UK 'performing well' 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 'shocking'

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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Councils eye public health funds

23 November 2010 Last updated at 20:53 ET By Nick Triggle Health 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.

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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 Quote Dr Frank Atherton Association 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."

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Binge drinks 'raise heart risk'

23 November 2010 Last updated at 20:52 ET

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.

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Drug 'reduces' HIV infection risk

23 November 2010 Last updated at 15:13 ET By Neil Bowdler Science 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.

The study is published in the New England Journal of Medicine.

Pills and condoms

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.

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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 Quote Dr Anthony Fauci Director, 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."

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Vatican clarifies condom comment

23 November 2010 Last updated at 09:49 ET

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.

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