NHS row as EU campaigns get under way

EU referendum: NHS cash row as campaigns get under way

  • 15 April 2016
  • From the section EU Referendum

Remain and Leave campaigners composite imageImage copyright
Getty Images

Image caption

The designated lead campaigns can spend up to £7m

The EU referendum campaign has kicked off with a row over claims millions could be freed up for the NHS if Britain voted to leave on 23 June.

Vote Leave claims £50m a day is being sent to Brussels – money it says could be spent instead on building hospitals and reducing pressures on the NHS.

But Britain Stronger in Europe says that figure is wrong – and leaving the EU would harm the health service.

Opinion polls suggest the referendum is too close to call with 10 weeks to go.

In the main campaign developments so far:

  • Chancellor George Osborne says families will “pay the price” if the UK exits the EU and it is likely mortgage rates would go up
  • UKIP leader Nigel Farage has challenged David Cameron to a head-to-head debate over the government’s £9m pro-EU leaflet
  • The head of the Catholic Church in England and Wales said the UK would face “more complex problems” outside the EU
  • A survey commissioned by ITV’s Good Morning Britain suggested 40% of those asked wanted to stay in the EU while 39% wanted to leave.

The NHS has emerged as the chief battleground on day one of the official campaign, with Leave campaigners calling for a large slice of the UK’s net contribution to the EU’s coffers – which it says amounts to £350m a week – to be pumped into the NHS instead.

Media captionEU referendum: Alistair Darling denies ‘Project Fear’
Media captionEU vote: Brexit to ‘free up’ NHS cash

“I think we ought to decide ourselves how we spend that money and I would suggest we spend it on the NHS,” said Gisela Stuart, the Labour MP and co-chair of the cross-party Vote Leave group.

“The NHS is under tremendous pressure, people have to wait longer whether it is for treatment or for A&E and I think £350m would be better spent on the NHS.”


Reality Check: Would Brexit mean extra £350m a week for NHS?

We’ve said it before and we’ll say it again – the UK does not send £350m a week to Brussels – the rebate is deducted before the money is sent, which takes the contribution down to £276m a week.

That figure includes £88m a week spent in the UK on things like regional aid and support for farmers. The government could decide after a Brexit that it should take that money away from farmers and give it instead to the NHS, but it might be an unpopular decision in rural areas.

Read more


Her message is being echoed by Conservative heavyweights, such as Mayor of London Boris Johnson and Justice Secretary Michael Gove, key figures in the Leave movement.

“At the moment the money we give to the European Union is spent by others, people we have never elected and never chosen and can’t remove,” Mr Gove said.

“If that money is taken back, that £50m a day will be spent on British people’s priorities and the NHS is top of people’s list.”

‘Project Fantasy’

Britain Stronger in Europe – the main Remain campaign – has said the £350m figure is inaccurate because the UK gets a large chunk of its membership fee back through the UK’s annual rebate, money which is already spent in a number of areas, including on farming subsidies.

Its executive director Will Straw described Vote Leave’s arguments as “unedifying speculation” and claimed several of its supporters wanted to privatise the NHS.

And the TUC said the NHS, which costs £2.25bn a week to run and is reliant on migrant labour, would face a staffing crisis if the UK was to vote to leave the EU.

The BBC’s political correspondent Iain Watson said there was likely to be a lot of trading of statistics during the campaign, with some opinions stated as facts.

Addressing the broader economic case for remaining in the UK, Lord Darling, who was Labour chancellor from 2007 to 2010, warned against choosing “isolation rather than influence”.

In a speech in London, the Labour peer – who led the successful Better Together campaign in the Scottish independence referendum – argued the referendum was “not about sovereignty” because the UK “is a sovereign nation and will remain so”.


EU referendum: In depth

Image copyright
Reuters

The UK’s EU vote: All you need to know

EU for beginners: A guide

UK and the EU: Better off out or in?

A-Z guide to EU-speak

Who’s who: The Vote Leave team

Who’s who: The Remain campaign


The Labour peer rejected claims that the Remain campaign was using the same tactics as Better Together did in 2014 – dubbed “Project Fear” by its opponents – saying he made “no apology” for exposing his opponents’ “fear of the spotlight of legitimate scrutiny”.

“It is not Project Fear. In truth, it is a reality check. The kind anyone would rightly take before making an enormous decision affecting their lives.”

Image copyright
EPA

Image caption

Nigel Farage has said the government’s arguments are “jammed full of lies”

Image caption

Cardinal Vincent Nichols said European solidarity had helped bring peace to the continent

Speaking in Washington, ahead of a visit by US President Barack Obama to the UK next week, George Osborne said it was the “overwhelming view” of foreign governments and international institutions such as IMF and Nato that the UK should remain.

Asked whether he agreed with the Remain campaign’s claim that mortgage rates would go up in the event of EU exit, Mr Osborne said this was a matter for the Bank of England but it was a widely held view that “prices would rise, jobs would be lost and living standards would fall”.

UKIP leader Nigel Farage has, meanwhile, challenged David Cameron to a face-to-face debate as he delivered a letter to Downing Street protesting at the government’s pro-EU £9m leaflet campaign.

Mr Farage, who took on former Lib Dem leader Nick Clegg during the 2014 European elections, said the government’s arguments were “jammed full of lies and inaccuracies” and the prime minister must front up to “see if your claims will stand up to public scrutiny”.

“Name your place and time and let’s have a live, televised, head-to-head debate where we can debate one of the greatest political questions of our time,” he said.

Meanwhile, Cardinal Vincent Nichols – the head of the Catholic Church in England and Wales – urged parishioners to “pray for guidance” and look beyond narrow economic concerns.

However he said he believed if the UK left the EU it would face “more complex problems than we would if we were playing an active part with Europe”.

“In the EU, trade is harnessed to peace. An essential feature of the EU is the peace that has been sustained in Europe since the end of the second world war.”

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Puberty timing influenced by both parents

Youngsters toboggan in the snow, in Princes Risborough, southern England January 5, 2009.     REUTERS/Eddie Keogh
Youngsters toboggan in the snow, in Princes Risborough, southern England January 5, 2009.

Reuters/Eddie Keogh


(Reuters Health) – Boys and girls may go through puberty sooner if their mothers and fathers were early bloomers, a recent Danish study suggests.

Researchers studied the timing of puberty for 672 girls and 846 boys relative to their parents and found kids who developed pubic hair and other hallmarks of adulthood at an unusually young age tended to have mothers and fathers who also matured early.

“Both genetic and environmental factors undoubtedly influence puberty timing,” said lead study author Dr. Christine Wohlfahrt-Veje, a growth and development researcher at the University of Copenhagen.

“Our study shows that both boys and girls inherit from both mothers and fathers, but indicates that the early pubertal markers – onset of breasts and pubic hair – in girls are less dependent on genetic and hence more on environmental factors such as childhood growth patterns and possibly other environmental exposures,” Wohlfahrt-Veje added by email.

Children who go through early puberty may be shorter than average adults because after their early growth spurt their bones may stop growing at a younger age, and they are also at increased risk of obesity as adults. During adolescence, they may face an increased risk of social and emotional problems and earlier sexual experiences.

Some recent research points to earlier puberty onset in general, especially in girls in developed countries. Environmental factors like diet, obesity and chemicals that mimic human hormones have all been suspected of playing a role.

To look at the contribution of genetics to puberty timing, Wohlfahrt-Veje and colleagues examined medical records from annual checkups kids received between 2006 and 2013 as well as data on parental puberty timing from questionnaires completed by their parents.

When fathers matured early, boys tended to develop pubic hair almost one year ahead of boys with fathers who went through puberty late. Sons of men who developed early also grew enlarged testes about 9.5 months sooner than sons of fathers who went through puberty late.

Girls with fathers that matured early started menstruating about 10.5 months sooner than girls with late-bloomers for fathers, and the girls of fathers who went through early puberty also developed pubic hair around 7 months before girls whose fathers developed late. Early breast development in girls, however, didn’t appear to be tied to early puberty in their fathers.

When mothers went through puberty early, their sons and daughters tended to follow suit.

Daughters of women who matured early typically started menstruating about 10 months sooner than girls with late-blooming mothers.

Sons of women who went through puberty early typically went through genital maturation about 6.5 months before boys with mothers who developed late.

One shortcoming of the study is that researchers relied on parents to accurately recall and report on when they went through puberty many years earlier. They also got more data from mothers than fathers, which may have affected the relative influence of each parent in the results.

Because the study didn’t find as strong an association with parental puberty timing and breast development in girls, this suggests that other factors beyond genetics may influence puberty in girls, the authors conclude in the Journal of Clinical Endocrinology and Metabolism.

“A broad normal variation exists within timing of puberty,” Wohlfahrt-Veje noted.

Still, when kids develop early, they quite likely came from a long line of early bloomers.

“A large proportion of this variation seems to be explained by genetics,” Wohlfahrt-Veje added. “If either the mother or father had early or late pubertal development it is likely to influence the timing of pubertal onset in both their sons and daughters.”

SOURCE: bit.ly/1Sd55zL Journal of Clinical Endocrinology and Metabolism, online March 25, 2016.


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Latest battle to wipe out polio begins with vast vaccine switch


In a huge immunization effort in 150 countries, health teams will on Sunday launch what they hope will be the final push against polio.

Stopping transmission of the contagious viral disease that has infected millions is possible within a year, experts say. And full, official, global eradication could be declared by the end of this decade.

First, however, the vaccine that has successfully fought polio for more than 30 years needs to be switched for one that targets the last few areas of risk.

It won’t be easy, or cheap, but the World Health Organization’s director of polio eradication, Michel Zaffran, says failure now – when there have only been 12 cases worldwide this year, in Pakistan and Afghanistan – means the virus could spread across borders again.

Success would make polio only the second human disease to be eradicated since smallpox was banished in 1980.   

“Taking our foot off the pedal now could mean polio will within a few years spread straight back into large parts of the world and create 100,000 or 200,000 cases,” Zaffran told Reuters. “The job has not been done and will not be done until we have fully eradicated the virus.”

VACCINE COMPLEXITIES

For the endgame in polio to succeed, a coordinated and complex vaccine switch is crucial.

Until now, many countries have been using a shot that protects against the three types of wild polio virus – type 1, type 2 and type 3 – but type 2 polio transmission has been stopped since 1999, meaning immunizing against it now makes no sense.

In rare cases it also poses a risk that the weakened type 2 virus in the vaccine can seep into circulation and cause “vaccine-derived” polio infections.

So from April 17 to May 1, some 150 countries will engage in a synchronized switch to a bivalent, or two-strain, vaccine that contains no type 2 virus but targets types 1 and 3.

It’s a massive undertaking and a major step towards eradication, says Zaffran. “We’re entering into uncharted territory. This has never been done before. But there’s no going back now.”  

That’s partly because polio vaccine manufacturers – among them France’s Sanofi Pasteur – have moved production to the bivalent shot and would find it tricky, costly, and time-consuming to reverse that move.

Anil Dutta, a vaccine expert at British drugmaker GlaxoSmithKline, which also makes polio shots, is looking beyond eradication to 2019 or 2020, when all “live” oral polio vaccines need to be discontinued.

Then the world will switch again, to “inactivated” polio vaccine, or IPV, to further reduce any risk of causing disease through immunization. Scaling up IPV production to meet the needs of the entire world takes years, he warns, and work must start now to avoid potential supply concerns.

HISTORY OF MISSES

But prediction has never been easy in the fight to wipe out polio, and health authorities have missed targets along the way.

The Global Polio Eradication Initiative, launched in 1988, originally aimed to end all transmission of the disease by 2000.

And while there has been a 99 percent reduction in cases worldwide since the GPEI launch, fighting the last 1 percent of polio has been far tougher than expected.

In 2013, the GPEI said the global fight against polio would require $5.5 billion in funding, and more will be needed beyond that to keep a lid on the disease.

The virus, which invades the nervous system and can cause irreversible paralysis within hours, spreads rapidly among children, especially in unsanitary conditions in war-torn regions, refugee camps and areas where healthcare is limited.

In Pakistan and Afghanistan, the last two countries where polio currently remains endemic, conflict and propaganda have hampered progress, and in the past posed risks to others.

The campaign to eliminate polio in Pakistan is fraught with risk, with Islamist militants attacking health teams they accuse of being Western spies. A polio worker was shot and wounded in February and in January a suicide bomber killed 15 people outside a polio eradication center in the city of Quetta.

In 2011, a polio virus from Pakistan re-infected China, which had been polio free for more than a decade.

In 2013, the disease re-emerged in Syria after a 14-year absence, prompting the need for a vast and expensive regional emergency vaccination campaign.

And last year, cases of type 2 vaccine-derived polio posed new threats in Ukraine and Mali.

David Salisbury, an immunization specialist and associate fellow at Britain’s Chatham House Centre on Global Health Security, says the last 1 percent is a “very long tail” on a stubborn epidemic.

“The original date for interruption of transmission was 2000. The next target was 2014 and it’s currently 2016,” Salisbury told Reuters, adding that even with case numbers as low as they are now, “2016 may be optimistic”.

Liam Donaldson, head of the Independent Monitoring Board of the GPEI, agrees that celebrating the expected extinction of polio virus “would not just be premature, it would be folly”.

“Polio is still out there,” he told a meeting in London. “(It) has fought back with a vengeance at every stage of the game. And it’s still fighting.”

(Reporting by Kate Kelland; editing by Giles Elgood)


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Patients Won't Take Charge of Cutting Health Costs

Lena Wright’s best friend was hunched over like a character from a French novel, with spinal bones so thin they would fracture with a fit of sneezing. Determined to avoid that fate, Wright (a pseudonym) asked her primary care doctor to test her for osteoporosis with a DEXA scan, also known as dual energy x-ray absorption. The scan would send two x-ray beams through her bones, one high-energy and the other low. The difference in how much energy passes through her bones would somehow (the wonders of physics!) allow her doctors to calculate the thickness of her skeleton.

If you need to figure out whether you have osteoporosis, a DEXA scan is a good idea. But if you don’t need such a scan, you end up exposing yourself to harmful radiation and, of course, to an unnecessary healthcare expense. According to the American Academy of Family Physicians, most people do not need the test, because they do not have risk factors for osteoporosis. Lena Wright, for example, harbored no family history of osteoporosis, had exercised regularly her whole life, didn’t smoke or drink and, very importantly, had received the test 5 years earlier at age 65, which showed her to have normal bone density at the time. In the best judgment of medical experts, a DEXA scan would bring Wright more harm than benefit.

But she was worried. So her doctor, to ease her anxieties, ordered another scan.

What, if anything, can we do to reduce unnecessary and potentially harmful medical testing?

We can start by trying to reduce patient demand for such services. That is an approach taken by the Choosing Wisely campaign, a voluntary effort by medical professionals to reduce wasteful medical care. As part of this effort, professional societies like the American Academy of Family Physicians put together “top 5” lists of wasteful services. Then, in partnership with organizations like Consumer Reports, they’ve tried to educate the general public about why they should be happy to avoid such services.

I am a huge fan of educating the general public and think that Consumer Reports does as fine a job at this as anyone in the business. But I also recognize that their reach — their ability to get the word out to the masses — is limited.

So I was excited to learn that a team of medical researchers decided to put educational materials in the hands of patients, to try to reduce their use of unnecessary services. They targeted three services:

  • Prostate cancer screening in men 50 to 69 years old
  • Colon cancer screening in people 76 to 85 years old
  • DEXA testing in women with low risk for osteoporosis

They gave patients brief, simple brochures laying out the benefits and risks of these screening tests, highlighting that the latter outweighed the former. They even tested out different ways of presenting this information: in words, in words and numbers, even with relatively “nudgey” language meant to dissuade patients from receiving the tests.

And they found essentially no clinically meaningful reduction in the use of these tests. Sigh.

Reducing low-value medical care is not easy. And expecting patients to do the brunt of the work is probably unrealistic. Suppose, for instance, a physician believes ardently in the value of prostate cancer screening. Do you think a one-page educational brochure given to a patient in the waiting room is going to compete with that?

Perhaps, then, doctors should take the lead in reducing low-value medical care. That’s certainly what another group of researchers thought when they set out to educate medical residents (physicians in training) about how to counsel patients effectively to reduce such wasteful care. They arranged for the residents to interact with standardized patients, actors trained to pretend to be patients. These standardized patients would show up in clinic unannounced, with the doctors unaware that they weren’t real patients. The actors were specifically training to request unnecessary tests, including some patients who requested DEXA scans. (They also had some patients request imaging for uncomplicated low back pain or for uncomplicated headaches.) The medical school instructors taught half of the residents how to respond to unnecessary patient requests; how to validate the patient’s concerns while informing and explaining the harmfulness of their requested services to them.

The researchers discovered that their waste-reducing educational training had no effect. Zilch. Not an iota! Physicians who received the training were just as likely to accede to patients’ wasteful requests as other doctors:

image

On the positive side, the majority of residents — in both the intervention and the control groups — were able to say no to the patients’ requests. It was rare, for instance, for doctors to order CT or MRI scans for patients with uncomplicated headaches.

What’s the bottom line from these excellent studies? First, reducing wasteful medical care won’t be easy. In addition, if we want to change patient or physician behavior, we need to do even more than what these researchers did, a tall order in our time and resource constrained world.

Ultimately, I don’t think educational efforts directed at patients or physicians will pan out until we change financial incentives to stop rewarding doctors for providing low-value care. As long as healthcare providers are paid well to perform unnecessary tests, a bit of education is unlikely to have much impact. Persuasion and education pale in comparison to the power of the purse.

Peter Ubel is a physician and behavioral scientist who blogs at his self-titled site, Peter Ubel and can be reached on Twitter @PeterUbel. He is the author of Critical Decisions: How You and Your Doctor Can Make the Right Medical Choices Together. This article originally appeared in Forbes, and also appeared in KevinMD.com.

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Check your 2015 Open Payments data

Check your 2015 Open Payments data

April 14
by Centers for Medicare & Medicaid Services

By Shantanu Agrawal, M.D, Deputy Administrator and Director of CMS’ Center for Program Integrity

The Centers for Medicare & Medicaid Services’ continues to publish data from applicable manufacturers and group purchasing organizations (GPOs) about payments they make to physicians and teaching hospitals on its website, https://openpaymentsdata.cms.gov/. We’re pleased that the public has searched Open Payments data more than 6.3 million times. Doctors, teaching hospitals and others receiving payments or other transfers of value that are sent to us from reporting entities, should take steps to ensure that this information about you, your related research, ownership, and other financial concerns are accurate.

Doctors and teaching hospitals have the chance to review and dispute the information shared about them before we post the new and updated Open Payments data on June 30, 2016. The data we post on June 30th is now available for review through May 15, 2016. Since April 1, this is the only chance for these health care providers to dispute inaccurate or incomplete data before we post it. After that they only have until the end of the year that this financial data is published to review and dispute any payment records and how it was attributed from GPOs, drug and device manufacturers.

Any doctor or teaching hospital that wants to look at the financial information reported on them by manufacturers and GPOs can register on the Open Payments website to create an account or log if they already have an account. Visit our website for instructions and quick tips.

Last June, we posted payments and ownership interests reported in 2014 about more than 607,000 physicians and 1,122 teaching hospitals, valued at $6.45 billion. Health care practitioners and teaching hospitals were paid for items like medical research, conference travel and lodging, gifts and consulting.

The Open Payments program is one way we can give patients, their families and caregivers transparency and information that helps them:

  • Become better informed health care consumers.
  • Talk to their doctors and other care professionals.

If you want to learn more about the program, visit the Open Payments program website or send questions to openpayments@cms.hhs.gov

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A&E delays reach new record level

A&E delays reach new record level

By Nick Triggle
Health correspondent
  • 14 April 2016
  • From the section Health

StretcherImage copyright
Thinkstock

A&E performance in England sank to a new low in February for the second month in a row, official figures show.

Hospitals are meant to see 95% of patients in four hours, but just 87.8% were, NHS England data revealed.

That is a slight drop on the January figures, which were the worst since the target was introduced in 2004.

And in another sign of growing A&E pressures, a unit in Lancashire is being forced to close overnight from next week because of a staffing crisis.

Bosses running the Chorley A&E said they had to take the step because they did not have the doctors to staff the unit.

  • What will it take to get the NHS back on track?
  • Staff shortage prompts A&E closure
  • Chorley A&E closure: a cautionary tale?

There is a national shortage of A&E doctors and Chorley said this had been exacerbated by the national cap on agency staff which has been brought in.

The cap limits the amount hospitals can pay for locum staff to no more than 55% above normal shift rates. It has been phased in since November as the government has demanded the health service curb the rising bill for agency staff, which has been cited as one of the major factors behind the deficits being racked.

Image copyright
Getty Images

The Chorley unit – part of the Lancashire Teaching Hospitals NHS Foundation Trust – tried to apply the cap but found it could not fill its rotas.

It relied heavily on locum staff because it did not have enough permanent doctors and so this month has stopped using the cap, under the emergency clause in the regulations, but still could not find the staff.

There have been suggestions other trusts have got round it by paying permanent doctors extra to fill shifts.

Trust medical director Prof Mark Pugh said: “We simply cannot staff the rotas and it is an unacceptable risk to patient safety to attempt to provide an emergency service with no doctors available to see people.”

Dr Cliff Mann, of the Royal College of Emergency Medicine, said Chorley was not the only unit affected. “A&E units rely on locums more than others because we have problems filling posts with permanent staff and we have to provide a 24/7 service.

“This is not a unique situation.”

The news emerged as NHS England published its monthly performance report for February.

As well as the problems in A&E, the 111 phone service, ambulances and cancer care also missed key performance targets.

The 18-week target to see patients needing routine treatments, such as knee and hip operations, was met although a number of trusts did not submit data.

Candace Imison, of the Nuffield Trust, said: “Today’s figures are the very visible symptoms of a system facing both inexorably increasing patient numbers and severe financial strain.”

NHS England’s Richard Barker said the problems in A&E were also related to a later-than-normal spike in flu cases and problems hospitals were experiencing discharging patients because of problems accessing social care support in the community for vulnerable patients.

“Despite these pressures, for the year as a whole more than nine out of ten patients have been admitted, treated or discharged in under four hours, while long trolley waits have halved compared with last year,” he added.

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Staff shortage prompts A&E closure

Staff shortage prompts Chorley Hospital A&E temporary closure

  • 14 April 2016
  • From the section Lancashire

Chorley Hospital

Image caption

Chorley’s Hospital accident and emergency department is to close temporarily

A hospital’s accident and emergency department is to close temporarily as it cannot “recruit enough staff to provide a safe service”.

Chorley Hospital in Lancashire will be downgraded to an urgent care service, a move that will “put lives at risk”, the area’s MP has claimed.

MP Lindsay Hoyle blamed “bad management”.

Lancashire Teaching Hospitals NHS Trust said there were “no other safe options” due to a shortage of doctors.

It has been unable to secure additional locum doctors, making staffing the emergency department “increasingly difficult”, it said.

A&E delays reach new record level

Chorley Hospital has eight of the 14 doctors it needs and can therefore only staff less than half the hours required.

Consultants have been working extra shifts to cover the staff rota, but “this is not sustainable and this approach is beginning to affect our ability to cover the consultant rota”, the trust said.

Ambulances will take patients to Royal Preston Hospital, 14 miles away, or other hospitals from Monday, the trust said.

Jamie Carson, director at Chorley Council said: “We cannot understand how the problem in Chorley has become so acute when other hospitals do not have to close their A&E service.”


Analysis

Nick Triggle, BBC Health Correspondent

The problem with central diktats is that they can have unintended consequences in an organisation as large as the NHS.

When ministers in England last year announced they were going to cap how much hospitals could pay agency staff they felt they had found a solution to a factor increasingly cited as a cause of the financial problems engulfing the health service.

But the temporary downgrading of Chorley’s A&E unit suggests it merely tackles the symptoms of the problem rather than the causes.

Chorley is unlikely to be the only site struggling like this – in fact there are suggestions some are playing fast and loose with the cap rules to stay afloat.


In November, a cap on spending on NHS agency staff came into force in England to save £1bn over the next three years.

It meant by April, NHS trusts will not be able to pay agency staff such as doctors and nurses more than 55% for a shift than a permanent member of staff.

From Monday, the emergency department at Chorley will be temporarily replaced by an urgent care service until the staffing crisis is resolved.


Image copyright
PA

Jessica Knight, who was in hospital for five to six months after she was stabbed 20 times while walking in a park, said: “The A&E at Chorley was a major point of my recovery. One of my wounds was in the neck and I might have had a heart attack.

Jessica, who was left for dead and found by a passing cyclist, added: “I was six hours in surgery and had four people working on me. The A&E was critical to my survival.

“If that was to happen now I wouldn’t be alive because I might have been taken to a hospital further away.”

Jessica’s attacker Kristopher Bedder, 21, was jailed for life with a minimum of 12 years.


Prof Mark Pugh, consultant anaesthetist and medical director of the trust, said: “Changing the current service provided at Chorley is a direct response to the immediate and significant staffing problem.

“We simply cannot staff the rotas and it is an unacceptable risk to patient safety to attempt to provide an emergency department service with no doctors available to see people.”

Image caption

Prof Mark Pugh said the pool of doctors they were trying to recruit is ‘no longer available’

‘Not beholden’

Prof Pugh said they were experiencing great difficulty in recruiting medical staff on a 24/7 basis. “We are actively recruiting today, at this minute, and as soon as that position allows us to safely open the unit again we will do so at the earliest opportunity,” he said.

He said they were recruiting doctors as the pool of staff they had relied on was no longer available and it was “a national problem”.

He said a lot of other departments in the region are “struggling.” He said: “We are not beholden on the agency cap that has been nationally imposed. We have gone out to try and recruit these people and they are no longer there.”

In a statement, NHS Improvement said: “It is clear that locally, recruitment of a particular speciality of accident and emergency staff has proved very challenging at the same time as demand for services has jumped by around 14% compared with previous years.

“While the majority of patients are still being seen at Chorley, more seriously ill people will need to be seen at the trust’s other A&E facility, in Preston. “

“An ambulance will be stationed at Chorley Hospital so life-threatening cases can be quickly transferred to Preston, although 41% of patients attending Chorley A&E don’t have any diagnostic tests or treatment.”

It added: “Patient safety is our and the trust’s absolute priority.”

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Staff shortage prompts A&E closure

Staff shortage prompts Chorley Hospital A&E temporary closure

  • 14 April 2016
  • From the section Lancashire

Chorley Hospital

Image caption

Chorley’s Hospital accident and emergency department is to close temporarily

A hospital’s accident and emergency department is to close temporarily as it cannot “recruit enough staff to provide a safe service”.

Chorley Hospital in Lancashire will be downgraded to an urgent care service, a move that will “put lives at risk”, the area’s MP has claimed.

MP Lindsay Hoyle blamed “bad management”.

Lancashire Teaching Hospitals NHS Trust said there were “no other safe options” due to a shortage of doctors.

It has been unable to secure additional locum doctors, making staffing the emergency department “increasingly difficult”, it said.

A&E delays reach new record level

Chorley Hospital has eight of the 14 doctors it needs and can therefore only staff less than half the hours required.

Consultants have been working extra shifts to cover the staff rota, but “this is not sustainable and this approach is beginning to affect our ability to cover the consultant rota”, the trust said.

Ambulances will take patients to Royal Preston Hospital, 14 miles away, or other hospitals from Monday, the trust said.

Jamie Carson, director at Chorley Council said: “We cannot understand how the problem in Chorley has become so acute when other hospitals do not have to close their A&E service.”


Analysis

Nick Triggle, BBC Health Correspondent

The problem with central diktats is that they can have unintended consequences in an organisation as large as the NHS.

When ministers in England last year announced they were going to cap how much hospitals could pay agency staff they felt they had found a solution to a factor increasingly cited as a cause of the financial problems engulfing the health service.

But the temporary downgrading of Chorley’s A&E unit suggests it merely tackles the symptoms of the problem rather than the causes.

Chorley is unlikely to be the only site struggling like this – in fact there are suggestions some are playing fast and loose with the cap rules to stay afloat.


In November, a cap on spending on NHS agency staff came into force in England to save £1bn over the next three years.

It meant by April, NHS trusts will not be able to pay agency staff such as doctors and nurses more than 55% for a shift than a permanent member of staff.

From Monday, the emergency department at Chorley will be temporarily replaced by an urgent care service until the staffing crisis is resolved.


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PA

Jessica Knight, who was in hospital for five to six months after she was stabbed 20 times while walking in a park, said: “The A&E at Chorley was a major point of my recovery. One of my wounds was in the neck and I might have had a heart attack.

Jessica, who was left for dead and found by a passing cyclist, added: “I was six hours in surgery and had four people working on me. The A&E was critical to my survival.

“If that was to happen now I wouldn’t be alive because I might have been taken to a hospital further away.”

Jessica’s attacker Kristopher Bedder, 21, was jailed for life with a minimum of 12 years.


Prof Mark Pugh, consultant anaesthetist and medical director of the trust, said: “Changing the current service provided at Chorley is a direct response to the immediate and significant staffing problem.

“We simply cannot staff the rotas and it is an unacceptable risk to patient safety to attempt to provide an emergency department service with no doctors available to see people.”

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Prof Mark Pugh said the pool of doctors they were trying to recruit is ‘no longer available’

‘Not beholden’

Prof Pugh said they were experiencing great difficulty in recruiting medical staff on a 24/7 basis. “We are actively recruiting today, at this minute, and as soon as that position allows us to safely open the unit again we will do so at the earliest opportunity,” he said.

He said they were recruiting doctors as the pool of staff they had relied on was no longer available and it was “a national problem”.

He said a lot of other departments in the region are “struggling.” He said: “We are not beholden on the agency cap that has been nationally imposed. We have gone out to try and recruit these people and they are no longer there.”

In a statement, NHS Improvement said: “It is clear that locally, recruitment of a particular speciality of accident and emergency staff has proved very challenging at the same time as demand for services has jumped by around 14% compared with previous years.

“While the majority of patients are still being seen at Chorley, more seriously ill people will need to be seen at the trust’s other A&E facility, in Preston. “

“An ambulance will be stationed at Chorley Hospital so life-threatening cases can be quickly transferred to Preston, although 41% of patients attending Chorley A&E don’t have any diagnostic tests or treatment.”

It added: “Patient safety is our and the trust’s absolute priority.”

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Colombia says two cases of microcephaly linked to Zika virus


Colombia’s health ministry said on Thursday it had confirmed two cases of the rare birth defect microcephaly are connected to the mosquito-borne Zika virus, after the disease was linked to more than a thousand confirmed cases of microcephaly in Brazil.

According to the World Health Organization, there is a strong scientific consensus that Zika can cause microcephaly as well as Guillain-Barre syndrome, a rare neurological disorder that can result in paralysis, though conclusive proof may take months or years.

U.S. health officials said on Wednesday that infection with the Zika virus during pregnancy causes microcephaly, a finding experts hope will refocus attention on prevention efforts.

(Reporting by Julia Symmes Cobb; Editing by Chizu Nomiyama)


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Colombia says two cases of microcephaly linked to Zika virus


Colombia’s health ministry said on Thursday it had confirmed two cases of the rare birth defect microcephaly are connected to the mosquito-borne Zika virus, after the disease was linked to more than a thousand confirmed cases of microcephaly in Brazil.

According to the World Health Organization, there is a strong scientific consensus that Zika can cause microcephaly as well as Guillain-Barre syndrome, a rare neurological disorder that can result in paralysis, though conclusive proof may take months or years.

U.S. health officials said on Wednesday that infection with the Zika virus during pregnancy causes microcephaly, a finding experts hope will refocus attention on prevention efforts.

(Reporting by Julia Symmes Cobb; Editing by Chizu Nomiyama)


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