Month: January 2013

At least 15,000 people marched in protest against proposals on Saturday

A decision is expected later on plans to close the Accident and Emergency department at Lewisham Hospital in south-east London and downgrade its maternity unit.

The proposal came after neighbouring South London Healthcare NHS Trust (SLHT) ran up debts of £150m.

Health Secretary Jeremy Hunt is expected to announce whether an “urgent care” ward will replace the A&E.

At least 15,000 people marched in protest on Saturday.

‘Dangerous precedent’

SLHT, which runs three hospitals, was placed in administration last year when it started losing about £1.3m a week.

Under the plans, the trust’s Queen Elizabeth Hospital site in Woolwich would come together with Lewisham Healthcare NHS Trust to create a new organisation.

Lewisham’s A&E unit would then be downgraded to an urgent care centre, meaning emergency cases would be seen at nearby hospitals. The maternity unit at Lewisham could also be slimmed down, with complex cases being dealt with elsewhere.

Shadow health secretary Andy Burnham said closing the A&E of a successful trust would set a “dangerous precedent”.

The closures are part of a radical overhaul proposed by special administrator, Matthew Kershaw, in response to SLHT going into administration.

The reorganisation proposed is intended to save around £42m from the payroll budget.

If implemented fully, Mr Kershaw said his recommendations would result in a radical overhaul of services in south London, and help deliver “safe, high-quality, affordable and sustainable services.”

The government has said “doing nothing is not an option”.

By Branwen Jeffreys Health correspondent, BBC News

Similar schemes have seen a fall in incidents of violent crime

A coalition pledge to make hospitals share violent crime data with police is being carried out in only a third of areas in England, an audit shows.

The government has written to hospitals and chief constables for an explanation after the Department of Health audit.

Accident and emergency departments are meant to share information about where knife or gun attacks are happening with the police and local council.

This was part of the government’s programme for government in 2010.

‘Disappointed’

In 2010 the coalition promised in its programme for government to make hospitals share non-confidential information with the police so crime hotspots could be identified.

An audit carried out for the Department of Health has revealed that is happening effectively in only a third of community safety partnership areas, and not at all in one-fifth.

The charity Victim Support said it was very disappointing that the plan was not being implemented.

Susannah Hancock, its assistant chief executive, said: “The NHS is the second most likely public service after the police to come into contact with victims of violent crime, many of whom will not have reported such incidents to the police at all. “

It is thought that police are aware of fewer than a third of assaults that lead to the victim being treated in hospital.

Pioneering research carried out in Cardiff tested the idea of regularly sharing collated information about the type and location of attacks, with all confidential patient information removed.

As a result, the city saw a 35% fall in the numbers of assault victims turning up at A&E for treatment between 2000 and 2005.

Professor Jonathan Shepherd, from Cardiff University, said the research showed sharing information costs little, and saves money in the longer term for the NHS and the criminal justice system. He said the findings of the audit were surprising, giving the strong evidence, and the commitment from government.

“I feel disappointed that it hasn’t been taken up faster than this, and I would want to say to hospitals and local authorities this is straightforward, ethical information-sharing that makes for safer communities – just get on with it.”

‘Win-win’

Arrowe Park hospital, in the Wirral, has seen some impressive results from setting up systems to share information every month with the police and local council. Anyone arriving at A&E with an injury caused by a violent assault is taken through a standard set of questions about the location and circumstances of the attack.

The information has all patient data removed from it before it is shared. Between 2004 and 2010, the number of alcohol-related assault victims arriving for treatment fell by 30%.

Chris Oliver, from the Wirral University Hospital Trust, said the results had convinced busy staff in A&E to get involved: “It’s owned by everyone within the department. The reception staff are very proactive when going through the questions. It’s very rewarding for our staff to see the reduction in people coming into the department. It’s a win-win.”

The Department of Health said Health Minister Anna Soubry had written this week to all hospital chief executives and chief constables in England to remind them of the government’s commitment on sharing information.

The letter says there are no legal reasons for not sharing anonymous information, and asks for any “good reasons why it cannot be done” in areas which have failed to put systems in place.

Despite this slow progress in implementing the approach in England, the idea has attracted international interest and there are pilot schemes under way in other countries.

By Branwen Jeffreys Health correspondent, BBC News

Similar schemes have seen a fall in incidents of violent crime

A coalition pledge to make hospitals share violent crime data with police is being carried out in only a third of areas in England, an audit shows.

The government has written to hospitals and chief constables for an explanation after the Department of Health audit.

Accident and emergency departments are meant to share information about where knife or gun attacks are happening with the police and local council.

This was part of the government’s programme for government in 2010.

‘Disappointed’

In 2010 the coalition promised in its programme for government to make hospitals share non-confidential information with the police so crime hotspots could be identified.

An audit carried out for the Department of Health has revealed that is happening effectively in only a third of community safety partnership areas, and not at all in one-fifth.

The charity Victim Support said it was very disappointing that the plan was not being implemented.

Susannah Hancock, its assistant chief executive, said: “The NHS is the second most likely public service after the police to come into contact with victims of violent crime, many of whom will not have reported such incidents to the police at all. “

It is thought that police are aware of fewer than a third of assaults that lead to the victim being treated in hospital.

Pioneering research carried out in Cardiff tested the idea of regularly sharing collated information about the type and location of attacks, with all confidential patient information removed.

As a result, the city saw a 35% fall in the numbers of assault victims turning up at A&E for treatment between 2000 and 2005.

Professor Jonathan Shepherd, from Cardiff University, said the research showed sharing information costs little, and saves money in the longer term for the NHS and the criminal justice system. He said the findings of the audit were surprising, giving the strong evidence, and the commitment from government.

“I feel disappointed that it hasn’t been taken up faster than this, and I would want to say to hospitals and local authorities this is straightforward, ethical information-sharing that makes for safer communities – just get on with it.”

‘Win-win’

Arrowe Park hospital, in the Wirral, has seen some impressive results from setting up systems to share information every month with the police and local council. Anyone arriving at A&E with an injury caused by a violent assault is taken through a standard set of questions about the location and circumstances of the attack.

The information has all patient data removed from it before it is shared. Between 2004 and 2010, the number of alcohol-related assault victims arriving for treatment fell by 30%.

Chris Oliver, from the Wirral University Hospital Trust, said the results had convinced busy staff in A&E to get involved: “It’s owned by everyone within the department. The reception staff are very proactive when going through the questions. It’s very rewarding for our staff to see the reduction in people coming into the department. It’s a win-win.”

The Department of Health said Health Minister Anna Soubry had written this week to all hospital chief executives and chief constables in England to remind them of the government’s commitment on sharing information.

The letter says there are no legal reasons for not sharing anonymous information, and asks for any “good reasons why it cannot be done” in areas which have failed to put systems in place.

Despite this slow progress in implementing the approach in England, the idea has attracted international interest and there are pilot schemes under way in other countries.

A customer selects vegetables at a supermarket in Prague June 14, 2011.

Credit: Reuters/David W Cerny

NEW YORK (Reuters Health) – Vegetarians are one-third less likely to be hospitalized or die from heart disease than meat and fish eaters, according to a new UK study.

Earlier research has also suggested that non-meat eaters have fewer heart problems, researchers said, but it wasn’t clear if other lifestyle differences, including exercise and smoking habits, might also play into that.

Now, “we’re able to be slightly more certain that it is something that’s in the vegetarian diet that’s causing vegetarians to have a lower risk of heart disease,” said Francesca Crowe, who led the new study at the University of Oxford.

Still, she noted, the researchers couldn’t prove there were no unmeasured lifestyle differences between vegetarians and meat eaters that could help explain the disparity in heart risks.

Crowe and her colleagues tracked almost 45,000 people living in England and Scotland who initially reported on their diet, lifestyle and general health in the 1990s.

At the start of the study, about one-third of the participants said they ate a vegetarian diet, without meat or fish.

Over the next 11 to 12 years, 1,066 of all study subjects were hospitalized for heart disease, including heart attacks, and 169 died of those causes.

After taking into account participants’ ages, exercise habits and other health measures, the research team found vegetarians were 32 percent less likely to develop heart disease than carnivores. When weight was factored into the equation, the effect dropped slightly to 28 percent.

The lower heart risk was likely due to lower cholesterol and blood pressure among vegetarians in the study, the researchers reported this week in the American Journal of Clinical Nutrition.

Meat eaters had an average total cholesterol of 222 mg/dL and a systolic blood pressure – the top number in a blood pressure reading – of 134 mm Hg, compared to 203 mg/dL total cholesterol and 131 mm Hg systolic blood pressure among vegetarians.

Diastolic blood pressure – the bottom number – was similar between the two groups.

Crowe said the difference in cholesterol levels between meat eaters and vegetarians was equivalent to about half the benefit someone would see by taking a statin.

The effect is probably at least partly due to the lack of red meat – especially meat high in saturated fat – in vegetarians’ diets, she added. The extra fruits and vegetables and higher fiber in a non-meat diet could also play a role.

“If people want to reduce their risk of heart disease by changing their diet, one way of doing that is to follow a vegetarian diet,” Crowe told Reuters Health.

However, she added, you also don’t have to cut out meat altogether – just scaling back on saturated fat can make a difference, for example. Butter, ice cream, cheeses and meats all typically contain saturated fat.

SOURCE: American Journal of Clinical Nutrition, online January 30, 2013.

The headquarters of Fresenius is pictured in Bad Homburg near Frankfurt February 24, 2010.

Credit: Reuters/Johannes Eisele

FRANKFURT (Reuters) – Fresenius Medical Care’s focus on a life-threatening illness and its buying power with suppliers mean the world’s biggest kidney dialysis provider may cope better with cuts in U.S. healthcare spending than many investors think.

FMC’s shares have slumped about 10 percent over the past three months on expectation the United States, battling to rein in its budget deficit, will reduce funds for state-run health schemes like Medicare that account for about 30 percent of the German company’s revenues.

A 2 percent cut to Medicare spending will come into effect in March, unless lawmakers agree to postpone it, while the federal agency in charge of Medicare is likely to announce a cut in reimbursements for dialysis providers for 2014 to reflect a drop in the use of an expensive drug to treat a side effect.

Congress has even set Medicare a non-binding target to slash spending on dialysis by $4.9 billion spread over ten years.

However, there are grounds for thinking the actual cutbacks, for dialysis providers at least, will not prove too severe.

Dialysis, where machines do the kidney’s vital job of cleaning blood of waste and excess fluids, accounts for only about $10 billion of Medicare’s $555 billion annual budget and is essential to patients’ survival.

Cutbacks are more likely to focus on less critical areas of healthcare, like joint replacements, some analysts think. What’s more, with longevity, obesity and diabetes on the rise across much of the world, demand for dialysis is growing.

“FMC has two years ahead of it that will be somewhat more difficult,” said Markus Manns, who manages a 200 million euro ($267 million) equity fund with a focus on healthcare at Union Investment in Frankfurt.

“But in the past, initial drafts have always been mitigated in such a way that both the government and dialysis providers were okay with in the end.”

WEAKER RIVALS

FMC, indirectly controlled by a German charitable trust, treats over 250,000 of the estimated 2.1 million people receiving kidney dialysis worldwide – a figure growing about 5-6 percent per year and expected to reach almost 4 million by 2020.

While about two-thirds of its 2011 net revenue of $12.8 billion came from North America, the company is seeing rapid growth in emerging markets as more sedentary lifestyles take hold and rising wealth drives an increase in insurance coverage.

For instance, it expects annual growth in patient numbers of 10 percent in Asia, compared with 4 percent in the United States, which will help to reduce its exposure to the latter.

In the meantime, FMC’s size – it operates more than a third of dialysis treatment centers in the United States – will be a big advantage in coping with spending cuts, analysts say.

More vulnerable will be the 100 or so smaller, less efficient firms that account for 25-30 percent of the market.

Indeed, shares in FMC’s closest rival in the United States, DaVita, have changed little in recent months, partly reflecting the view in that country that even if Medicare spending on dialysis is reduced, the larger players will be able to take a bigger share of the smaller pot.

The smaller firms often serve rural communities. As it could be politically difficult for Washington to drive these out of business, that may lead to lenient treatment for all dialysis providers when it comes to apportioning spending cuts.

“Many of the smaller dialysis chains and one-clinic operations continue to struggle to generate profits, something which we believe will continue to act as a buffer for the large dialysis organizations,” said Berenberg Bank analyst Tom Jones.

THE NEXT BIG THING

It’s undoubtedly going to be an uncertain few years.

“Visibility about (FMC’s) medium-term financial plans is fairly low,” said Credit Suisse analyst Christoph Gretler.

He described the stock’s valuation as “not overly attractive,” despite its slide to 1-1/2 year lows this month.

But some analysts believe that changes in the way Medicare operates could work in favors of bigger firms like FMC.

Rather than paying for the actual amount of drugs and services given to patients, Medicare is switching to a system of lump-sum reimbursements.

This will reward the industry for finding cheaper ways of providing dialysis, as long as it maintains the same quality of care. Medicare will eventually cut the reimbursement rate to claw back some of the efficiency gains, but only with a delay.

FMC’s size is expected to help it cut treatment costs, for instance by negotiating better drug buying terms with suppliers.

For now, the lump-sum reimbursement, or bundled rate, covers intravenous drugs but from 2016 oral drugs will be added and in the longer term, more sweeping reforms could be on the cards.

Under a plan dubbed accountable or comprehensive care, dialysis providers would have to pay for patients’ hospital stays due to dialysis-related conditions. In return, providers would receive an additional lump sum per patient, again rewarding them for more careful and less costly patient care.

“This would be the next mega-revolution in the healthcare industry,” said Union Investment’s Manns.

($1 = 0.7477 euros)

(Editing by Mark Potter)