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Public faces ‘care injustice’ as NHS struggles

The public is facing a growing “care injustice” as people are finding it more difficult to get help ..

The public is facing a growing "care injustice" as people are finding it more difficult to get help in England, the regulator is warning.

The Care Quality Commission highlighted growing hospital waiting lists, delays at A&E and record dissatisfaction levels with GPs in its annual report.

Mental health and old-age care were also becoming harder to access.

And the report said even where there was care available many people only had the choice of failing services.

In its 130-page review, the regulator pointed to

  • the lack of out-of-hours GP care
  • rising rates of preventable admissions to hospitals
  • overcrowding on wards and worsening A&E waiting times
  • the growing waiting list for routine operations
  • mental health patients being made to travel long distances for treatment
  • older people going without the help they need for daily tasks such as washing and dressing

Don Redding, of the patient group, National Voices, said it was clear the system was "malfunctioning" and the report should act as a "loud alarm bell".

He urged the government and NHS leaders to take notice as they prepare to publish their 10-year NHS plan later in the autumn, setting out how the extra funding for the health service will be spent in the coming years.

The report is being published as the BBC relaunches its NHS Tracker project, which enables users to find out how their local areas are performing on cancer, A&E, hospital care and mental health services.

Which places are struggling the most?

The CQC is particularly worried about four areas of the country where access to good hospital and social care is problematic.

These have been named as the Isle of Wight, Kent, Wirral and Portsmouth.

People in these areas are hit by both struggling hospitals and poorer-than-average care services, with inspectors worried things are going to get better in the future.

In Kent there are seven local hospitals that are all judged to be not good enough, while one in three nursing homes is failing.

The Isle of Wight's only hospital has an inadequate rating and a third of care homes are failing.

In Wirral, half the nursing homes are judged not good enough along with the two local hospitals, while nearly half of home care services in Portsmouth and its main hospital are not up to scratch.

Does this mean services are getting worse?

No. Overall, the CQC said the majority of services were rated as good or outstanding and the quality of care was being maintained.

In fact, on each measure, there has been a small increase in the number of good and outstanding performers on the year before.

However, that should not be interpreted as a definitive sign of improvement.

The CQC prioritises the worst-performing services for reinspection which means the overall picture is more likely to improve than deteriorate, because the poorest performers cannot get a lower rating.

Instead, the problem being highlighted is more a matter of it getting harder to access services.

People are waiting longer for treatment, going without or – in the case of mental health care – sometimes having to travel long distances for treatment.

What has gone wrong?

It is a simple matter of supply and demand. The ageing population and rise in illnesses such as diabetes means more and more people need care.

While the NHS budget has been rising, it has not been enough to keep up with the growing numbers of people needing treatment.

There are shortages of staff in key areas – 12% of nurse posts and 9% of doctor posts are vacant.

But the CQC is also clear there is a structural problem.

The nature of illness, which means people rely on ongoing care for incurable conditions like dementia, is placing a greater reliance on the way the NHS works with care services, such as nursing homes and help in the home for tasks such as washing and dressing.

Care services are organised by councils or rely on people paying for it privately.

It has created a situation where growing numbers are simply going without help in their later years.

The CQC pointed to figures showing the numbers not receiving the care they need has increased nearly a fifth in two years to 1.4 million – that is nearly one in seven older people.

Caroline Abrahams, of Age UK, said it has got so bad that it has become "pot luck" whether you can get help.

What is being done about this?

The Department of Health and Social Care said action is being taken.

It pointed to the increased funding for the NHS that was announced by the prime minister in the summer.

That will mean by 2023 the budget will have risen by more than £20bn a year in real terms.

There is also a big emphasis being placed on the NHS to work closely with care services.

On top of this, ministers have promised to reform the funding system for social care, with a Green Paper expected to be published later this year.

A spokesman added: "We want the NHS to be the safest healthcare system in the world – and this starts by ensuring every single patient in this country receives the highest quality of care, no matter where they live."

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Length of ring and index fingers ‘linked to sexuality’

Women whose left index and ring fingers are different lengths are more likely to be lesbians, a stud..

Women whose left index and ring fingers are different lengths are more likely to be lesbians, a study suggests.

Scientists measured the fingers of 18 pairs of female identical twins, where one was straight and the other gay.

On average, the lesbians, but not the straight twins, had different sized index and ring fingers, typically a male trait, but only on the left hand.

This may be the result of exposure to more testosterone in the womb, the University of Essex researchers said.

The scientists also measured the fingers of 14 pairs of male identical twins, where one was straight and the other gay, but found no link.

Both men and women were exposed to the "male" hormone, testosterone, in the womb – but some may be exposed more than others, the scientists said.

Study author Dr Tuesday Watts, from the psychology department at Essex University, said: "Because identical twins, who share 100% of their genes, can differ in their sexual orientations, factors other than genetics must account for the differences.

"Research suggests that our sexuality is determined in the womb and is dependent on the amount of male hormone we are exposed to or the way our individual bodies react to that hormone, with those exposed to higher levels of testosterone being more likely to be bisexual or homosexual.

"Because of the link between hormone levels and difference in finger lengths, looking at someone's hands could provide a clue to their sexuality."

The findings are published in Archives of Sexual Behaviour. (more…)

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4 ways cancer is changing how we test medicines

This article is part of the Global Policy Lab: Decoding Cancer.

Genomics, its said, has the potent..

This article is part of the Global Policy Lab: Decoding Cancer.

Genomics, its said, has the potential to turn every cancer into its own unique snowflake, to be tackled not with off-the-shelf treatments but a personalized regimen. That threatens to make the gold standard of drug testing, the randomized clinical trial, look a bit tarnished.

Here are four ways cancer is changing the way we test drugs and treatments, from the perspective of industry, regulators, doctors, researchers and patients.

Out-of-body

In a typical drug trial, the manufacturer sends pills to patients, identical little capsules to be swallowed. Not so for personalized therapies like the prostate cancer treatment currently being tested by Sotio, a mid-sized biotech in the Czech Republic. Instead, patients blood samples are collected in more than 200 sites in more than 20 countries and then sent to Prague, where technicians re-engineer cells to fight their cancer and send them back to the patients.

That makes it “extremely complicated from the logistics point of view,” said Radek Špíšek, Sotios chief executive. In addition to satisfying the usual medicines regulators, the company had to work things out with transport agencies to get the blood on planes. Some countries wanted to put the samples “through X-rays which would kill some cells,” Špíšek said. Once the blood arrives at Sotios site, each treatment for the nearly 1,200 study participants has to be created in a separate room, to avoid mixing them up — a physical space constraint that slows the process down.

Minor additions

Clinical trials typically start recruiting patients at age 18, which means teens dont get much access to experimental treatments. “Physiologically, there is no reason why a 16-year-old couldnt go into that trial,” said Pamela Kearns, the president-elect of the European Society for Paediatric Oncology. There are no legal barriers, either, she said, but rather practical ones: “It now means that youve got that trial not just in an adult unit but also in a pediatric unit.”

Theres a growing movement to bring young patients into trials — driven in part by activist networks of young adults — Kearns said, and a video is making the rounds calling out both scientists and pharma companies for not doing just that. “From personal experience, this is changing in the U.K., but weve got a long ways to go,” said Kearns. “In the rest of Europe, were just beginning to get the message out there.”

Less evidence of more

As we pursue cures for rare cancers, studies are getting smaller; but the breakthroughs can nonetheless be dramatic. Thats convincing drugs regulators that the benefit of a medicine is worth approving, even if developers cant produce the volume of stats theyre accustomed to.

The European Medicines Agencys senior medical officer, Hans-Georg Eichler, cited statins, a treatment for high cholesterol, as an example of traditional testing; in a study with over 1,000 patients, regulators might see 4 percent of patients have a heart problem with the medication, and 6 percent without, and they have to figure out whether that little difference is thanks to the drug. But with rare cancers, the math plays out differently. If a killer cancer starts going into remission in most of the 70 patients receiving an experimental drug in a small trial, “it is in patients best interest to allow a product onto the market based on smaller studies,” Eichler said.

Studies could get even smaller. Rafal Swierzewski, an associate consultant for the European Cancer Patients Coalition, noted the possibility of a clinical trial of one, to see what works for that snowflake cancer. Until recently this possibility existed primarily in the imaginations of academics. But now some companies are giving it a try. (more…)

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Inducing labor at 39 weeks may help mothers, babies

Mothers and babies both may benefit from inducing labor at 39 weeks, according to a study in the Jou..

Mothers and babies both may benefit from inducing labor at 39 weeks, according to a study in the Journal of Obstetrics.

Choosing to induce at that point may reduce the risks of a C-section and lower the odds of a mother's having high blood pressure from the pregnancy. It also may help babies breath more easily.

Water breaking, vaginal bleeding or frequent regular contractions all can be signs of impending labor, but how and when the baby actually appears can vary wildly. Data have shown that both maternal and fetal complications increase with pregnancies longer than 39 weeks.

A pregnancy is considered full term between 39 and 40 weeks, according to the American College of Obstetrics and Gynecology. A so-called post-term pregnancy is a gestation that last beyond 42 weeks.

"Placental function declines post-term, which forms the basis of most of the complications of post-term pregnancy," said Dr. Alexandros Sotiriadis, a professor of maternal-fetal medicine at Aristotle University of Thessaloniki.

After 42 weeks, according to the Academy of Family Physicians, risks increase related to a mother's bleeding after delivery or suffering an infection linked to the placenta or uterus. The baby's risk of shoulder issues also may rise.

This study considered data from more than 7,200 cases and compared inducing labor to waiting for the baby to arrive naturally. Researchers looked at whether mothers required surgery as part of the delivery, whether the baby required admission to the intensive care unit, the rate of maternal death and other potential secondary issues.

Expectant mothers considering inducing at 39 weeks should explore every possible option with their doctors, Sotiriadis said.

"Labor after induction may be sometimes a bit lengthier and slightly more painful than spontaneous onset of labor," the doctor said, adding that more studies should focus on women's decisions whether to induce.

Dr. Tambetta Ojong is a family medicine resident at SUNY Downstate Medical Center and a member of the ABC News Medical Unit. (more…)

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