Hospitals 'still lack basic care'

2 December 2010 Last updated at 00:02 ET By Jane Hughes Health correspondent, BBC News

Nursing care must be strengthened and the complaints system overhauled because of continued poor care of older people in hospital, says the Patients Association.

The patient lobby group has highlighted 17 cases in England and Wales where patients were left lying in faeces, or desperately hungry and thirsty.

It said it had been inundated with similar stories.

The government said it was committed to tackling shortfalls in patient care.

The Patients Association acknowledged that most patients do get good treatment, but said some were still being denied the essentials of nursing care, even though it highlighted serious problems last year.

A national survey of hospital experiences in England suggests that nearly half of all patients rate their care as excellent, and just 2% said it was "poor".

Family complaints

Liz Pryor said her elderly mother Anne Robson went to hospital following a fall in January and became badly dehydrated and lost weight. She says her mother was left lying in a nightdress that was wet up to her armpits with urine.

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It's a scandal, and it's outrageous that it has been persisting for years"

End Quote Katherine Murphy Patients Association

She died within hours of being discharged.

"Mum was admitted with a suspected fractured hip and she was discharged a week later about to die," said Liz Pryor. "I think that's unacceptable.

"I don't think anyone did anything on purpose, but it's a systemic, viral attitude."

The hospital does not accept that she deteriorated during her hospital stay, according to the report compiled by the Patients Association.

Louise Jacob's daughters Deborah and Rebecca said she went to hospital in January following a stroke. They said staff often failed to give her the medication she needed, and she was left propped on a bed pan for long periods of time.

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Liz Pryor said her mother's hospital care was "unacceptable"

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They were then prevented from visiting her because of an outbreak of the winter vomiting bug, norovirus, on the ward. Mrs Jacob died a few days later.

"The indescribable heartache and anguish caused through us not being allowed to visit our mother will be with us for ever," her daughters told the Patients Association. "We can never forgive the hospital for the way Mum was badly let down during the last few weeks of her life."

According to the report, the hospital apologised to the family and said it was not their intention to stop visits to seriously ill patients.

Wider failings

The Patients Association said the 17 cases highlighted wider failings in NHS nursing care.

It is calling for the introduction of independent "patient safeguarding champions" at every hospital to check that nursing standards are maintained.

It also wants the NHS complaints process to be overhauled.

"Surely the essentials of nursing care are what every patient deserves and should get?" said Chief Executive, Katherine Murphy.

"It's a scandal, and it's outrageous that it has been persisting for years."

The family of former Patients Association president, Claire Rayner, who died in October, is backing the calls for change.

"If she were here today she would have been hollering from the roof tops about it," said Claire Rayner's son Jay.

"Any health system is only as good as its failings, and those detailed in these pages are truly dismal."

'No excuse'

The Royal College of Nursing said there was no excuse for poor care.

General Secretary Peter Carter said: "Neither the RCN nor the overwhelming majority of committed and caring nurses can possibly condone the neglect, rudeness and in some cases outright cruelty outlined in this report."

However, he said problems often arise when staffing levels are cut.

Care Services Minister, Paul Burstow said the report painted a disturbing picture.

"It is an unacceptable legacy that this government is committed to tackling."

He said that was why the government would soon start publishing details about complaints.

"The NHS must become much more tuned into patient views and experience."

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Miscarriage &#39;raises heart risk&#39;

2 December 2010 Last updated at 04:04 ET

Having multiple miscarriages increases the risk of a heart attack later in life, according to researchers.

The German study, published in the journal Heart, found that women who had more than three miscarriages had a five-fold increase in risk.

The relatively young age of the women meant overall risk remained low, but miscarriages could alert doctors to future problems, the researchers said.

UK specialists said that the reason for the link was still unclear.

The study looked at more than 11,500 women aged between their mid-30s and mid-60s.

They looked at the pregnancy history of those who had suffered heart attacks, and compared this to the rate of miscarriages in the other women.

They found that one in four of the women in the study reported having a miscarriage - although this number could be higher because some women become pregnant then miscarry without realising what has happened.

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It is possible that there is some common predisposing risk factor for both miscarriage and heart disease"

End Quote Professor Gordon Smith Cambridge University

When other factors linked to heart problems - such as weight, alcohol consumption and smoking - were accounted for, having three or more miscarriages increased the risk of heart attacks by more than 500%.

A smaller increase in risk was recorded in women who had miscarried fewer than three times.

The researchers, from the German Cancer Research Centre in Heidelberg, said that the results suggested a "substantially higher" risk later in life.

They suggested that a history of miscarriage should be recorded by doctors as an "important indicator" when trying to work out whether a woman was likely to suffer heart problems in middle-age and beyond.

The age of the women involved in the study meant that the overall risk of heart attack could not be tested.

The five-fold increase refers to a much smaller risk - that a woman would have a heart attack at a younger age.

This means that even a five-fold increase does not mean that a woman who suffers multiple miscarriages is very likely to have a heart attack.

Indeed, among a sample of 2,876 women who reported miscarriages, there were 82 heart attacks over a ten-year period.

No firm conclusions

However, other specialists said that the link between miscarriage and heart attacks remained a concern.

Professor Gordon Smith, from Cambridge University, said that other studies had pointed to an increase in heart disease risk among women who had pregnancy complications, which included pre-eclampsia, and premature birth alongside miscarriage.

However, he said that the reasons why were still not fully understood, with some evidence suggesting that it was not an effect of having miscarriages.

He said: "It is possible that there is some common predisposing risk factor for both miscarriage and heart disease. During pregnancy, it is manifested by increased risk of miscarriage, and later in life, it manifests itself as an increase in heart disease risk.

"Perhaps this involves an increased propensity to blood clotting - but the honest answer is that we don't yet know."

A spokeswoman for the British Heart Foundation said that it was hard to draw firm conclusions from the study.

She said: "While this is certainly an interesting observation it gives no proven explanation for an increase in heart attack risk.

"It's not simply a case of saying multiple miscarriages increase your risk of a heart attack - lots of other factors come into play.

"It's known in some cases of multiple miscarriages that the women have previously undiagnosed heart and circulatory disease, or significant risk factors for the disease, so they may have an increased heart attack risk which is unrelated to the pregnancy."

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Prostate cancer clue in fingers

30 November 2010 Last updated at 19:01 ET By Fergus Walsh Medical correspondent, BBC News

The length of a man's fingers can provide clues to his risk of prostate cancer, according to new research.

A British Journal of Cancer study found men whose index finger was longer than their ring finger were significantly less likely to develop the disease.

Researchers made the discovery after comparing the hands of 1,500 prostate cancer patients with 3,000 healthy men.

The length of the fingers is fixed before birth and is thought to relate to sex hormone levels in the womb.

Being exposed to less testosterone before birth results in a longer index finger and may protect against prostate cancer later in life, say researchers at the University of Warwick and the Institute of Cancer Research.

One of the report authors, Professor Ros Eeles, said more studies would be needed, but if these confirmed the findings it could be used a simple test for prostate cancer risk.

She said: "This exciting finding means that finger pattern could potentially be used to select at-risk men for ongoing screening, perhaps in combination with other factors such as family history or genetic testing."

The study was funded by the charities Prostate Action and Cancer Research UK.

Emma Halls, chief executive of Prostate Action, said: "This research brings us another step closer to helping determine risk factors for prostate cancer, which is possibly the biggest issue in current thinking about preventing and treating the disease.

"However, we are still a long way from reducing the number of men who die of prostate cancer every year and need more research and education in all areas to achieve this."

Dr Helen Rippon, head of research at The prostate Cancer Charity, said the research added to growing evidence that the balance of hormones we are exposed to before birth influences our health for the rest of our lives.

But she said men with shorter index fingers should not be "unduly worried".

"They share this trait with more than half of all men and it does not mean they will definitely develop prostate cancer in later life."

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Age affects appointment chances

1 December 2010 Last updated at 03:02 ET

Age, sex and wealth all affect how likely your GP is to refer you for a specialist appointment, a study has concluded.

A UK team analysed data for 130,000 patients, reporting their findings in the British Medical Journal.

Older people were less likely to be referred for three common symptoms, with sex and deprivation also influential.

A charity said the study should raise alarm bells across the NHS.

Michelle Mitchell, Charity Director at Age UK, said: "A doctor's decision to refer patients must be based solely on the patient's clinical need, not their age. Age discrimination in health provision will be unlawful from 2012 and it can't come a moment too soon for older people in need of medical care."

The study from the King's Fund and University College London covered decisions on patients with postmenopausal bleeding, hip pain and heartburn from 326 UK practices across a six-year period.

Once everything else that might influence a doctor's decision to refer - such as smoking, weight, alcohol use and pre-existing conditions - was taken into account, the researchers found significant differences in referral rates between old and young, male and female.

As a guide, the older the patient, the less likely a referral was - in postmenopausal bleeding, someone aged 85 or over was 61% less likely to get a specialist appointment, compared with someone aged 55 to 64.

For patients with hip pain, the difference in referral rates was 32%.

Women were 10% less likely to be referred for hip pain than men, while there was some evidence that coming from a poorer background made a specialist appointment for hip pain and heartburn less likely.

The reasons behind the decisions were not revealed by the study - however, the authors suggested that older patients might be less likely to ask for referral, and that GPs choosing to work in deprived areas might be generally less inclined to refer.

However, they said that the differences could lead to "delays in treatment and poorer outcomes" - and might be an even greater concern if similar patterns emerged in referrals for other common symptoms, some of which could be linked to serious illness.

In an accompanying commentary, Professor Moyez Jiwa, from the Curtin Health Innovation Research Institute in Perth, Australia, said it was hard to know how harmful decisions like this could be.

While some patients might be "denied timely access" to experts, she wrote, others who were referred could be harmed by unnecessary testing and treatment.

She added: "The appropriate referral of cases has economic, quality and safety ramifications that resonate across the health sector and the globe."

She said that database analysis like this could not help researchers understand why GPs and their patients behaved in a certain way in the consulting room.

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Elderly &#39;miss skin cancer signs&#39;

30 November 2010 Last updated at 10:42 ET

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."

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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 Quote Sara Hiom Cancer 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."

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Councils get public health role

30 November 2010 Last updated at 03:55 ET By Nick Triggle Health reporter, BBC News <!-- Embedding the video player --> <!-- This is the embedded player component -->

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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.

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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 Quote Angela Mawle UK 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."

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