slimming groups help people with motivation and are cost effective.

Dozens of NHS trusts across the UK recommend people join slimming clubs to help them achieve a healthy lifestyle.

'Quick fix'?

Someone with a weight problem can be referred onto groups such as Slimming World and in most cases the NHS will pay for membership to get them started.

Twelve weeks on a Slimming World programme costs the NHS around ?50 per person, half of what it would cost for weight loss medication such as diet pills.

However, some charities say they are only a short term solution.

Continue reading the main story

Most people re-gain the weight they lose within two years, and many gain more than they first lost.

Beat Chief Executive Susan Ringwood

Tam Fry from the National Obesity Forum (NOF) is concerned they are 'quick fixes' and not addressing the real problem.

He said: "The government has got to come up with a solution to stop people getting fat in the first place.

"It's relying too much on companies like Slimming World and Weight Watchers to do their job for them and it would be far better to put money into real prevention measures."

Beat, the UK's biggest Eating Disorder Charity, also supports the NOF's argument.

'Push I needed'

Chief Executive Susan Ringwood said: "Most people regain the weight they lose within two years, and many gain more than they first lost.

"Quick fixes that don't work just add to someone's sense of failure and can lead to the downward spiral of helplessness that can lead to much more serious mental health issues."

Twenty-two-year-old Debbie Rugg from Somerset has dropped from a size 20 to a size 12 since she was referred by her doctor to Slimming World last Summer.

The NHS spent nearly ?37m on anti-obesity drugs last year

She was diagnosed as clinically obese and had spent time in hospital after doctors feared her weight was having a deteriorating effect on her health.

She said: "At my heaviest, I was 15 stone and decided to do something about it after a breast cancer scare and lumps appearing on my body.

"I was given 12 weeks' worth of free vouchers and in the last ten months I've lost two and a half stone.

"Without being advised to join the programme and having my initial membership paid for, it wouldn't have given me the push I needed to get down to a healthy size."

Weight loss alternatives

However, the Slimming World study did show a third of people dropped out before completing their 12-week course, with critics suggesting more improvements are needed when it comes to long term weight loss plans.

Recent results from a weight loss scheme in Kent showed high drop-out rates and disappointing weight loss results overall.

Hundreds of people were given a cash reward, ranging between ?70 and ?425, depending on how much weight they lost during set target periods.

However two thirds of people on the 'Pounds for Pounds' programme didn't lose a clinically significant amount of weight and many dropped out before their course was over.

There are other weight loss treatments available on the NHS such as diet pills.

Last year the NHS spent nearly ?37m on anti-obesity drugs. Other treatments include working with dieticians and psychologists.

In the most extreme cases, some people may choose weight loss surgery, such as gastric band operations.

Latest figures show there are more than 4,000 weight loss surgery procedures, done on the NHS every year - each operation costs anything between ?5,000 and ?14,000.

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Supplement 'helps pre-eclampsia'

20 May 2011 Last updated at 00:22 GMT Pre-eclampsia is a serious condition which can affect up to 10% of pregnant women. A dietary supplement given to pregnant women at high risk of pre-eclampsia can reduce the likelihood of the disease occurring, a study says.

Writing in the British Medical Journal, researchers says the presence of an amino acid and antioxidant vitamins in the supplement helps to combat abnormally high blood pressure.

More than 600 women took part in the study in Mexico City.

But experts say more research is needed on the effects of the supplement.

Pre-eclampsia is a serious condition where abnormally high blood pressure and other problems develop during pregnancy.

It affects up to 10% of all first-time pregnancies and is dangerous for both mother and child.

Pre-eclampsia is thought to be linked to a deficiency in L-arginine, an amino acid that helps maintain a healthy blood flow.

So, as part of their study in the British Medical Journal, researchers in Mexico and the United States gave 228 pregnant women at high risk of pre-eclampsia daily food bars containing L-arginine and antioxidant vitamins.

Another 222 pregnant women received bars containing only vitamins, and another group of 222 got bars containing no L-arginine or vitamins, the placebo group.

The supplements began when women were 20 weeks pregnant and continued until they gave birth.

Major health risk

The research team found that 30.2% of women developed pre-eclampsia in the placebo group, 22.5% in the group given a vitamin bar and 12.7% in the L-arginine and vitamin group.

The study authors said the L-arginine and vitamin group women were significantly less likely to develop pre-eclampsia.

Continue reading the main story

There are lots of questions still to be asked about the effects of the supplement.”

End Quote Gail Johnson Royal College of Midwives "This relatively simple and low cost intervention may have value in reducing the risk of pre-eclampsia and associated preterm birth," they said.

But they added that further studies are needed to see whether the results can be repeated.

Gail Johnson, midwife teacher at the Royal College of Midwives, cautioned that it was a relatively small study which excluded some high-risk groups.

"It's a starting point for looking at pre-eclampsia, which poses a significant health risk and is an important thing to solve, but there are lots of questions still to be asked about the effects of the supplement."

Andrew Shennan, professor of obstetrics and gynaecology at St Thomas' Hospital, said there were established scientific reasons why L-arginine and antioxidants reduce the occurrence of pre-eclampsia.

"Previous studies, testing each supplement individually, have shown little effect, so it is exciting that in combination they seem to have such a profound effect on preventing pre-eclampsia."

"However, it is unusual that so many people in the control group developed pre-eclampsia - 30% is an unusually high rate of incidence of the disease so I would be interested to see if the effects of the study could be replicated elsewhere."

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Wales 'behind' on disabled living

24 May 2011 Last updated at 15:33 GMT Wales trails the UK in helping disabled people to live independently in the community, says a charity.

Disability Wales told a Westminster inquiry that the lack of a Welsh strategy on independent living disadvantages disabled people.

The inquiry is discussing whether changes to the law are needed.

A Welsh Government spokesperson said that improving services for disabled people across Wales remained a priority.

Continue reading the main story

It's not just about getting out of bed, it's about being able to be part of your community, whether that's through voluntary work, or... education and learning”

End Quote Rhian Davies Disability Wales Independent living would "be the best way to mitigate cuts in services and benefits," argued Disability Wales

Rhian Davies, its chief executive, who addressed the Joint Committee on Human Rights inquiry, told BBC Radio Wales that a Welsh strategy would lead to bodies such as councils, health trusts and police developing action plans and co-ordinating spending.

"People need support with everyday tasks such as washing and dressing, getting up," she said.

Ms Davies said it was about "being in control of that personal assistance, not just waiting for someone to turn up at times convenient to the service - it's about meeting your own needs".

"It's not just about getting out of bed, it's about being able to be part of your community, whether that's through voluntary work, or whether that's through education and learning".

The charity said that national policies had been introduced in England, Scotland and Northern Ireland and has presented a petition with over 700 signatures, calling for a Welsh strategy, to the Welsh assembly's petitions committee.

A Welsh Government spokesperson said: "We are committed to improving the lives of disabled people by ensuring that they are able to live independently for as long as they choose.

"The work on independent living for disabled people is to be considered as part of the implementation of the Equality Act 2010.

"The Welsh Government is the first government in the UK to introduce specific regulations, including the disability equality duty to support the wider duty imposed by the Equality Act and these regulations will bring about real changes in terms of people's life chances and life experiences."

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Worried parents 'bypassing GPs'

24 May 2011 Last updated at 00:22 GMT By Michelle Roberts Health reporter, BBC News Fever was one of the 10 common problems parents sought help for Rising numbers of parents are bypassing GPs and taking children to hospitals' A&E departments for medical treatment, researchers say.

Attendance for 10 common medical problems, including fever and rash, rose 42% in a decade at Nottingham's Queen's Medical Centre, they said.

Difficulty accessing out-of-hours GP care may be to blame, they say in the Emergency Medicine Journal.

The government said it was developing a strategy for out-of-hours care.

It said it wanted to deliver high quality, urgent care services around the clock.

During the past 10 years, the way the NHS provides care for common medical problems at night and at weekends has changed.

GPs are no longer obliged to provide out-of-hours care and advice to worried parents, with large private companies now generally contracted to provide this instead.

Continue reading the main story

We need to have more integrated care rather than the confusing, expensive system we have currently”

End Quote John Heyworth President of the College of Emergency Medicine John Heyworth, president of the College of Emergency Medicine, says this has caused some confusion for patients and, in some instances, has made it harder for them to access care.

"Parents have found in the last few years that accessing primary care is more difficult than previously."

He said more and more patients were turning to A&E departments.

"We've been recognising this. Attendances are going up by between eight and nine per cent a year."

'Shortcomings'

In the study spanning a decade, the number of patients attending the children's emergency department at Queen's remained similar, but the number attending with common medical problems had risen by 42%.

A total of 39,394 children were seen in 2007-8, of whom 14,724 had medical problems. This compared with 38,982 children seen overall in 1997, of whom 10,369 had medical problems.

Dr Heyworth said the findings highlighted the shortcomings in the way services were currently organised.

He said: "We need to have more integrated care rather than the confusing, expensive system we have currently.

"It is very patchy and the public are frankly getting a raw deal."

The college is calling for GP services to be co-located next to A&E departments to deal with people who need to see a GP.

A Department of Health spokesperson said: "Our vision is to replace the ad-hoc, uncoordinated system that has developed over more than a decade, and has been characterised by poor quality and too much variation."

Meanwhile, a study in the same journal reveals most UK hospital A&E departments are ill-equipped to treat children with serious head injuries.

A confidential enquiry found 87% of hospitals in England, Wales, Northern Ireland and the Channel Islands and Isle of Man could not care for a critically ill child on site.

The authors say transferring these sick children some miles to other hospitals could harm their survival chances as treatment delays can prove fatal.

Around 210,000 children with head injuries attend hospital every year, and around 34,500 are admitted. A few children with serious head injuries will require emergency surgery and intensive care.

But the way services are currently organised - with centralised intensive care services - means some patients need to be transferred to get the care they need.

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Facelift woman given £6m damages

23 May 2011 Last updated at 11:04 GMT Penny Johnson said the stress of the court case made her condition worse A woman has won more than ?6m in damages against a plastic surgeon who she said "played God" with her life.

Penny Johnson, from Godstone, Surrey, brought the High Court case against Le Roux Fourie who she said carried out "experimental surgery" in 2003.

The businesswoman said she suffered nerve damage in a facelift, which led to her financial and IT consultancy business going into administration.

Mr Fourie admitted liability but denied the surgery in Leeds was experimental.

At the High Court, sitting in London, Mrs Johnson asked Mr Justice Owen to award her a proportion of the ?54m she said was her potential loss, as a 50% shareholder, when Bishop Cavanagh Ltd failed in 2009.

She said the stress of the litigation had made her condition worse.

The judge gave his ruling in the case on Monday, awarding her ?6,190,884.92.

During the hearing, Mrs Johnson said her face was constantly contracting as a result of the operation carried out at Bupa Methley Park Hospital in Leeds.

Lost earnings

"I don't sleep and I have a permanent buzzing around my eye which can be so intense that I can't think about anything," she said.

Alain Choo Choy, QC for Mr Fourie said his client put the potential business loss at only ?9m.

During her absence, the company was managed by her husband, Peter, with whom she now owns another business, BC Direct.

The bulk of the damages award relates to lost earnings, both past and future.

In his ruling, the judge said Mrs Johnson was formerly a confident, happy and outstandingly successful woman.

'Different person'

The negligent surgery had serious physical and psychological consequences, resulting in anxiety and depression and had affected her marriage.

As well as injuries to her face, Mrs Johnson suffered pain from the replacement of pre-existing breast implants which was carried out at the same time as the facelift.

"Their marriage has survived; but the claimant said in evidence that she is no longer a wife to her husband," the judge said.

"He says that she is now a completely different person and that their marriage is not what it used to be.

"They no longer go out together as they used regularly to do, and have become detached from the close knit group of friends whose company they used to enjoy."

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Doctor warned over Christian talk

23 May 2011 Last updated at 15:54 GMT Dr Richard Scott has refused to accept a warning from the General Medical Council A Kent doctor could face a disciplinary hearing after discussing his Christian faith with a non-Christian patient.

Dr Richard Scott, from Margate, has received a warning from the General Medical Council (GMC) after it received a complaint.

Dr Scott, who has not accepted the complaint, said: "It's very important as a Christian always to do the standard medicine, which I do."

The GMC said it had investigated, but there is no date yet set for a hearing.

The investigation centres around a consultation Dr Scott held in August 2010, with a patient at the Bethesda Medical Centre at the request of the patient's mother.

Dr Scott said that after about 20 minutes he thought the patient may be helped if they had a spiritual discussion.

'Vulnerable patient'

"He said he was OK with that so we discussed my own faith and where he was with his faith, and I opened up the discussion," Dr Scott said.

Two months after the consultation, Dr Scott received papers telling him the patient's mother had complained to the GMC.

In March, he was told by the GMC that they were going to take on the case and invited a response from Dr Scott.

The complaint stated that Dr Scott had "exploited a vulnerable patient".

Niall Dickson, the chief executive of the GMC, said: "The GMC does not discuss individual cases but our guidance, which all doctors must follow, is clear; doctors should not normally discuss their personal beliefs with patients unless those beliefs are directly relevant to the patient's care.

"They also must not impose their beliefs on patients, or cause distress by the inappropriate or insensitive expression of religious, political or other beliefs or views."

Laura Sandys, Conservative MP for South Thanet, said: "We totally appreciate that medical standards need regulating, but monitoring and then sanctioning doctors on conversations with patients, that do not relate to their medical condition, must be a matter between the individuals and dealt with locally.

"The GMC has over-reacted and needs to put an end to misplaced activism that is putting a respected doctor's profession on the line."

Dr Scott said he would present his case at any disciplinary hearing.

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'Posts will go'

20 May 2011 Last updated at 16:14 GMT By Jane Dreaper Health correspondent, BBC News How will the changes to the NHS in England affect services and patients at a local level?

That's the question I'm setting out to answer, as I track the reforms and efficiencies in Leicester over the next few years.

Malcolm Lowe-Lauri warns NHS posts will go

If the government succeeds in its stated aim of modernising the NHS to improve health outcomes, places like Leicester - where people die earlier than the national average - need to see the results.

It's never long before another patient arrives by ambulance at the Leicester Royal Infirmary. The busy hospital is one of three in the city run by Malcolm Lowe-Lauri.

He arrives slightly breathless for our interview, having paced upstairs from the medical assessment unit, where he was keeping an eye on a surge in cases.

Mr Lowe-Lauri has a busy in-tray. He is finalising an application for foundation trust status, which would give more freedom to University Hospitals of Leicester.

And he is working out how to meet the huge efficiency challenge set by the head of the NHS in England, Sir David Nicholson. In Leicester, this means generating savings of ?158m over the next five years.

Continue reading the main story

It's no good getting the legislation right and losing the plot on the money”

End Quote Malcolm Lowe-Lauri University Hospitals Leicester 'Not good news' Mr Lowe-Lauri said: "More than 60% of our costs are locked up in people.

"You cannot get away with dealing with the Nicholson challenge without significantly reducing the number of people employed in the health service.

"That may not be seen as good news - and nobody likes doing it - but that is the reality.

"The challenge is to do that in a civilised and effective way, but recognising that over five years there will be many posts that will go."

The estates and IT departments are likely to be reorganised - and there are plans to centralise pathology labs across the region.

Mr Lowe-Lauri stresses there are opportunities too.

Moving care away from hospital needs to become a reality. His team is meeting with colleagues in primary care every month to discuss how to re-design services.

Prof Azhar Farooqi is co-chair of the new GP consortium in Leicester

And he feels Leicester is well-placed to cope with change because it doesn't have bills from a PFI (Private Finance Initiative) development.

Mr Lowe-Lauri is among the experts putting the finishing touches to their recommendations on how the government should change its troubled Health and Social Care Bill.

Losing the plot

He said: "It's no good getting the legislation right and losing the plot on the money.

"In a sense, this is an industry trying to become aware of its need to become a service."

My next stop is a surgery in deprived east Leicester.

Continue reading the main story

I'm having to learn quite a lot about the local authority and social care”

End Quote Prof Azhar Farooqi Leicester City GP consortium Azhar Farooqi is a professor in primary care - and he works there as a GP three days a week.

He's also co-chair of the GP consortium, which will take over organising care in Leicester during the next two years, with a budget of ?400m.

Some experienced primary care colleagues are already leaving the NHS. Professor Farooqi said: "I know the NHS well, but I'm not so familiar with the local authority and social care.

"In the new world we'll work closely with them, so that's an area I'm having to learn quite a lot about.

"The Health and Social Care Bill needs to be more explicit about the role of public and patients. That's really important in how the local population holds health professionals to account."

Ballu Patel is concerned about the future

And for his part, he told me the consortium would hold its meetings in public once it's up and running.

A couple of miles away at the Peepul Centre, where gym memberships cost just ?20 a month, I met Ballu Patel.

Over-prescribing

He helped establish the airy building, and he chairs the Leicester Mercury Patients' Panel, which was set up by the local paper.

Mr Patel thinks the government's listening exercise will tweak the reforms rather than fundamentally change them.

And his panel members fear the consortium may target GP prescribing if it needs to save money.

He said: "Much of the commissioning money will go to the hospital providers. So there's not much room for negotiation outside those contracts - and the consortium will have to look internally for savings.

"The next headline budget is prescribing. So will pressure be put on GPs if they're seen to be over-prescribing?"

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Bacteria 'linked' to Parkinson's

22 May 2011 Last updated at 23:03 GMT Could this bacterium cause Parkinson's disease? The bacteria responsible for stomach ulcers have been linked to Parkinson's disease, according to researchers in the US.

Mice infected with Helicobacter pylori went onto develop Parkinson's like symptoms.

The study, presented at a meeting of the American Society for Microbiology, argues that infection could play "a significant role".

The charity Parkinson's UK said the results should be treated with caution.

Parkinson's disease affects the brain and results in slow movements and a tremor.

Middle-aged mice, the equivalent of being between 55 and 65 in humans, were infected. Six months later they showed symptoms related to Parkinson's, such as reduced movement and decreased levels of a chemical, dopamine, in the brain.

These changes were not noticed in younger mice.

Toxic

Dr Traci Testerman, from the Louisiana State University Health Sciences Center, said: "Our findings suggest that H. pylori infection could play a significant role in the development of Parkinson's disease in humans.

"The results were far more dramatic in aged mice than in young mice, demonstrating that normal ageing increases susceptibility to Parkinsonian changes in mice, as is seen in humans."

The researchers believe the bacteria are producing chemicals which are toxic to the brain.

They said H. pylori was able to "steal" cholesterol from the body and process it by adding a sugar group.

The bacteria responsible for stomach ulcers may have a role in Parkinson's say researchers.

Dr Testerman said this new chemical was almost identical to one found in seeds from the cycad plant, which had been shown to trigger a Parkinson's-like disease among people in Guam.

She told the BBC: "H. pylori eradication in late stage Parkinson's disease is unlikely to result in significant improvement.

"Certain neurons are killed before symptoms begin, and more are killed as the disease progresses. Those neurons will not grow back."

Dr Kieran Breen, director of research at Parkinson's UK, said: "We believe Parkinson's is most likely caused by a combination of environmental factors together with an individual's genetic susceptibility to developing the condition.

He said there was some evidence that bacteria can prevent the main drug to treat Parkinson's, levodopa, being absorbed, but there was no strong evidence that people who have H. pylori in their gut are actually more likely to develop Parkinson's.

He added: "The current study is interesting and suggests that the bacteria may release a toxin that could kill nerve cells.

"However, the results should be treated with caution. The research was carried out in mice that were infected with relatively high doses of the bacterium or its extract.

"While they developed movement problems, we don't know whether this was actually due to the death of nerve cells. Further research needs to be carried out".

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