Thousands of NHS posts lie vacant

Thousands of NHS nursing and doctor posts lie vacant

By Dominic Hughes and Vanessa Clarke
BBC News
  • 29 February 2016
  • From the section Health

Nurses walking in a hospitalImage copyright
Science Photo Library

More than two-thirds of trusts and health boards in the UK are actively trying to recruit from abroad as they struggle to cope with a shortage of qualified staff, figures reveal.

Tens of thousands of NHS nursing and doctor posts are vacant.

The statistics, obtained by the BBC, show the scale of the NHS recruitment crisis.

Health unions blame poor workforce planning, but officials say the NHS has more staff than ever before.

Data from a BBC Freedom of Information request shows that on 1 December 2015, the NHS in England, Wales and Northern Ireland had more than 23,443 nursing vacancies – equivalent to 9% of the workforce.

Agency workers

Media captionRose Lagrosas from Manila explains why she wants to work in the UK

In comparison, the average vacancy rate across the UK economy from November to January 2016 was 2.7%, according to the Office for National Statistics.

The figures – which include 106 out of 166 trusts and health boards in England, Wales and Northern Ireland – also revealed:

  • Between 2013 and 2015, there has been a 50% increase in nursing vacancies, from 12,513 to 18,714.
  • For doctors, the number of vacancies went from 2,907 to 4,669 – an increase of roughly 60%.
  • In England and Wales, there were 1,265 vacancies for registered nurses in emergency departments – about 11% of the total.
  • For consultants in emergency medicine there were 243 vacancies – again 11% of the total.
  • Paediatric consultants – specialists in the care of babies, children and young people – were also hard to recruit, with 221 vacancies – about 7% of the total.

Analysis: Dominic Hughes, health correspondent

There are many reasons for the large number of vacancies in nursing and doctor posts on hospitals in England, Wales and Northern Ireland. One simple reason is that more posts now exist, but the number of trainees has not kept up. In the wake of the 2008 financial crash, nursing places were cut, although they are now on the way back up. The BMA suggests it takes around 15 years between a medical student starting out at university and becoming a consultant so planning the NHS workforce supply and demand is a complicated process with a long lead-in time.

But there are also increasing pressures on the health service right across the UK which the NHS is having to respond to – a growing population that is older and sicker, with more complex health needs. In plain language “complex health needs” means more than one thing going on at a time, so an elderly person might be having to cope with arthritis, diabetes and heart problems. But one other important factor is the “Francis effect” – the report by Sir Robert Francis into the scandal at Stafford Hospital identified a shortage of nurses as a key factor in the poor care of patients. Trusts in England in particular have been under pressure to recruit more staff. But when there is a shortage of qualified nurses they have resorted to expensive agency staff and that in turn has led to a growing financial crisis.


Vacancy rates in Scotland are published quarterly and so comparable figures are not yet available.

In England, many hospitals are having to rely on expensive agency workers to make up the shortfall in staff.

That has been identified as a key factor driving a growing financial crisis within the health service.

NHS recruitment crisis

69%

of UK trusts are actively recruiting abroad for doctors or nurses

  • 23,443 nursing vacancies in England, Wales & Northern Ireland

  • 9% vacancy rate for nurses

  • 6,207 doctor vacancies

  • 7% vacancy rate for doctors

Source: BBC Freedom of Information request

Science Photo Library

One solution to the staff shortage adopted by many trusts is employing doctors and nurses from overseas.

The BBC also asked trusts and health boards across the UK whether they were actively recruiting staff from abroad, and in this case Scottish hospitals were also able to answer.

The figures show more than two-thirds – 69% – of all NHS trusts and health boards are seeking staff overseas.

And in just England and Wales, the figure is nearly three-quarters of all trusts and health boards – 74%.

Some are travelling from as far afield as India and the Philippines.


‘No opportunities back home’

Image caption

Maca Fernandez Carro said she liked working for the NHS

Maca Fernandez Carro is a nurse who is originally from Bilbao in Spain, but has worked at Royal Bolton Hospital since 2014.

She told BBC Radio 5 live: “There was no opportunities for us back home. The options were having a three-month contract [in Spain], or coming here with a permanent position.

“Nursing is so different back home. When we qualify [in Spain] we are expected to do all the techniques that over here you’d need extra training [for].

“So we do a four-year degree, instead of a three-year one, so we have an extra year in which we train the technical part of nursing.

“Even though we are really under pressure, and really, really stressed – I like working for the NHS.”


Matthew Hopkins, who is the chief executive of Barking, Havering and Redbridge University Hospitals NHS Trust, told BBC Radio 4’s Today programme that employing more agency workers compromised patient safety and care.

“The difficulty with running a relatively high vacancy rate is it does inhibit the ability to provide the best care for our patients,” he said.

“We have to supplement our staff with agency workers who are not part of the team on a regular basis and therefore the quality of teamwork, which we know has the biggest impact on patient care and patient safety, is compromised.”

Ian Cummings, the chief executive Health Education England, told the same programme the nursing shortage in the NHS had been partly caused by “quality failings” – such as the Mid Staffs scandal.

Media captionDominic Hughes explains how the recruitment process works

“The quality failings in the NHS have caused our regulators and hospitals to look very carefully at how many nurses they need to deliver safe and high quality care.

“So the hospitals, for roughly the same number of beds compared to three years ago, now have a need for 24,000 more qualified nurses,” he said.

Meanwhile, the Royal College of Nursing and the British Medical Association blame poor workforce planning for the problems hospitals are having in finding qualified staff.

Janet Davies, chief executive of the Royal College of Nursing, said: “Nursing posts are often the first target when savings need to be made, leading the NHS to find itself dangerously short and having to spend more on agency staff and recruitment from other countries.”

Image copyright
Science Photo Library

Image caption

Doctors and nurses are in demand in the NHS

A spokesman for the doctor’s union the BMA – which is currently locked in a dispute with the government in England over a new contract for junior doctors – said: “Poor workforce planning means we aren’t producing enough doctors and sending them to the right areas,” he said.

However, in a statement, the Department of Health in England said: “Staffing is a priority — that’s why there are already over 29,600 extra clinical staff, including more than 10,600 additional doctors and more than 10,600 additional nurses on our wards since May 2010.”

But the statement also acknowledged that “much more needs to be done”, and said the government was “changing student nursing, midwifery and allied health professionals funding to create up to 10,000 more training places by the end of this Parliament.”

A Welsh Government spokesperson said: “There are now more doctors, nurses, midwives, paramedics and dental staff working in the Welsh NHS today than there were 10 years ago.

“We will continue to do all we can to support recruitment initiatives proposed by health boards and trusts and to address recruitment and retention at a national level.”

Viewers in England can see more on this story on Inside Out on BBC One at 19:30 GMT.

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'Hundreds' of young in old people's homes

‘Hundreds’ of young in old people’s homes

By Eleanor Bradford
BBC Scotland Health Correspondent
  • 29 February 2016
  • From the section Scotland

Romana

Image caption

Romana was placed in a care home after suffering a brain haemorrhage at 23

Younger people with neurological conditions are being cared for in old people’s homes, according to the charity Sue Ryder.

It said there is nowhere else for them to go because of a lack of specialist facilities.

The Scottish government said it wants people to be treated in their own homes or as close to home as possible.

Minister Jamie Hepburn said it plans to invest £250m a year to “protect and grow” social care services.

Romana was placed in a care home for the elderly at the age of just 23, after suffering a severe brain haemorrhage when she was four months pregnant with her second child.

She couldn’t see her children apart from short visits.

“It felt very strange because everyone around me was so much older; I was a very young girl at the time, and I felt I had lost my family,” she said.

Image caption

After two years at a Sue Ryder centre, Romana is preparing to move into her own flat

After two years, the Sue Ryder charity heard of her case and offered her a place at their neurological centre in Aberdeen.

With specialised rehabilitation, Romana learned to walk and live independently.

She is now looking forward to having her own flat, and sleeping under the same roof as her children for the first time in seven years.

Sue Ryder asked every local authority and health board in Scotland how many people with neurological conditions are being cared for in old people’s care homes.

Neurological conditions include Parkinson’s, multiple sclerosis, motor neurone disease, Huntington’s disease and brain injuries.

Only a third of local authorities provided figures. They said 63 people under the age of 65 were being cared for in such an environment.

If those figures were replicated across the remaining health boards it would mean about 250 people are in an inappropriate environment.

They said a further 182 people aged over 65 with neurological conditions were in a care home for older people.

Image caption

The charity believes up to 1,000 people could be missing out on appropriate treatment

Image caption

The charity has called on the Scottish government to “take immediate action”

The charity said this meant a total of nearly 1,000 people could be missing out on specialist treatment, support and rehabilitation.

Sue Ryder’s assistant director Scotland, Pamela Mackenzie, said: “Romana was quite a different lady when she first came. She was withdrawn and depressed and she really had been written off.

“Older people’s care homes do a great job for people in their 80s and 90s, but people like Romana need a different environment. Their conditions are quite different.

“It is clear from our research that the needs of people with neurological conditions have largely been overlooked in recent years.

“We urge the Scottish government to take immediate action to address these inequalities so people with neurological conditions get the chance of a better quality of life.”

‘Vital role’

The minister for health improvement, Jamie Hepburn, said: “Our 2016/17 budget sets out plans to invest a further £250m per year through health and social care partnerships, to protect and grow social care services, and invest £11.6m to implement self-directed support.

“We also recognise the vital role specialist nurses play in patient care. This is why we committed £2.5m of recurring funding for specialist nursing and care, including up to £700,000 to specifically target MND care.

“The health boards involved are currently recruiting additional nurses, or increasing the hours of existing nurses in order to fulfil our pledge to double the number of MND nurses in Scotland.

“Some posts have already been filled and the remaining posts are expected to be filled by spring 2016.”

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Closely watched AstraZeneca cancer drug fails in mesothelioma


A closely watched AstraZeneca drug did not extend lives of patients with the rare cancer mesothelioma when given on its own, but the drugmaker said it still believed the medicine had a role to play in combination treatments.

Mesothelioma is a deadly form of cancer that affects the lining of the lungs or abdomen. Patients typically live only nine to 12 months after initial diagnosis.

In a clinical trial tremelimumab failed to meet the goal of improving overall survival in hard-to-treat mesothelioma patients whose disease had already been treated unsuccessfully with standard drugs, AstraZeneca said on Monday.

Shares in the company fell 2.2 percent following the news.

“We are disappointed that tremelimumab monotherapy did not demonstrate a survival benefit in this patient population with no approved medicines beyond first-line treatment,” said Robert Iannone, the company’s head of immuno-oncology.

“However, we remain confident in tremelimumab’s clinical activity in combination.”

Tremelimumab is also being tested in combination with another of AstraZeneca’s immune-boosting drugs called durvalumab in multiple tumour types, including non-small cell lung cancer.

AstraZeneca is relying heavily on new cancer drugs to drive long-term growth and replace sales lost from older products that are going off patent.

Its biggest oncology bets are in the field of immunotherapy, or medicines that boost the body’s natural immune system defences to fight cancerous cells.

However, the British-based group is facing tough competition from various rivals, including Bristol-Myers Squibb, which has pulled ahead in the race to dominate the hot new area of cancer medicine.

(Reporting by Ben Hirschler; Editing by Greg Mahlich)


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Swiss Basilea says profits still 2-3 years away


Swiss drugmaker Basilea expects to move into profit by 2018, counting on new anti-infection drugs to help mitigate setbacks such as last month’s collapse of efforts to win U.S. approval for an eczema treatment.

On Monday, Basilea reported a full-year 2015 net loss of 61.6 million Swiss francs ($60.9 million), bringing total losses since 2011 to nearly 250 million francs.

The Basel-based company, whose strategy hinges on winning partners to sell drugs it develops, could lose up to 60 million francs on an operating level this year, it said.

To spur a turnaround, Chief Financial Officer Donato Spota remains optimistic following the 2015 rollout of two new drugs: Zevtera, an antibiotic for severe lung infections, and Cresemba, to fight rare but deadly fungal infections.

“We’re expecting to reach profitability within the next two to three years,” Spota said in a telephone interview.

The shares rose 3 percent by 1430 GMT, as analysts from J. Safra Sarasin said Cresemba’s 13.9 million francs in royalties following its U.S. approval last March “suggests a healthy launch.”

Basilea will not be able to count on U.S. milestone payments from partner GlaxoSmithKline from its eczema drug Toctino to help reach profitability.

The British company in January abandoned its bid to win U.S. Food and Drug Administration approval for the treatment.

GSK sells Toctino outside the United States, where the drug accounted for nearly 75 percent of Basilea’s 52.8 million francs in total revenue in 2015.

Chief Executive Ronald Scott is now studying the implications of the GSK decision and added that Toctino’s U.S. fate will be decided before April.

“If we were to take the drug back, then we would look for an additional partner,” Scott said in the interview. “We will not file the drug in the United States by ourselves.”

Basilea has 364.7 million francs in cash, money the company said is needed to pay for its share of winning U.S. approval for Zevtera — a process that could take three years — as well as to develop a pair of investigational cancer drugs.

(Reporting by John Miller; Editing by Keith Weir)


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France says detects first sexually transmitted Zika case


France has detected its first sexually transmitted case of Zika in a woman whose partner had traveled to Brazil, the epicenter of an outbreak of the virus, a senior health official said on Saturday.

U.S. officials said earlier this week they were investigating 14 reports of the mosquito-borne disease that may have been transmitted through sex, including to several pregnant women.

Francois Bourdillon, head of France’s Institute for Public Health Surveillance (IVS), said the infected woman was the country’s “first confirmed indigenous case of transmission”.

“This was a woman who had never traveled. Her partner had come from Brazil, so she was tested,” Bourdillon said in an interview broadcast on BFM TV, adding that both patients were doing well.

Marie-Claire Paty, who helps monitor diseases transmitted by insects for the IVS, told Reuters the current epidemic seemed to confirm sexual transmission, which was identified as a possibility during an earlier outbreak in Polynesia in 2013-14, when the virus was isolated in sperm.

Brazil has declared a public health emergency over Zika, which may be linked to thousands of cases of the microcephaly birth defect that is marked by undersized heads and underdeveloped brains.

There is no cure or treatment for the virus, which is usually transmitted by mosquitoes and has spread to more than 30 countries.

(Reporting by Yann Le Guernigou; Writing by James Regan; Editing by Helen Popper)


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France says detects first sexually transmitted Zika case


France has detected its first sexually transmitted case of Zika in a woman whose partner had traveled to Brazil, the epicenter of an outbreak of the virus, a senior health official said on Saturday.

U.S. officials said earlier this week they were investigating 14 reports of the mosquito-borne disease that may have been transmitted through sex, including to several pregnant women.

Francois Bourdillon, head of France’s Institute for Public Health Surveillance (IVS), said the infected woman was the country’s “first confirmed indigenous case of transmission”.

“This was a woman who had never traveled. Her partner had come from Brazil, so she was tested,” Bourdillon said in an interview broadcast on BFM TV, adding that both patients were doing well.

Marie-Claire Paty, who helps monitor diseases transmitted by insects for the IVS, told Reuters the current epidemic seemed to confirm sexual transmission, which was identified as a possibility during an earlier outbreak in Polynesia in 2013-14, when the virus was isolated in sperm.

Brazil has declared a public health emergency over Zika, which may be linked to thousands of cases of the microcephaly birth defect that is marked by undersized heads and underdeveloped brains.

There is no cure or treatment for the virus, which is usually transmitted by mosquitoes and has spread to more than 30 countries.

(Reporting by Yann Le Guernigou; Writing by James Regan; Editing by Helen Popper)


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More tooth decay among English children

Tooth decay still on the rise among English children

By Dominic Howell
BBC News
  • 26 February 2016
  • From the section Health

tooth decayImage copyright
Thinkstock

The number of children in England having their teeth removed because of decay has increased for the fourth year in a row, new figures suggest.

In 2014-15 there were 33,781 cases of children, aged 10 and under, needing the removal of one or more teeth – a rise of 3% on the previous year.

The Chief Dental Officer for NHS England, Sara Hurley, described the figures as “disappointing”.

She said children in England drank more sugary drinks than anywhere in Europe.

“Even though people understand the impact of a sugary diet so many children have advanced tooth decay – a highly preventable disease,” said Ms Hurley.

“We are also creating a legacy of obesity and significant health problems.

“If we are to get serious about tackling this then prevention is the key,” she added.

‘Unacceptable’

Since 2011-12 there has been a steady rise in the number of children needing tooth extractions, according to statistics collated by the Health and Social Care Information Centre (HSCIC).

Over the four-year period there were 128,558 cases in total of children having teeth removed because of decay.

And the 2014-15 figures show a 9.8% rise from the 30,761 recorded in 2011-12.

Prof Nigel Hunt from the Royal College of Surgeons said: “An almost 10% increase in the number of children being admitted to hospital for tooth extraction due to decay over a four-year period is unacceptable.”

“The need for tooth extraction continues to be the number one reason why five to nine-year-old children are admitted to hospital.”

He also said that poor oral health education was another reason for the rise.

‘Deprivation correlation’

The figures also showed a wide regional variance across England.

For example, in 2014-15 the rate of tooth extractions in Yorkshire and the Humber was 894.5 for every 100,000 people (6,413 episodes).

That was more than five times the rate recorded in the East of England, which was 164.5 per 100,000 population (1,328 episodes).

The authors of the HSCIC study said: “Nationally, there is a strong correlation between area deprivation and the rate of tooth extraction.”

“As deprivation increases so does the rate of tooth extraction.”

London had the most children needing hospital admission as an inpatient for tooth decay, with 8,362 cases.

In the North West, there were 6,672 cases, and 6,413 in Yorkshire and Humber.

The shadow public health minister, Andrew Gwynne, described the figures as “disturbing”.

“The government should be standing up for parents, particularly those living in more deprived communities, and helping them to tackle tooth decay,” he said.

A Department of Health spokesperson said: “Children’s teeth are dramatically healthier than they were 10 years ago, but we still know there is more to do.”

“We are radically changing NHS dentistry, so that dentists will be paid for keeping the nations’ teeth healthy, rather than just for treating problems as they arise.”

The figures over the past four years break down as follows:

  • 2014-15 – 33,781 episodes of care
  • 2013-14 – 32,741 episodes of care
  • 2012-13 – 31,275 episodes of care
  • 2011-12 – 30,761 episodes of care

What is tooth decay?

Image copyright
Thinkstock

Tooth decay is caused by plaque collecting, in particular, around the gum line, the edges of fillings and the grooved surfaces of the teeth.

Plaque is made up of food debris, saliva and bacteria normally present in the mouth.

The acids generated by bacteria breaking food down can begin to attack tooth enamel within 20 minutes of a meal.

If plaque is allowed to collect over time it will harden into tartar.

Both tartar and plaque contain acids which, over time, can dissolve the protective, hard, enamel coating of the tooth and create holes, or cavities.

Most cavities form over a period of months, or even years.

They are usually painless, but they can grow very large and damage the much softer internal structures of the tooth such as the dentin and the pulp, which is found at the core.

If they remain untreated, they can kill the nerve and blood vessels of the tooth, and ultimately the tooth itself.

The most obvious sign of tooth decay is toothache, particularly after hot or cold food or drinks.

Pits or holes may also be visible in the teeth.

Plaque and tartar also irritate the gums, and lead to a gum disease called gingivitis.

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China says to speed up approvals for some drugs

Shelves displaying medicines are seen at a pharmacy in Shanghai, China, November 27, 2015.  REUTERS/Aly Song
Shelves displaying medicines are seen at a pharmacy in Shanghai, China, November 27, 2015.

Reuters/Aly Song


China’s drug regulator said it would accelerate approvals of new medicines, long a headache for pharmaceutical firms who complain it takes too long to get drugs to market.

The China Food and Drug Administration (CFDA) said in a statement published on Friday that it would prioritize the approval of drugs with clear clinical value, including those that use advanced technology or innovative methods.

It added that certain categories of drugs would get priority, including those for children and the elderly, rare diseases, AIDS, malignant tumors and viral hepatitis.

China’s drug market, the world’s second largest, is a magnet for global pharmaceutical makers, despite growing local competition and downward pressure on prices.

IMS Health estimates the market will be worth $185 billion by 2018.

Industry executives have said in recent years that China has toughened the approval process, leading to a growing backlog and waits of as much as six to eight years to get to market.

The announcement, published on the CFDA’s website, also outlined new processes for applying for clinical trials and manufacturing registration.

(Reporting By Alexandra Harney; Additional reporting by Adam Jourdan; Editing by Andrew Heavens)


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China says to speed up approvals for some drugs

Shelves displaying medicines are seen at a pharmacy in Shanghai, China, November 27, 2015.  REUTERS/Aly Song
Shelves displaying medicines are seen at a pharmacy in Shanghai, China, November 27, 2015.

Reuters/Aly Song


China’s drug regulator said it would accelerate approvals of new medicines, long a headache for pharmaceutical firms who complain it takes too long to get drugs to market.

The China Food and Drug Administration (CFDA) said in a statement published on Friday that it would prioritize the approval of drugs with clear clinical value, including those that use advanced technology or innovative methods.

It added that certain categories of drugs would get priority, including those for children and the elderly, rare diseases, AIDS, malignant tumors and viral hepatitis.

China’s drug market, the world’s second largest, is a magnet for global pharmaceutical makers, despite growing local competition and downward pressure on prices.

IMS Health estimates the market will be worth $185 billion by 2018.

Industry executives have said in recent years that China has toughened the approval process, leading to a growing backlog and waits of as much as six to eight years to get to market.

The announcement, published on the CFDA’s website, also outlined new processes for applying for clinical trials and manufacturing registration.

(Reporting By Alexandra Harney; Additional reporting by Adam Jourdan; Editing by Andrew Heavens)


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China says to speed up approvals for some drugs

Shelves displaying medicines are seen at a pharmacy in Shanghai, China, November 27, 2015.  REUTERS/Aly Song
Shelves displaying medicines are seen at a pharmacy in Shanghai, China, November 27, 2015.

Reuters/Aly Song


China’s drug regulator said it would accelerate approvals of new medicines, long a headache for pharmaceutical firms who complain it takes too long to get drugs to market.

The China Food and Drug Administration (CFDA) said in a statement published on Friday that it would prioritize the approval of drugs with clear clinical value, including those that use advanced technology or innovative methods.

It added that certain categories of drugs would get priority, including those for children and the elderly, rare diseases, AIDS, malignant tumors and viral hepatitis.

China’s drug market, the world’s second largest, is a magnet for global pharmaceutical makers, despite growing local competition and downward pressure on prices.

IMS Health estimates the market will be worth $185 billion by 2018.

Industry executives have said in recent years that China has toughened the approval process, leading to a growing backlog and waits of as much as six to eight years to get to market.

The announcement, published on the CFDA’s website, also outlined new processes for applying for clinical trials and manufacturing registration.

(Reporting By Alexandra Harney; Additional reporting by Adam Jourdan; Editing by Andrew Heavens)


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