Smokers and problem drinkers who are admitted to hospital in England will be given help to quit or cut down, to reduce demands on the health service.
The measures are part of a long-term plan to be announced over the next few days by NHS England.
It said addiction to alcohol and tobacco were two of the biggest causes of ill health and early death.
And the right support could save lives and help people stay fitter for longer.
Health charity Ash said it was delighted by the plans and Public Health England called the move "smart", saying it would save thousands of lives and help the NHS survive into the future.
Alcohol-related harm costs the NHS in England around £3.5bn each year – admissions to hospitals have increased by 17% in the past decade to just over 2% of the total number.
But the use of specialist Alcohol Care Teams has seen a significant reduction in A&E attendances, ambulance callouts and readmissions.
The teams offer specialist help to patients on how to give up drinking and support to stay off it, which includes written advice, as well as counselling.
That scheme is already running in Bolton, Salford, Nottingham, Liverpool, London and Portsmouth.
It will now be expanded to 50 hospitals with the highest number of alcohol-related admissions across the country.
And every smoker admitted to hospital – around half a million people a year – will be offered specialised support to quit.
This includes pregnant women and their partners.
Recent figures show that 10% of women in England are still smoking when their baby is born, which can double the risk of stillbirth and increase the risk of miscarriage.
Areas of particular need, such as Blackpool where one in five pregnant women smokes, will be given priority over the next five years, NHS England says.
'Sea change in care'
Simon Stevens, NHS England chief executive, said: "Drinking to excess can destroy families, with the NHS too often left to pick up the pieces.
"Alcohol and tobacco addiction remain two of the biggest causes of ill health and early death, and the right support can save lives."
He said the long-term plan delivered a "sea change in care for a range of major conditions" like cancer, mental ill health and heart disease.
And he said it gave patients "the support they need to take greater control of their own health and stay fitter longer".
The Royal College of Physicians said many patients only come to the attention of the NHS during their first stay in hospital.
"Every contact a health professional has with a patient is an opportunity to help the patient give up smoking – having a system in place to treat tobacco dependency with allocated funding will help make it happen.
"The focus on the management of alcohol-related disease is also very welcome.
"We mustn't forget prevention though and further measures to reduce harmful drinking are much needed."
Smokers' campaign group Forest criticised the NHS initiative as being "tantamount to bullying".
Its director, Simon Clark, said: "It's stressful enough being in hospital without the additional pressure of being hounded to stop smoking.
"Pressuring smokers to quit, especially if they're in hospital for a non smoking-related reason, is an invasion of privacy."
NHS ‘should not prescribe acne drug’
The parents of young people who have killed themselves and patients unable to have sex are calling f..
The parents of young people who have killed themselves and patients unable to have sex are calling for the NHS to stop prescribing acne drug Roaccutane.
Ed Henthorn said it had caused him erectile dysfunction, psychosis and suicidal thoughts.
And one man who believes his son killed himself after taking the drug said the risks "are just too high".
Manufacturer Roche said "millions of patients worldwide have benefited from taking the drug".
The majority of those who take the drug have a positive experience.
"I used to think about girls… but my feelings, thoughts, just faded away," Ed Henthorn told the BBC's Victoria Derbyshire programme.
He was 19 when he took Roaccutane. He describes his acne as mild but bad enough to want to treat.
After three weeks he started to experience side-effects, including reduced energy and sex drive.
Then he experienced erectile dysfunction.
"That was why I decided to stop taking it," he said. (more…)
Spina bifida: Keyhole surgery repairs baby spine in womb
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In a UK first, doctors have used keyhole surgery to su..
In a UK first, doctors have used keyhole surgery to successfully repair the spine of a baby with spina bifida while it was still inside the womb.
Surgeons at King's College Hospital say the procedure is not a cure, but could be the difference between some children learning to walk or not.
Sherrie Sharp and her son Jaxson had the operation 27 weeks into the pregnancy.
Spina bifida was diagnosed after the routine 20-week pregnancy scans.
They showed Jaxson's spine and spinal cord were not forming correctly.
Gaps in the developing spine meant the cord was bulging out of his back and was left exposed to the amniotic fluid in the womb.
This damages the crucial nerves in the spinal cord and could lead to paralysis, a loss of sensation in the legs and problems controlling the bladder and bowels.
The longer the spinal cord is left exposed, the greater the damage.
Sherrie, 29, and from West Sussex, said the news was a shock, but an abortion was a "definite no". (more…)
Less chemotherapy better for older or frail patients with advanced stomach and oesophageal cancers
Less chemotherapy is as effective at controlling disease for elderly or frail patients with advanced..
Less chemotherapy is as effective at controlling disease for elderly or frail patients with advanced cancer of the stomach or oesophagus (food pipe), and leads to fewer side effects such as diarrhoea and lethargy. These are the results of a Cancer Research UK funded study, presented prior to the ASCO conference today (Wednesday).
“Increasingly were realising its not just age that affects how well someone can tolerate their treatment and we need to do more work to understand how other conditions or aspects of frailty might play a role.” – Dr Peter Hall, Cancer Research UK Edinburgh Centre[contfnewc]
Results from the GO2 trial could change the standard of care for patients who cant have full dose chemotherapy due to their age, frailty or medical fitness.
The study, which ran at hospitals all over the UK, coordinated from the University of Leeds, involved 514 people with stomach or oesophageal cancer. Their average age was 76 and the oldest was 96 years old. All were either frail, elderly or medically unfit, and for those reasons would be unlikely to tolerate full-strength treatment, which involves three chemotherapy drugs.
Patients went through a careful medical assessment, then went onto chemotherapy with just two drugs* and were allocated at random to receive them at either full-strength, medium-dose or low-dose. They were then carefully monitored to see how well the cancer was controlled, whether they had symptoms and side-effects, whether they felt their treatment was worthwhile, and what overall effect it had on their quality of life.
The researchers reported that the medium and lower doses of chemotherapy were as effective as the full-strength dose for controlling the cancer. But when the researchers looked at the overall effect of treatment, including quality of life, they reported that it was the lowest dose treatment that came out best.**
Around 15,800 people in the UK are diagnosed with stomach and oesophageal cancers every year***. Almost half (45%) of these people are 75 and over****. By 2035, this proportion is projected to rise to 55%*****, because of the UKs ageing population. This study, is one of few phase III trials in the country that seek to address how to best care for and treat this increasing population of elderly or frail cancer patients.
These findings also open up the possibility of more older and frail patients being able to take part in clinical trials.
Professor Charles Swanton, Cancer Research UKs chief clinician, said: “These valuable results reduce fears that giving a lower dose chemotherapy regimen is inferior and could make a huge difference for patients with stomach or oesophageal cancer who cant tolerate intensive courses of treatment.
“Older or frail patients are often not considered for new drug trials or standard of care therapy as theyre less able to tolerate combination chemotherapy. These trials are critical to provide much needed evidence on the effectiveness of new therapies and combination approaches, helping us develop new treatments for this growing group of patients.”
The researchers also assessed whether there were differences for the patients in the study who were under 75, or less frail, who might be expected to benefit from stronger treatment; but will be reporting that the lowest dose treatment gave the best results for them as well. (more…)
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