Older people are less likely to get skin changes checked by a doctor, leading to a steep rise in cancer deaths, say researchers.
The East of England Cancer Registry reports that deaths from melanoma among the over 65s have tripled in the past 30 years.
The elderly are more likely to be diagnosed when the cancer has spread.
Cancer Research UK says pensioners should keep a close eye on moles and report suspicious changes to GPs.
Melanoma is the most dangerous form of skin cancer, and is linked to cumulative sun exposure over a lifetime.
This means that the over-65s are more likely to develop the disease in the first place.
Overlooked
However, unlike younger people, the registry data reveals that the classic signs of a cancerous mole are being overlooked among a host of other changes to older skin.
This means that by the time the mole cannot be ignored, the cancer is likely to be at a more advanced stage, making it far harder to treat.
Dr Jem Rashbass, the director of the East of England Cancer Registry, which collates data on cancer to identify trends among the population, said: "Although there have been some improvements in the number of over 65s being diagnosed with melanoma at a late stage, the figures suggest that more needs to be done to raise awareness about skin cancer among this generally retired population."
Melanoma is a largely preventable disease. Summer may be over, but the damage to skin cells shown by sunburn can remain long after the redness fades"
End QuoteSara HiomCancer Research UK
The registry data revealed that, for every year since 1997, significantly more elderly people have been diagnosed with late-stage melanoma compared with under-65s.
While the death rate among older people rose from four deaths per 100,000 people in 1979 to 11.4 per 100,000 in 2008, the death rate for people aged between 15 and 64 has remained stable.
Sara Hiom, from Cancer Research UK, said: "Melanoma is a largely preventable disease. Summer may be over, but the damage to skin cells shown by sunburn can remain long after the redness fades."
Her colleague Caroline Cerny, from the charity's "Sunsmart" campaign, highlighted the classic warning signs of melanoma.
She said: "If a mole is as big as a pencil-top eraser, bleeds, is sore or itchy, uneven in colour or has jagged edges, then people should visit their GP without delay."
30 November 2010Last updated at 03:55 ETBy Nick TriggleHealth reporter, BBC News
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Andrew Lansley: "If you want to impact positively on people's health you have to look beyond the health service"
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Councils are to be put in charge of encouraging healthier lifestyles under plans to be unveiled by ministers.
Local public health directors will be moved out of the NHS and into local government as part of the shake-up.
The government believes the wider remit of councils in areas such as housing, transport and leisure puts them in a stronger position to tackle smoking, drinking and obesity in England.
A ringfenced pot of NHS money will also be set aside to help.
The protection of the public health budget - the first time this has been done since the 1800s - is considered essential because of the cuts councils are facing following October's Spending Review.
To support local government, the Department of Health's public health white paper will also propose creating a new public health service that will provide advice and support on issues such as health protection, nutrition and treatment.
'Real impact'
A health inclusion unit will be set up as well to oversee the drive to reduce health inequalities, which have widened over the past decade.
Extra money - dubbed health premiums - will be given to the poorest areas to help tackle some of the most entrenched problems.
But details on how the government aims to tackle individual problems, such as obesity, smoking and drinking, will not be spelt out until the new year.
Both the Association of Directors of Public Health and Local Government Association have welcomed the impending changes.
Councils have the potential to make a real difference, but it important public health directors are given the power to influence what is happening"
End QuoteAngela MawleUK Public Health Association
And Health Secretary Andrew Lansley told the BBC the new system would have a "real impact on improving health".
He said: "Health is not just about the quality of healthcare. It's probably at least as much about the quality of people's lives - the environment, the housing, their education and employment."
He said the strategy was intended to improve the health of the nation and reduce health inequalities.
He told the BBC Radio 4 Today programme: "We have got to arrive at a point where politicians stop just telling people how to be healthy but actually help them to do it, which is about positive steps on supporting people on things like physical activity as well as necessary interventions."
The public health White Paper will say the key to encouraging healthier behaviour lies in creating the right environment and then "nudging" people into making different choices.
Examples of this include schemes such as incentivising children to walk to school and providing more support through nurses and health visitors to encourage new mothers to breastfeed.
Employers will also be told they have an important role in helping and supporting staff as well.
Mr Lansley has in the past been critical of what he has said has been the lecturing tone of previous public health drives.
He has also been keen to stress that the solutions do not necessarily require greater regulation.
In fact, the White Paper is expected to make reference to a "responsibility deal" that could be launched in the new year which will see industry sign up to schemes to encourage healthier behaviour.
Angela Mawle, of the UK Public Health Association, which has members in both local government and the NHS, said: "Councils have the potential to make a real difference, but it important public health directors are given the power to influence what is happening.
"I also don't think we should turn our back entirely on regulation. It still has a place."
A gene therapy technique which aims to ease memory problems linked to Alzheimer's Disease has been successfully tested in mice.
US scientists used it to increase levels of a chemical which helps brain cells signal to each other.
This signalling is hindered in Alzheimer's Disease, the journal Nature reported.
The Alzheimer's Research Trust said the study suggested a way to keep nerve cells in the brain communicating,
Ageing populations in many countries around the world mean that Alzheimer's disease and other forms of dementia are set to increase.
Researchers at the Gladstone Institute of Neurological Disease in San Francisco believe that boosting the brain chemical, a neurotransmitter called EphB2, could help reduce or even prevent some of the worst effects of the condition.
Their research suggests that the chemical plays an important role in memory, and is depleted in Alzheimer's patients.
One of the most noticeable features about the brains of Alzheimer's patients is the build-up of "plaques" of a toxic protein called amyloid. Over time this leads to the death of brain cells.
'Thrilled'
However, another characteristic of amyloid is its apparent ability to bind directly to EphB2, reducing the amount available to brain cells, which could in part explain the memory symptoms involved.
This research adds a piece to the Alzheimer's puzzle and provides new leads for researchers"
End QuoteRebecca WoodAlzheimer's Research Trust
To test this idea, they used gene therapy experiments to artificially reduce and increase the amount of available EphB2 in the brains of mice.
When levels of the chemical were reduced, healthy mice developed memory symptoms similar to those seen in mice bred to have a condition similar to Alzheimer's.
Conversely, when the "Alzheimer's" mice were given gene therapy which boosted levels of EphB2, their memory symptoms disappeared.
Dr Lennart Mucke, who led the study, said that his team had been "thrilled" to find this.
"We think that blocking amyloid proteins from binding to EphB2, and enhancing EphB2 levels or functions with drugs might be of benefit in Alzheimer's Disease."
However UK researchers said that the find, while interesting, did not offer a swift answer to Alzheimer's patients.
Rebecca Wood, chief executive of the Alzheimer's Research Trust, said: "Our brains are hugely complex and understanding how they work and become damaged by diseases like Alzheimer's is a massive task.
"This research adds a piece to the Alzheimer's puzzle and provides new leads for researchers.
"It suggests a way to keep nerve cells in the brain communicating, which is vital for thinking and memory."
But she added: "We don't know yet if these findings will lead to a new treatment for Alzheimer's - that's some way off."
Report author Roger Taylor says transparency is crucial if problems are to be dealt with
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An analysis of deaths in English hospitals has found 19 NHS trusts have higher rates than would be expected.
But monitoring body Dr Foster's report on 147 trusts shows an improvement on 2009, when the figure was 27.
The survey also shows that four trusts had a higher than expected number of patients who died after surgery.
The NHS Confederation said the report showed where the NHS "could do better". The government says unsafe care will not be tolerated.
However, Patients Association chief executive Katherine Murphy said safety was still "clearly not the top priority" of every NHS organisation.
"We cannot continue with a situation where patients are stuck with poor healthcare because of where they live," she said.
Dr Foster's survey looks at overall death rates and deaths after surgery as well as a range of other indicators to try to build a picture of patient care.
Two trusts - Hull and East Yorkshire Hospitals and University Hospitals Birmingham - had higher than expected overall death rates and rates of deaths after surgery.
A spokesman for Hull and East Yorkshire NHS Trust said its figures reflected that it looks after a population with the highest rates of smoking in the country, along with alcohol problems, obesity and heart disease, and that many of the patents who walk through its doors are already very ill.
Meanwhile, Dr Dave Rosser, executive medical director at University Hospitals Birmingham NHS Foundation Trust, said the report's methodology was flawed. Figures may have been skewed by high numbers of patients with liver disease and could cause unnecessary distress among patients, he added.
The report acknowledges that figures cannot be taken in isolation but should act more like an alarm to point up possible areas of concern.
Roger Taylor, director of research at Dr Foster, said there seemed to have been an overall improvement since last year.
"Safety standards are improving, mortality rates are falling, the variation between the best and the worst is getting less.
Avoidable complications
"However, we do still have a long way to go in terms of involving patients in decisions about their care, enabling them to understand what their options are and ensuring they can always reliably and safely get the best quality care."
Richard Hamblin of the NHS safety regulator the Care Quality Commission says Dr Foster's figures were a useful tool if used properly.
"If a mortality rate is higher than we would expect, or higher than it is elsewhere, we need to start asking why is this?
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Health Secretary Andrew Lansley: "When something goes wrong, hospitals have a duty to report it"
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"Are the patients sicker? Is it that the care is worse? Is it something to do with how the details of the patients are being recorded?"
Of greater concern perhaps are more than 62,000 accidents, mistakes or avoidable complications recorded across all 147 hospital trusts, says BBC health correspondent Dominic Hughes.
The report says many incidents go unrecorded - so the true number may be much higher, he adds.
Nigel Edwards, acting chief executive of the NHS Confederation, which represents the majority of NHS organisations, said: "There are still parts of our health system where particular services are having problems, and for the hospitals concerned this report presents an opportunity to learn and improve.
"There will always be variations in any nationwide system but the golden principle must be that our NHS is safe for the patients who rely on it - this report shows where we can do better."
Health Secretary Andrew Lansley welcomed the report, saying such information was vital to allow patients to make informed choices about care.
But he said: "Unsafe care will not be tolerated. Patients have a right to expect the very best care from the NHS and when something goes wrong, hospitals have a duty to report it and make sure that others can learn from their mistake."
He said the government was taking measures to make the NHS more accountable.
"In future, clinicians will not only be responsible for designing and paying for local health services, they will also be held to account for the quality of care for their patients," he added.
Hospitals with higher-than-expected death rates were:
Barking, Havering and Redbridge University Hospitals NHS Trust
Buckinghamshire Hospitals NHS Trust
City Hospitals Sunderland NHS Foundation Trust
Derby Hospitals NHS Foundation Trust
East Sussex Hospitals NHS Trust
George Eliot Hospital NHS Trust
Hull and East Yorkshire Hospitals NHS Trust
Isle Of Wight NHS PCT
Mid Cheshire Hospitals NHS Foundation Trust
Northampton General Hospital NHS Trust
Pennine Acute Hospitals NHS Trust
Royal Bolton Hospital NHS Foundation Trust
Shrewsbury and Telford Hospital NHS Trust
South London Healthcare NHS Trust
Southport and Ormskirk Hospital NHS Trust
The Dudley Group Of Hospitals NHS Foundation Trust
The Royal Wolverhampton Hospitals NHS Trust
University Hospital Birmingham NHS Foundation Trust
Western Sussex Hospitals NHS Trust
Hospitals with higher-than-expected death rates after surgery were:
Hull and East Yorkshire Hospitals NHS Trust
The Newcastle upon Tyne Hospitals NHS Foundation Trust
University Hospitals Birmingham NHS Foundation Trust
University Hospital of North Staffordshire NHS Trust
Taking the temperature outside A&E could give staff an accurate way to predict number of injuries and who will suffer them.
Experts know that extreme weather can affect A&E patient numbers.
Warwick University researchers found that even 5C falls or rises could make a difference to injury rates.
Rates for children were up to 70% higher in summer compared to winter, the Emergency Medicine Journal reported.
Many trusts plan ahead for winter, when the arrival of frost, snow and ice, as well as flu and pneumonia, is traditionally linked to busier shifts.
The study of 60,000 patients found that each 5C drop in minimum temperature during the day meant a three per cent rise in serious accidents to adults.
Heat of summer
The arrival of snow and ice led to an eight per cent rise, as the number of slips, trips and car accidents rose.
However, the study found other increases linked to the heat of the summer, often viewed as a slightly calmer period in emergency departments.
Even among adults, every five degree centigrade rise in maximum temperature during the day, and additional two hours of sunshine, meant a 2% rise in the rate of serious injury.
We've always known that there is increased activity in emergency departments during winter, but in recent years, we've noticed that this doesn't really diminish during the summer months - we remain busy all year round"
End QuoteProfessor John HeyworthCollege of Emergency Medicine
This effect was particularly noticeable in children, who are more likely to get injured while playing outside during the warmer months.
For them, a 5C rise meant a 10% increase in injury cases, and two hours of extra sunshine boosted cases by six per cent.
While these connections were made by comparing records of hospital admissions with historical weather data, the researchers are convinced that the principle could be used to help emergency teams plan ahead for days when their workload is likely to be higher.
They wrote: "This model could clearly be used to provide predictions of daily admissions, with clear implications for the scheduling of staff and other resources at UK trauma-receiving hospitals.
"The challenge for the future is to improve forecast accuracy further in order to provide sufficient time for the detailed planning and allocation of resources that would be necessary to implement these models."
Professor John Heyworth, president of the College of Emergency Medicine, agreed that the detailed study could help clinical teams know what to expect on any particular day, although he questioned whether the current accuracy of medium-term weather forecasts was good enough to justify staffing changes.
He said: "We've always known that there is increased activity in emergency departments during winter, but in recent years, we've noticed that this doesn't really diminish during the summer months - we remain busy all year round.
"If you have your emergency department set up to deal with this expected load, then you can deal with extra cases due to weather conditions.
A quarter of people with HIV in the UK, over 22,000, are unaware they have the virus, experts from the Health Protection Agency have suggested.
The 2009 estimate is based on anonymous blood samples supplied for other reasons but tested and found to be HIV positive.
It is at the same level as 2008's estimate.
The Terrence Higgins Trust said more investment was still needed in prevention and awareness programmes.
The Health Protection Agency said 6,630 people were newly diagnosed with HIV in 2009, down for the fourth year in a row.
The HPA's report also found over half of those were diagnosed after the stage when treatment should have started.
In all, the number of people living with HIV in the UK reached an estimated 86,500 last year.
'Test all'
Dr Valerie Delpech, consultant epidemiologist and head of HIV surveillance at the HPA, said: "We're very concerned that a large number of people in the UK are unaware of their HIV status and that half of all newly diagnosed people are diagnosed late, meaning they may not benefit from very effective treatments."
It's vitally important we invest in targeted HIV prevention and awareness programmes"
End QuoteSir Nick PartridgeTerrence Higgins Trust
She called for better access to HIV testing in areas where rates of HIV infection are high.
"Pilot studies have shown that in these areas testing all adults registering at GPs or accessing certain hospital services can make an impact."
"The evidence shows that this testing is feasible to undertake and acceptable to patients. We would like to see this rolled out in areas where HIV infection is more common to reduce the number of people who are unaware of their HIV status and increase the chances of early diagnosis, when treatment is more successful."
The HPA added that those at higher risk of HIV, such as men who have sex with men and black Africans living in this country, should know their status and consider being tested regularly.
Sir Nick Partridge, chief executive of the Terrence Higgins Trust sexual health charity, said: "With more people living with HIV than ever before in the UK it's vitally important we invest in targeted HIV prevention and awareness programmes, particularly for gay men who are most at risk.
"We also need to re-double work to get people to test, to reduce the high numbers of people who don't know that they have HIV for far too long before being tested and prevent needless deaths."
25 November 2010Last updated at 23:02 ETBy Adam BrimelowHealth Correspondent, BBC News
Leading sports doctors have strongly criticised the way PE is being taught in English schools.
Experts say many children do not get a proper workout which helps them develop coordination, strength and agility.
The British Association of Sports and Exercise Medicine wants all schools to use a short exercise routine called '5 in 5'.
But the government said PE was a matter for individual schools.
Specialists in sports and exercise medicine say that too often PE lessons focus on developing sports skills rather than encouraging flexibility and movement.
The British Association of Sports and Exercise Medicine has endorsed a quick training programme designed to address this.
'5 in 5' provides five exercises in five minutes. A leading international sports coach, Kelvin Giles, has devised more than 20 five-minute routines.
He has worked with elite sports men and women around the world, from athletics and rugby to football and tennis.
"Catastrophic" fitness
He also spends a lot of time in schools, and said PE lessons in the UK do not give children a proper workout.
Zoe Biggs started the programme with her class of nine and 10-year-olds at Camps Hill Primary School in Stevenage last year.
The children have been delighted as their fitness has improved.
"Some of them really struggled at the beginning, and once they worked at it and persevered they really came alight", said Ms Biggs.
"They looked so happy they could do it and they'd achieved it and done it themselves".
Progress was closely monitored through the academic year.
The improvements - in terms of flexibility, coordination and strength - were dramatic.
Children said they enjoyed it.
"It's quite hard at first but when you do lots it's actually quite easy", said one.
Another said it was fun, but confessed that it sometimes left him feeling "hot and bothered".
They have worked their way through several sets of exercises, many of them with catchy names such as "upside-down bug" or "hot-foot lizard".
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"Out of the 40 minutes there's eight minutes of activity going on. Very often the kids are standing around and just listening to the teacher talk. So heart rates aren't being raised. Mechanical efficiency isn't being looked at."
As a result, he says, the level of fitness in most children is "catastrophic".
The '5 in 5' routines involve squatting, lunging, pushing, bracing and rotating.
"You can get stronger, you can get more stable, you can have a much better posture, by exposing yourself to five minutes a day", said Mr Giles.
The initiative has won the backing of the UK's leading sports doctors. To mark its annual conference in London, the British Association of Sports and Exercise Medicine has called on UK governments to incorporate the programme in all schools.
The Association's chairman is former Olympic gold medallist rower, and chief medical officer for the London Olympics, Dr Richard Budgett. He is deeply concerned about PE in schools.
"If you're not a natural athlete, not attracted to sport and exercise, there is a real problem. It's very easy to drop out."
"By using a programme like 5-in-5 in schools we can get young people with the skills that they can then use as they get older. So they can keep fit, keep their joints working properly and prevent all sorts of diseases, from osteoarthritis through to diabetes and heart disease."
The Department for Education in England says it will be up to schools to decide if they want to adopt this.
It wants them to focus more on competitive sport. Sports physicians say '5 in 5' will help gifted children to excel, while ensuring all receive a proper physical education.
25 November 2010Last updated at 11:48 ETBy Nick TriggleHealth reporter, BBC News
Private company Circle is to take over the running of Cambridgeshire's Hinchingbrooke hospital.
The trust, near Huntingdon, becomes the first to be entirely run by a private business after it beat another bidder, Serco, to the contract.
Regional NHS bosses sought new management after the trust amassed nearly �40m of debts.
They said the move would improve the running of the hospital, but unions warned it heralded a new era of privatisation.
The involvement of private companies in the health service is nothing new.
Risks
They have already lent management support to hospitals, as well as winning contracts to provide specific services such as pathology.
The private sector also runs a number of treatment centres, which carry out minor non-emergency surgery.
But this move breaks new ground in that the company, which is partly owned by its employees in a John Lewis-style model, will be entirely responsible for running the hospital and the risks involved.
Under the terms of the deal, the staff and assets will remain part of the NHS.
Dr Stephen Dunn, director of strategy at the East of England Strategic Health Authority, said Circle had been chosen as they were a "cutting edge" partner.
It has already won contracts to run what are called independent sector treatment centres.
These were set up to carry out non-emergency surgery, such as knee and hip replacements when the government was trying to get waiting lists down.
Circle also runs a private hospital in Bath.
It treats NHS patients at this site as under the patient choice initiative the private sector can treat NHS cases if providers are willing to see them at NHS prices.
The company calls itself a social enterprise - although it is not formally registered as one - because it is half owned by its employees.
The other half is owned by private investors.
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He added: "Hinchingbrooke has major debts and might have had to close, or receive a large subsidy paid for by the taxpayer. Thanks to this process this is not the case."
Ali Parsa, Circle's managing partner, said he wanted to liberate doctors and nurses "to deliver the best services for the patients they know best".
Circle is due to take over the running of the hospital in June, subject to government and regulatory approval.
The hospital was built in 1983, but has spent recent years struggling for money.
There are a variety of reasons for this. Management of the trust has been criticised at various points, although the hospital has undoubtedly suffered from the creation of a more competitive market in the NHS.
The hospital serves a relatively small population of about 160,000 people, but with NHS trusts now largely paid per patient treated it has struggled for funds.
Paul Flynn, of the British Medical Association, said: "This could be the start of much greater privatisation. There are quite a few other trusts with debts and private companies want to get a foothold into the NHS. But my concern is that they do not have the wider interests of the health service in mind."
But Professor John Appleby, chief economist at the King's Fund, said: "I'm not sure we will see a wave of these. There could well be more, but private management is not the only option, there are also mergers or reorganisation of services that can solve problems."
25 November 2010Last updated at 08:11 ETBy Dominic HughesHealth correspondent, BBC News
An ex-head of the British Medical Association has been cleared to return to work after a disciplinary hearing.
A General Medical Council panel had earlier rejected many allegations involving the clinical and surgical practice facing James Johnson, 64, a Cheshire-based surgeon.
But he was found to have not involved himself properly with the post-operative care of some patients.
His lawyer said the hearing had been a "chastening and humbling" experience.
'Lurid' headlines
Mr Johnson, who worked at two hospitals in Runcorn and Warrington in Cheshire, had been accused of "acting with arrogance", and of carrying out amputations when other operations should have been considered.
But Martin Ford, representing Mr Johnson, said that despite "inappropriate and lurid" headlines, the panel had found no patient had suffered because of Mr Johnson's care, that he had not carried out any unnecessary amputations and any allegation of clinical incompetence was proved wrong.
The panel agreed and decided that Mr Johnson's fitness to practice was not impaired.
It also decided against issuing him with a warning given that he has apologised, the incidents were isolated and he has already modified the way he worked.
In a statement after the hearing Mr Johnson said he was delighted with the outcome.
But he added: "I have nevertheless reflected upon the issues raised in the hearing and have either modified my practise or will do so where appropriate."
"I remain dedicated to my patients and look forward to continuing to practise as a surgeon."
It had been claimed Mr Johnson had spent too much of his time in his role as chairman of the BMA, and too little time caring for his patients and keeping his surgical practice up to date.
The GMC did find Mr Johnson sometimes did not properly involve himself with the post-operative care of his patients because he was away in London on BMA duties.
It said that "at the very least", he should have "picked up the telephone" in order to find out how his patients were faring post-operatively.
It was also found that, on occasion, Mr Johnson did not involve himself in discussions with other healthcare staff prior to surgery.
But the GMC panel cleared him of most of the charges, including all the more serious ones.
The UK is outperforming most of Europe when it comes to survival rates from heart bypass operations, according to an international audit.
Across Europe, 2.4% of patients on average die following a bypass.
This compared with 2.2% in Scotland, 1.8% in England and just 1.1% in Wales, the study found.
The European Association for Cardiothoracic Surgery looked at data from more than a million operations in 23 countries.
A leading heart surgeon said the decision to collect data on hospital performance had helped cut mortality by 50% in five years.
This is the first ever comparative study of heart operations across the continent, and the NHS was one of the most enthusiastic participants, contributing a large slice of the total data used.
However, a number of countries including France, Denmark, The Netherlands, Austria and the Czech Republic did not participate.
Older and sicker
Nonetheless, the result is a major fillip to the reputation of NHS cardiac surgery - with England and Wales together outperforming the European average by 25%.
This is despite evidence that the task of keeping heart patients alive is tougher here than in many countries.
Patients here were on average older and sicker than in most of the other countries taking part in the audit.
The above-average performances are also set against general improvements in mortality throughout Europe in recent years.
This excellent data is the culmination of years of hard work carried out by NHS cardiac units"
End QuoteJohn BlackRoyal College of Surgeons
David Taggart, president of the Society for Cardiothoracic Surgery in Great Britain and Ireland, said: "The results confirm that cardiac surgery in the UK is amongst the very best in Europe and that mortality rates have fallen by half over the past five years as a direct result of the collection, analysis and publication of outcome data.
"Our European partners should be encouraged that this approach is likely to lead to a similar improvement in results."
The Royal College of Surgeons said that the results were "significantly better than expected", and its president, John Black, also expressed his pleasure.
"This excellent data is the culmination of years of hard work carried out by NHS cardiac units.
"As a result of the profession's dedication we are now leaders in Europe in the measurement of quality and outcomes of cardiac surgery."
Other good news, revealed the audit, was that hospital stays tended to be shorter in the UK - less than nine days compared with an average of 10.
This saves the NHS considerable amounts of money - �6.4m each year just from heart bypass operations alone.
Dr Mike Knapton, from the British Heart Foundation, said: "What wonderful news for heart patients in the UK to hear that our cardiac surgeons are leading the way in clinical excellence.
"The decision to audit and publicly disclose the outcomes of cardiac surgery is a powerful driver for improved quality.
"This transparency and openness can only help to ensure excellent care in the operating theatre and during post op rehabilitation.
"We are facing uncertain financial times but it's vitally important we continue to support and publish surgical outcomes so all our good work isn't undone in the future."
24 November 2010Last updated at 20:33 ETBy Branwen JeffreysHealth correspondent, BBC News
Variations in the amputation rates in diabetes patients in England have been described as shocking by a charity.
Department of Health data reveals the rate of major amputations in the South West, at three in 1,000, is almost twice the rate in the South East.
The Diabetes UK charity says the majority could be prevented.
The government says it is publishing the information, which also covers other conditions and has been dubbed an "atlas of care", to help improve care.
The amputation difference is one of the most striking revealed in a series of 34 "maps" of healthcare produced.
Treatment of last resort
It also looks at key treatments for some of the most serious conditions including stroke, heart disease and asthma.
There are more than 70 major amputations a week carried out on type 2 diabetes patients in England. It is thought 80% of amputations are potentially preventable.
Most people in the health service are so focused on what they're doing, working so hard, they've got no idea if they are doing better or worse than someone else"
End QuoteSir Muir Gray
Diabetes can lead to a loss of sensation in the feet so minor injuries can become badly infected without the patient noticing.
If the infection becomes too severe, amputation of a foot or the leg below the knee becomes the treatment of last resort.
Barbara Young, the chief executive of Diabetes UK, said "The existing situation around foot care and amputations is shocking, given the that the majority of amputations can be prevented."
The atlas also reveals a big variation in the percentage of people with diabetes who are receiving all the essential checks to monitor their condition.
This includes the simple foot checks which can help prevent amputation.
While some geographical differences would be expected, researchers say unwarranted variation is a cause for concern. They adjusted their data to take account of different populations in different areas.
Sir Muir Gray, the public health academic who led the research within the Department of Health, said: "Most people in the health service are so focused on what they're doing, working so hard, they've got no idea if they are doing better or worse than someone else.
"The atlas is now going, for the first time, to give them a clear idea of where they are. "
Unwarranted variation
This is particularly true in areas of care where the evidence is clear. Patients with a suspected mini-stroke are at higher risk of a major stroke. The national guidelines recommend they should have specialist tests within 24 hours.
The atlas shows a greater than 10-fold difference in the percentage of patients who are getting that gold standard treatment.
A handful of areas are managing for all the patients at risk but in many parts of England that falls to fewer than half.
Some experts believe reducing the variations to give priority to treatments backed by evidence could help find the savings it needs.
Professor Chris Ham, chief executive of the King's Fund, said "If performance across the NHS can be brought up to the level achieved by the best, then much of the pressure on local NHS budgets can be relieved without having to cut services for patients."
The data in the atlas predates the coalition government but ministers have supported its publication.
Health minister Lord Howe said: "Making this information available will help to identify and address unwarranted variation to better meet the needs of their local populations."
23 November 2010Last updated at 20:53 ETBy Nick TriggleHealth reporter, BBC News
Cash-strapped councils are seeking control of �4bn of NHS funds earmarked for public health, the BBC has learned.
Over 150 public health directors in England will be transferred from the NHS to local government under plans to be set out by ministers next week.
They are expected to get a ring-fenced budget to spend on projects to combat problems such as obesity and smoking.
But local government chiefs want the money put into the general pot as their funding will be cut by 26% by 2014.
Public health directors are currently employed by primary care trusts. But as these will be scrapped with the introduction of GP consortiums in 2013 it has been decided that public health should revert back into local government - as it was before 1974.
Lobbying
Health Secretary Andrew Lansley has long-argued the public health budget should be protected as it is often raided during tough financial times because the benefits of investment take a long time to be realised.
But councils have been lobbying in meetings with civil servants and ministers as well as through a formal consultation for the money not to be reserved.
It comes after local government was one of the worst hits areas of the public sector in the recent spending review.
Funding from central government is due to fall from �29.7bn to �24.2bn over the next four years, a cut of more than a quarter once inflation is taken into account.
We know the strain councils are under, but I think most public health directors would say it is right that the money is ring-fenced, certainly in the short-term. Otherwise the temptation for councils would be to shore up their existing budgets"
End QuoteDr Frank AthertonAssociation of Directors of Public Health
The Local Government Association, which represents councils, has argued that they should be free to decide how money is spent as the government has promised to devolve power down from the centre.
It has also claimed that since much of the public health agenda cuts across council departments - for example public health directors work with highways and planning over things such as cycle networks and with schools over issues such as school meals and healthy lifestyle promotion - it could be counter-productive to set aside a specific pot.
Councillor David Rogers, chairman of the LGA's community well-being board, said: "Far from protecting resources for public health, a ring-fence may have the reverse effect and be viewed as the total amount of money which should be spent on making people healthier.
"Public health needs to be at the heart of what all councils do and not seen as a separate function."
He added councils were "fully committed" to tackling public health problems, but said they needed "financial freedom" to decide what was in their residents' interests.
He said the LGA would continue putting its case even if the white paper proposes the ring-fencing which currently amounts to just under 4% of the NHS's �104bn budget.
Dr Frank Atherton, president of the Association of Directors of Public Health, said he understood the position local government was taking.
"We know the strain councils are under, but I think most public health directors would say it is right that the money is ring-fenced, certainly in the short-term. Otherwise the temptation for councils would be to shore up their existing budgets."
Binge drinkers have a risk of heart disease twice that of people who consume the same amount of alcohol but more steadily, researchers say.
The study compared 10,000 male drinkers from "booze-bingeing" Belfast and "moderate" France over 10 years.
It concluded that downing lots of alcohol in one or two sessions is worse than drinking more regularly in a week.
Experts said the British Medical Journal work reinforced what was known but was a wake-up call for bingers.
Amy Thompson, senior cardiac nurse at the British Heart Foundation, said: "This reinforces what we already know - that drinking high levels of alcohol can be harmful to your heart.
"It's important to avoid binge drinking and it's better to have a small amount of alcohol regularly rather than large amounts in one go. If you do drink, it's important to keep within the recommended limits."
The official advice in the UK is that women should not regularly drink more than two to three units (about two glasses of wine or one pint of beer) a day and men should not regularly drink more than three to four units a day.
In the study, some 9% of the middle-aged men in Belfast were binge drinkers, consuming at least three pints of beer or five glasses of wine in one sitting, mostly on a weekend, compared with 0.5% of those in France.
The French men tended to drink less alcohol in each sitting but drank more regularly.
Three-quarters of the French men drank daily, compared with 12% in Belfast.
The researchers found the men who were binge drinkers had nearly twice the risk of heart attack or death from heart disease compared with regular drinkers over the 10 years of follow up.
Professor Jean Ferri�res, from Toulouse University Hospital, who carried out the research, believes the irregular pattern of drinking is to blame.
Another reason for the higher risk of heart disease in Belfast, said the authors, could be that more men there tended to drink beer and spirits than wine - the opposite of what the men in France tended to drink.
23 November 2010Last updated at 15:13 ETBy Neil BowdlerScience reporter, BBC News
A drug used to treat HIV-positive patients may offer gay and bisexual men some protection against contracting the virus, the authors of a new study say.
Trials of the combination drug Truvada among nearly 2,500 men suggested it could reduce the chances of male-to-male HIV infection by 44%.
Those using the drug regularly could further reduce the risk of infection, it was claimed.
Truvada is the trade name of a drug manufactured by the California-based company Gilead Sciences Inc which combines two antiretroviral drugs, used to treat Aids.
But this new study looks at whether it could be used to prevent HIV infection in the first place.
We need to know if we get similar results in women as well as in heterosexual men, which we have reason to believe we will"
End QuoteDr Anthony FauciDirector, National Institute of Allergy and Infectious Diseases
Almost 2,500 gay or bisexual men were randomly selected in Peru, Ecuador, Brazil, South Africa, Thailand and the United States. Half were given the pill, half were given dummy tablets.
All the men were also given condoms and counselling on safe sex.
What the researchers found after about a year of testing was that the drug appeared to cut male-to-male HIV transmission by 44%, when the group taking the pill was compared with the placebo group.
Those who were took the pill regularly were deemed to have reduced their risk of infection further, by up to 73%, and blood tests were run to confirm this relationship between pill-usage and protection levels.
The research was funded by the Bill & Melinda Gates Foundation, and the federal US body, the National Institute of Allergy and Infectious Diseases (NIAID). The pills were donated by their manufacturer.
NIAID director, Dr Anthony Fauci, conceded more work needed to be done, but called the results impressive.
"This has been done in men who have sex with men. We need to know if we get similar results in women as well as in heterosexual men, which we have reason to believe we will," he told the BBC.
"We also need to get a long term view of were there any toxicities. We didn't see anything that was significant but we need to follow that for a long period of time."
Questions and concerns
The trial does of course raise questions and concerns. Is it possible, for instance, that the results were skewed by greater condom use in the group that took the pill; and won't such findings encourage some men to dispense with condoms altogether in favour of a drug?
There is also the issue of prohibitive cost of Truvada, which retails in the US for around $36 a day, and which makes the drug unaffordable to many possible users.
Dr Fauci argues that the two groups were fully randomised and says that drugs can only play a complementary role in the war on HIV. Condoms and fewer partners, he said, remain the first line of defence.
"We're hoping that if this does become a useable tool in prevention, then the associated counselling will complement the effect of the drug and stop people becoming cavalier about it and say 'now I have a pill I don't have to worry'.
"That's exactly the opposite of what we want to happen. We want to add something rather than have it replace something."
Sir Nick Partridge, chief executive of the Terrence Higgins Trust, called the trial results "potentially significant".
"It's vital that we expand the ways we can prevent HIV transmission, particularly amongst those most at risk," he said in a statement. "This trial proves that HIV treatment will have an impact on prevention, but that it's not ready for widespread use yet.
"Three major hurdles are still going to be its cost, the risks of drug-resistant strains of HIV developing and taking a drug treatment every day."
The Vatican has clarified Pope Benedict XVI's comments on condoms, saying their use by men and women to prevent HIV could be an act of "responsibility".
The clarification follows comments suggesting Pope accepted their use only in exceptional circumstances.
But the Vatican's senior spokesman said the key point was taking the life of the other person into consideration.
The comments come from a book based on a series of interviews with the Pope, published on Tuesday.
In the text, the Pope appeared to suggest that condoms could reduce the risk of infection in certain circumstances, such as for a male prostitute.
'Taking responsibility'
The Pope's meaning was questioned because the Italian translation of the book used the feminine form of the word for prostitute, whereas the original German used the masculine.
Vatican spokesman Father Federico Lombardi said he had personally asked the Pope if there was a serious, important problem in the choice of the masculine over the feminine.
"He told me 'No'," Fr Lombardi said. "The problem is this... It's the first step of taking responsibility, of taking into consideration the risk of the life of another with whom you have a relationship."
"This is if you're a woman, a man, or a transsexual," he added.
Despite this shift, the Vatican still believes that changing attitudes to sexuality is the proper way to combat HIV/Aids.
In the book, the Pope says that condoms are "not really the way to deal with the evil of HIV infection".
The Pope's attitude towards homosexuality and artifical contraception has not shifted, with other passages in the book reaffirming the Vatican's opposition to both.
The Roman Catholic Church's traditional opposition to contraception has led to the Vatican being heavily criticised for its position in the context of the Aids crisis.
The book - Light of the World: The Pope, the Church and the Signs of the Times - is based on interviews that the Pope gave the German Catholic journalist, Peter Seewald, earlier this year.
The number of new HIV infections and deaths from Aids are falling globally, according to new statistics from the UN's programme on HIV/Aids.
There are now signs the epidemic is declining, it says, however, stigma and discrimination continue to cause problems for the estimated 33m people living with HIV.
Last year there were 2.6m new HIV infections.
This is down almost 20% since the peak of the Aids epidemic in 1999.
In 2009, 1.8m died from Aids-related illnesses, down from 2.1m in 2004.
Mixed progress
The report says rates of treatment using anti-retroviral drugs have risen from 700,000 in 2004 to over 5m people in 2009.
Sub-Saharan Africa continues to be the region most affected by the epidemic, with around 70% of all new HIV infections occurring here.
But infection rates are falling, particularly in South Africa, Zambia, Zimbabwe and Ethiopia.
There is a mixed picture in other parts of the world.
Eastern Europe and central Asia show sharp rises in new infections and Aids-related deaths.
And the UN says bad laws and discrimination, particularly in respect to drug users and homosexuals, continue to hamper the fight against Aids.
"We are breaking the trajectory of the Aids epidemic with bold actions and smart choices," said Mr Michel Sidibe, executive director of UNAids.
"Investments in the Aids response are paying off, but gains are fragile - the challenge now is how we can all work to accelerate progress."
23 November 2010Last updated at 06:44 ETBy Dominic HughesHealth correspondent, BBC News
The number of extra deaths occurring in England and Wales last winter fell despite the coldest weather for 14 years.
Figures from the Office of National Statistics show there were an estimated 25,400 extra deaths.
That marks a reduction of around 30% on the previous year.
The fall is possibly because while it was certainly cold last winter, there was no big outbreak of seasonal flu.
The figures measure the number of extra deaths that occur between December and March - usually the coldest months of the year - when compared to the average deaths that occur in autumn and spring.
The official term used by the ONS is "excess winter mortality".
The elderly are especially vulnerable during the colder winter months but although there are more deaths in winter, few die directly as a result of hypothermia.
We would urge anyone with symptoms such as nasty cough, wheezy chest or breathlessness to ask their GP for a lung function test or to take our online breath test"
End QuoteDame Helena Shovelton,British Lung Foundation
However, the Royal Pharmaceutical Society of Great Britain said that a few may be early symptoms of lung cancer.
They said that a cough that lasts more than a few weeks, coupled with breathlessness, or fatigue, deserves the attention of a GP rather than just more cough medicine.
Graham Phillips, a member of the society's board, said: "Many people will repeatedly buy cough medicines or maybe iron tablets for tiredness and a lack of energy.
"If you can't seem to shake off symptoms that seem similar to colds and flu, such as a persistent cough or chest infection, or if you keep losing your voice, feel breathless or tired and lacking in energy, then ask your pharmacist for advice instead of buying an over-the-counter medicine or picking something up in the supermarket."
Lung cancer is difficult to treat in many cases because, by the time symptoms become obvious, it is well advanced.
Only one in 10 of more than 30,000 people who develop it each year are alive after five years.
A survey by the Roy Castle Lung Castle Foundation found that only a third of people questioned associated a cough with lung cancer, and only 11% said that a persistent cough would be a worry.
Dr Jesme Fox, the charity's medical director, said he hoped that the joint campaign would increase early detection, and save lives.
The British Lung Foundation agreed that a persistent cough deserved a GP appointment, but said there were other, more likely explanations than cancer.
Dame Helena Shovelton, its chief executive, said: "A persistent cough can be an early sign of lung cancer but it can also be an early symptom of other lung diseases such as chronic obstructive pulmonary disease (COPD) which includes chronic bronchitis.
"Our research has shown that nearly 3.5 million people in the UK are at a high risk of having lung conditions such as COPD and 28% of smokers would think their cough was just a 'smoker's cough'.
"We would urge anyone with symptoms such as nasty cough, wheezy chest or breathlessness to ask their GP for a lung function test or to take our online breath test.
"The earlier people are diagnosed with lung cancer or other lung conditions the better their chances of getting treated successfully."
Young children are to be immunised against six diseases at once, the Government has confirmed.
After their first birthday toddlers will be offered a single appointment to have three injections to guard against measles, mumps, rubella, two types of meningitis and a form of pneumonia.
This replaces the existing NHS policy for England and Wales of spacing the vaccines over a couple of months.
The change is designed to boost vaccination rates.
Currently around 85% of all toddlers turn up to get immunised.
Boosting uptake
Although this is more than in previous years, experts are still having to work hard to get the figure up to the 95% level that is necessary to effectively stop the spread of the disease in the community.
Independent scientific research has shown that providing these vaccines at the same time is safe, effective and more convenient for parents"
End QuoteDepartment of Health spokeswoman
The vaccination rate has been well below this level for several years, ever since the Lancet medical journal published controversial research about the MMR vaccine in 1998.
The study has since been discredited, but confidence has been slow to return in the combined measles, mumps and rubella vaccine.
Government advisors believe simplifying the immunisation schedule will help boost vaccine uptake by making it easier for parents to get their children vaccinated.
While some parents will welcome one fewer visit to the doctor, others may be concerned about exposing their children to so many vaccines in one sitting.
But experts say combining the vaccines should not pose any additional risk.
A Department of Health spokeswoman said: "Independent scientific research has shown that providing these vaccines at the same time is safe, effective and more convenient for parents."
Children will still be offered the usual series of baby vaccinations as well as their pre-school booster jabs after their third birthday.
Many depictions of mental illness on TV are frightening and misleading, a government-backed report says.
The study, commissioned by the Department of Health, found nearly half of all mentally ill characters were portrayed as dangerous to others.
Its author said the "axe-wielding maniac" stereotype should be ditched.
Mental health charity Mind said progress had been made in dramas such as EastEnders and Shameless, but more improvement was needed.
Television and films have been using the "madman" as a dramatic device for decades, but in reality, the vast majority of people with mental health problems pose no risk to others.
The Glasgow Media Group, working on behalf of a Department of Health campaign called "Shift", examined dozens of popular dramas and comedies to see how mental illness was presented to the viewer.
It found that most references to mentally ill people were insulting, examples being the terms "crackpot", "basket case" or "a sad little psycho".
In addition, 45% of storylines involving people with mental health problems found them posing some kind of risk to others.
Recent examples were a character in ITV soap Emmerdale who drugs the village vicar, or a schizophrenic killer in the popular US show CSI: Miami.
'Improve perceptions'
Even in BBC One soap EastEnders, which was praised for a realistic portrayal of bipolar disorder with character Stacey Slater, had the same character eventually commit murder.
There is still much work to be done until we are at a stage where accurate depictions are the norm rather than the exception"
End QuotePaul FarmerMind
Professor Greg Philo, who led the research, said: "Fictional film characters like Hitchcock's Norman Bates in 'Psycho' have long established the idea of the 'mentally ill' as crazed and dangerous in the public mind; television has been doing the same thing for decades.
"Great progress has been made in recent years, but we've some way to go before we see more of the everyday realities of living with a mental health problem properly represented and stereotypes like the axe-wielding maniac take a back seat."
Almost half of programmes did offer sympathetic portrayals, although these often showed the character as a "tragic victim", the researchers said.
The depiction of another character with bipolar disorder on Channel 4's Shameless won praise for accuracy and sensitivity.
Paul Farmer, the chief executive of Mind, said that improvements over the past decade had been due to the willingness of scriptwriters and programme producers to involve people with personal experience of mental health problems while carrying out research.
He said: "It is also clear, however, that there is still much work to be done until we are at a stage where accurate depictions are the norm rather than the exception.
"I hope this report will encourage programme makers to follow these examples of good practice to create accurate, well-rounded characters that can improve perceptions of mental health."
At least 30 genes appear to play a role in the age at which girls reach puberty, according to an international group of scientists.
The team scanned the genetic code of more than 100,000 women, reporting their findings in the journal Nature Genetics.
In the UK, girls as young as 10 are now showing the first signs of puberty.
A specialist said early puberty was linked to an increased risk of female cancers later in life.
The reasons why girls are going through puberty several years earlier than a century ago are not well understood by scientists.
Some have suggested a relationship between early puberty and obesity, and the latest research, carried out by the Reprogen consortium of scientists from the US, Europe and Australia, supports this idea.
Among the 30 genes highlighted by their genome research were some already linked to fat metabolism and weight regulation.
However, it is still not clear whether being obese or overweight in childhood is itself the cause of early puberty, or just another consequence of a different mechanism.
In addition, the study does not show how much of the risk is due to genes, and how much other environmental factors such as diet and upbringing are responsible.
Fat stores
One author, Dr Ken Ong, from the Medical Research Council Epidemiology Unit in Cambridge, said: "We know that girls who are overweight are more likely to go through puberty at young ages.
You need to be aware that you may be laying down your future risk from childhood"
End QuoteProfessor Anthony Swerdlow,Institute of Cancer Research
"If rates of childhood obesity continue to rise we will see many more girls with puberty at young ages."
Dr Anna Murray, another of the researchers from Exeter University, suggested that holding larger stores of fat might signal to the brain that it had the resources to start a woman's reproductive life.
She said: "We found that the timing of puberty is related to fatty acid metabolic pathways - there is evidence that the brain can sense these types of body fats."
Aside from the confusion experienced by young children entering puberty, it carries other health risks in the longer term.
Professor Anthony Swerdlow, from the Institute of Cancer Research, said that early puberty meant a higher risk of female cancers, particularly breast cancer.
This was possibly due to a higher lifetime exposure to sex hormones such as oestrogen.
He said that good diet and exercise, or the lack of it, in early childhood might be crucial to health many decades later.
He said: "What we increasingly believe is that, at least for breast cancer, the risk starts very, very young, even before puberty.
"If you are to prevent it, you need to be aware that you may be laying down your future risk from childhood."
Cigarette packets should have plain packaging to make smoking less attractive, ministers have suggested.
The government is currently planning to ask retailers to cover up their displays of cigarettes from next year to protect children.
But now cigarette packets could also be made a standard colour like grey, rather than the existing bright colours.
Campaign group ASH says this is "an enormous leap forward".
The Department of Health is considering the idea of asking tobacco firms to put only basic information and health or picture warnings on their packets.
Making the cigarette packets a plain colour would protect children from taking up smoking in the first place, it suggests.
It would also help support people who are trying to give up smoking, the department said.
'Costs too high'
Health Secretary Andrew Lansley, said it was time to try a new approach.
The industry use packaging to seduce our kids and mislead smokers"
End QuoteMartin DockrellASH
"The evidence is clear that packaging helps to recruit smokers, so it makes sense to consider having less attractive packaging. It's wrong that children are being attracted to smoke by glitzy designs on packets.
"We would prefer it if people did not smoke and adults will still be able to buy cigarettes, but children should be protected from the start.
"The levels of poor health and deaths from smoking are still far too high, and the cost to the NHS and the economy is vast. That money could be used to educate our children and treat cancer," Mr Lansley said.
"We will shortly set out a radical new approach to public health in a White Paper."
Martin Dockrell, director of policy and research at ASH, (Action on Smoking and Health), said the industry calls packaging "the silent salesman".
"They use it to seduce our kids and mislead smokers into the false belief that a cigarette in a blue pack is somehow less deadly than a cigarette in a red one.
"By helping smokers who want to quit and protecting our children from the tobacco ad men this will be an enormous leap forward for public health, perhaps even bigger than the smoking ban," he said.
"The government accepts that packaging and tobacco displays influence young people, so there is no time to waste. It may take years to pass a new law on plain packs but the law on tobacco displays is already on the statute books and comes into force next year."
Recent research published in Tobacco Control showed that putting tobacco out of sight in shops not only changes young people's attitude to smoking, it also doesn't result in retailers losing money.
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