Quarter 'unaware of HIV status'

25 November 2010 Last updated at 22:23 ET

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."

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It's vitally important we invest in targeted HIV prevention and awareness programmes"

End Quote Sir Nick Partridge Terrence 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."

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PE "failing" to provide a workout

25 November 2010 Last updated at 23:02 ET By Adam Brimelow Health 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.

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'HOT FOOT LIZARDS' AND MORE

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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.

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Private firm to run NHS hospital

25 November 2010 Last updated at 11:48 ET By Nick Triggle Health 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.

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What is Circle?

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Circle is not new to the NHS.

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."

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BMA ex-leader cleared to operate

25 November 2010 Last updated at 08:11 ET By Dominic Hughes Health 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.

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UK &#39;performing well&#39; on heart ops

24 November 2010 Last updated at 19:35 ET

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.

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This excellent data is the culmination of years of hard work carried out by NHS cardiac units"

End Quote John Black Royal 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."

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Amputation variation &#39;shocking&#39;

24 November 2010 Last updated at 20:33 ET By Branwen Jeffreys Health 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.

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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 Quote Sir 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."

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