Migrants and overseas visitors are to face new charges for some NHS services in England, ministers say.

They include extended prescription fees, the introduction of charges for some emergency care and higher rates for optical and dental services.

However, GP and nurse consultations will remain free, and nobody will be turned away in an emergency.

Ministers say they are keen to clamp down on any abuse of the system, but doctors' leaders have voiced concerns.

The government had considered charging for GP consultations, but decided that easy initial access was important to prevent risks to public health such as HIV, TB and sexually transmitted infections.

Other types of primary care services that are being considered for charging include minor surgery that is carried out by a GP and physiotherapy that has been referred through a GP.

There are also plans to introduce a new system for identifying and recording patients who should be charged for NHS services.

Specific details of how the plans will be implemented are due to be unveiled in March 2014.

FREE NHS FOR WHOM?

Free NHS care is offered to anyone living in the UK who has temporary or permanent permission to do so

Asylum seekers, non-European Economic Area nationals who do not have permission to live in the UK, British expats, and visitors usually have to pay for treatment

The UK has reciprocal agreements with most European nations and 28 other countries, and under these visitors are given free NHS care

The NHS should claim these costs back from the relevant governments - but research suggests just 73m a year is recouped out of more than 460m at present.

The government said the changes would allow the NHS to recoup money, and encourage only those who need urgent and emergency care to attend.

Health Minister Lord Howe said: "Having a universal health service free at the point of use rightly makes us the envy of the world, but we must make sure the system is fair to the hardworking British taxpayers who fund it.

"We know that we need to make changes across the NHS to better identify and charge visitors and migrants. Introducing charging at primary care is the first step to achieving this.

"We are already looking at taking action and next year we will set out our detailed plans to clamp down on the abuse of our NHS."

A report by the King's Fund think tank has estimated that an average attendance at A&E costs the NHS approximately 111.

'Unintended drawbacks'

The British Medical Association said it was concerned the proposals would require doctors and GPs to spend more time on paperwork and that it could cost more in administration charges than what it would recuperate.

Dr Mark Porter, chairman of the BMA Council, said: "The government's current proposals could create unintended drawbacks for the NHS and patients.

"They are likely to create a complex patchwork of charging and access entitlements where some services remain free, such as GP appointments, while others will be chargeable, including A&E visits and other services provided via many GP practices, such as physiotherapy."

Dr Chaand Nagpaul, who leads the BMA's GP committee, added: "We cannot have a situation where any patient with a serious health need is deterred from visiting a GP, especially if their condition raises a potential public health risk."

Labour shadow health minister Lord Hunt accused ministers of "putting spin before substance".

"Labour is in favour of improving the recovery of costs from people with no entitlement to NHS treatment," he said.

"Rather than more grand-standing, the government needs to deliver practical, thought-through changes to make that happen.

"Instead this out-of-touch government is left asking doctors and nurses to act as surrogate immigration officials."

The announcement follows a Department of Health study which estimated that up to 500m could be recovered from overseas visitors' and migrants' use of the NHS every year through better charging. However, it estimated that only approximately 8m would come from charges for using A&E.

However, academics have argued that the extent of deliberate health tourism - where people travel to the UK specifically to use the NHS - has been hugely overstated and is responsible for only a small part of NHS expenditure.

The government has already announced a 200-a-year levy on migrants from outside the European Economic Area staying for between six months and five years.

A cost-recovery unit will help hospitals claw back money they are owed by other governments for treating foreign nationals visiting the UK.

The lack of data on the effectiveness of medicines available to doctors and researchers is "of extreme concern" say a group of MPs.

The Public Accounts Committee is calling for all data on drugs being prescribed in the UK to be made available.

It also says the government spent 424m stockpiling the antiviral Tamiflu despite a lack of agreement on how effective the drug is.

Campaigners called for "urgent action".

Half of trial data is not being published and pharmaceutical companies have a strong bias towards revealing the positive results, the committee's report says.

It raises questions about whether patients are being given the medication which is most likely to save their lives.

In a statement the Department of Health said: "The UK is recognised by the World Health Organization as being one of the best prepared countries in the world for a potential flu pandemic and our stockpile of antivirals is a key part of being prepared."

On trials overall, it added: "We agree that clinical trials need to be more open and transparent and we're working with health organisations in the UK and EU to make this happen.

"All clinical trials conducted in the UK must now be registered on a public database.

Researchers in Oxford have developed a degradable implant which they say has huge potential to improve surgical success rates.

The protective patch, which wraps round soft tissue repairs, will be trialled in patients with shoulder injuries.

It is hoped in time this approach could help patients with other conditions including arthritis, hernias and heart defects

Professor Andrew Carr, has led a research project to improve the success rate and ensure a quicker recovery. This collaboration between the university and the hospital trust helps move ideas quickly from the lab to the clinic.

Professor Carr's team have developed a protective patch - an implant which wraps around the surgical repair, like a splint.

Joe Dunbar, director of operations at IPRO Interactive, a health diagnostics provider serving sport, the military and the corporate sectors, says: "We can now measure employee stress levels using a portable saliva testing machine that can give us an accurate reading in minutes, rather than hours in a laboratory."

The reader, which costs about 1,500 and is manufactured by German medicare company Qiagen, measures levels of the main stress hormone cortisol, as well as other hormones such as testosterone and immunoglobulin.

High stress levels can reduce our immune systems and make us more susceptible to illness and coronary heart disease, research shows.

"Once we know what an employee's stress level is we can then put interventions in place," says Mr Dunbar, "from encouraging more exercise to changing work patterns."

Research by a team of scientists in Wales has shown early signs of being able to regenerate damaged heart tissue.

By experimenting at Cardiff and Swansea university laboratories, Cell Therapy hopes to develop new treatments for heart failure over the next five years.

Alcoholics are being paid in beer to clean the streets of Amsterdam as part of a project partly funded by the Dutch government - the organisers think other countries should abandon "old-fashioned political correctness" and adopt the same approach.

He is one of 20 alcoholics who have joined this initiative. They arrive at 09:00 and work until 15:00. They take extended breaks for beer, cigarettes and a hot lunch, all provided free of charge

"It's quite difficult to get these people off the alcohol completely. We have tried everything else. Now this is the only thing that works. We might not make them better, but we are giving them a better quality of life and it's better for the neighbourhood, they're giving something back to society."

But Ms van de Noord argues it is a cost-effective way to tackle the impact of alcoholism. "If people are being arrested, it also costs society a lot of money. So this can only be a good thing. I don't see why other countries wouldn't want to do it."

He is one of the remaining alcoholics who have not been persuaded to abandon their park benches.

Since the street-cleaning programme started 12 months ago, local police have received fewer reports of stabbings and muggings in the park. And all of the residents we spoke to said they were happy with the government supporting this unconventional approach.

Instead of being ostracised by society, the alcoholics' needs appear to have been incorporated into the Dutch healthcare system.

Floor van Bakkum of Amsterdam's Jellinek anti-addiction clinic says the project is a good way to deal with "a very problematic group - it's kind of harm reduction". She likened it to giving carefully monitored methadone or heroin doses to chronic heroin addicts.

"It might help them to do something else with their life. You always have to monitor such a project, so it shouldn't attract new alcoholics - it's not an open invitation to drink in Oosterpark." She said such a scheme would be inappropriate for alcoholics who still live at home and have a job.

( The Home Office says on its website that about three-quarters of crack and heroin users claim they commit crime to feed their habits.

Professor John Strang, who led the project, said the results were "very positive" because the scheme had helped cut crime and avoid "expensive" prison sentences.

PILOT SCHEME FINDINGS

Three-quarters reduced use of street heroin Offences down from 1,731 in 30 days to 547 in six months Spending on drugs down from 300 to 50 a week )

The majority of this increase was seen in the developing world, particularly in countries where incomes were rising, such as Egypt and Mexico.

The ODI's Future Diets report says this is due to changing diets and a shift from eating cereals and grains to the consumption of more fats, sugar, oils and animal products.

"People with higher incomes have the ability to choose the kind of foods they want. Changes in lifestyle, the increasing availability of processed foods, advertising, media influences... have all led to dietary changes."

He said this was particularly the case in emerging economies, where a large middle class of people with rising incomes was living in urban centres and not taking much physical exercise.

The result, he says, is "an explosion in overweight and obesity in the past 30 years" which could lead to serious health implications.

This is because consumption of fat, salt and sugar, which has increased globally according to the United Nations, is a significant factor in cardiovascular disease, diabetes and some cancers.

http://www.bbc.co.uk/news/health-24645171

Would a tax on sugary drinks make Mexico healthier?

One thing that both those for and against the tax agree on is that by itself it will not be enough to significantly reduce the obesity epidemic in Mexico.

More support is needed, they say, for the health system as a whole and for healthy eating campaigns, especially those targeted at children.

Mental health nurses are to be based in police stations and courts in 10 areas of England as part of a pilot scheme aimed at cutting reoffending.

The nurses' duties will include helping officers to respond to calls and identify those with problems.

Ministers said "too often" criminals with mental health problems were being diagnosed only once they reached jail

Where there is crime there is often mental illness, but the criminal justice system has a mixed record in dealing with it in police stations and courts - after all, police officers will never be as good at spotting the signs of depression or psychosis as a trained psychiatric nurse.

But it seems logical that criminals with untreated mental health problems will be more likely to break the law again.

The results from a trial scheme in Cornwall are promising - reoffending cut by 49% for those with a history of poor mental health. It might even work both ways.

While filming at Bethnal Green police station, officers told me that a suspect had been arrested feigning mental health problems - including an apparent attempt to strangle himself.

But the police station psychiatric nurse, who knew his medical history and saw through his act, sent him back to the cell.

The biggest issue is one of resources. Police say there is no point in the mental health nurse being there only 9 to 5.

The government has provided limited funding for pilot schemes -partly to try to work when the peak demand occurs. Providing cover 24/7 across England won't be cheap

"We welcome this initiative, which has the potential to stop people going unnecessarily to prison, reduce reoffending rates and save millions in taxpayers' money.

He added: "Nurses bring vital skills and knowledge to these complex and challenging cases and we know that the police greatly value working in partnership with nursing staff.

"Having more nurses in liaison and diversion services will improve the health care that people in the criminal justice system receive and it will also support the police's public protection work."

The NHS in England is to start collecting anonymised data on patient care by GPs for the first time.

"This initiative is about upgrading our information systems to get a more complete picture of the quality of care being delivered across all parts of the NHS and social care."

Non-urgent cases told to avoid Swansea and Bridgend A&E

People with minor injuries in Swansea and Bridgend are being advised to stay away from their local A&E departments.

Swansea's two hospitals have seen 18 operations cancelled while a rise in norovirus cases has shut wards at Neath Port Talbot hospital and Bridgend.

bed blocking

Hospital 'bed blocking' pressure worry for older patients

Older patients should not be put under pressure to leave hospital before they feel ready to do so, a charity warns.

Measures to ease pressures on hospital beds

Joint plans agreed by health boards and ambulance service to reduce ambulance waits at hospitals to be implemented immediately

Health boards to draw up plans within six weeks to improve unscheduled care outside hospital, for example out-of-hours GP services

NHS and councils told to speed up assessments of care needs Chairman of Cwm Taf Health Board, Dr Chris Jones, to advise

minister and act with his authority Plans for a 111 phone service for non-emergency calls to be

accelerated after consistent finding that too many people turn up at A&E unnecessarily

National conversation about way in which care services best meet needs of an ageing population to be held

http://www.bbc.co.uk/news/health-25628009 A&E

He said there were a variety of issues which led patients to become frequent visitors, including mental health and problems such as drug and alcohol abuse, which suggested that with better support in the community, particularly from social care, repeat visits could be prevented.

But he also said others were using A&E simply because they had had good experiences in the past, while those who struggled with the language may be using A&E units as a default because they found it hard to navigate their way round the system.

Ask any A&E doctor or nurse and they will have a tale about a patient who keeps coming back.

Often they will have health issues - both physical and mental - that are not being dealt with properly in the community.

But for some patients A&E becomes a crutch. They may be lonely or scared and turn to A&E because its doors are always open.

In one unit I visited recently I met one such patient. She was elderly and had been in several times over the past few weeks.

Staff gave her a cup of tea, checked her over and sent her on her way. She had a range of chronic illnesses, but the job done that evening was one that would traditionally have been done by social care or district nurses.

But with those services stretched it was A&E that was left to pick up the pieces.

She said improving access to GPs could make a big difference - before Christmas, official NHS data showed the number of people waiting longer than a week to be seen by a GP was growing.

"These figures show how vital it is for every hospital with an A&E unit to have 24/7 access to mental health advice and support. Too many people with mental health problems struggle to get the help they need in a crisis."

Belgium legalised the right to euthanasia for adults in 2002. Now the Senate has voted to extend the law to children who are terminally ill, and suffering

unbearable physical pain. Supporters believe this would be a logical move. Opponents say it is insanity

children must understand what euthanasia is, and their parents and medical teams have to approve the child's request to die.

A senator who voted against the bill, Christian Democrat Els Van Hoof, thinks it is based on a misplaced idea of self-determination - that everyone has the right to make decisions not only about how they live, but also about how they die. She disagrees, and fought successfully, with a group of other senators, to restrict the scope of the bill to children with terminal illness suffering unbearable physical pain.

"In the beginning they presented a law that included mentally ill children," she says. "During the debate, supporters of euthanasia talked about children with anorexia, children who are tired of life - so how far does it go?"

In the case of adult euthanasia, she fears a "slippery slope" is already in evidence. The 2002 law governing euthanasia allows adults to choose to end their lives, if they:

are competent and conscious repeatedly make the request are suffering unbearably - physically or mentally - as a result of a

serious and incurable disorder

On 20 April 2012, Tom Mortier, a chemistry lecturer, got a message to call a Brussels hospital. His mother was dead. Godelieva De Troyer was 64 and had been suffering from depression. She had sent her son an email three months before she died telling him she had asked for euthanasia, but he did not think doctors would allow it.

He is enraged. He does not accept the argument that his mother had a "right to die".

"If we can't treat the pain, then we can sedate children. And if we see that the situation is really inhumane, we can go to our Ethics Committee and ask for

permission to end life. But we have to have the consensus of a lot of people to do that."

For Renard, the critical point is that in her experience, children do not ask to die.

"I've seen a lot of young adolescents with very severe pain and symptoms. They always had some hope for the next day. I've never had one who told me, 'I can't do it any more, please stop it.' They don't want to die. They want to live."

http://www.bbc.co.uk/news/health-25592214 asthma changing diet

Tests on mice, published in the journal Nature Medicine, showed that a high-fibre diet could reduce inflammation in the lungs.

The extra fibre changed the nutrients being absorbed from the gut, which in turn altered the immune system.

The researchers argue the shift to processed foods may explain why more people are developing asthma.

The airways are more sensitive to irritation and more likely to become inflamed in people with asthma.

It leads to a narrowing of the airways that make it harder to breathe.

A team at the University of Lausanne in Switzerland showed that the high and low fibre diets altered the types of bacteria living in the guts of the mice.

Bacteria which can munch on soluble fibre, the type found in fruit and vegetables, flourished on the high-fibre diet and they in turn produced more short-chain fatty acids - a type of fat, which is absorbed into the blood.

The scientists said these fatty acids acted as signals to the immune system and resulted in the lungs being more resistant to irritation.

The opposite happened in low-fibre diets and the mice became more vulnerable to asthma.

Their report argued that a dietary shift away from fibre in favour of processed foods may be involved in rising levels of asthma.

It said: "In recent decades, there has been a well-documented increase in the incidence of allergic asthma in developed countries and coincident with this increase have been changes in diet, including reduced consumption of fibre."

http://www.bbc.co.uk/news/health-25625934

Cancer-killing "sticky balls" can destroy tumour cells in the blood and may prevent cancers spreading, early research suggests.

The most dangerous and deadly stage of a tumour is when it spreads around the body.

They attached a cancer-killing protein called Trail, which has already been used in cancer trials, and other sticky proteins to tiny spheres or nanoparticles.

When these sticky spheres were injected into the blood, they latched on to white blood cells.

Tests showed that in the rough and tumble of the bloodstream, the white blood cells would bump into any tumour cells which had broken off the main tumour and were trying to spread.

The report in Proceedings of the National Academy of Sciences showed the resulting contact with the Trail protein then triggered the death of the tumour cells.

He believes the nanoparticles could be used before surgery or radiotherapy, which can result in tumour cells being shed from the main tumour.

It could also be used in patients with very aggressive tumours to prevent them spreading.

http://www.bbc.co.uk/news/health-25635121

Although smoking is becoming less popular in many parts of the world, the total number of smokers is growing, global figures reveal.

In 2012, 967 million people smoked every day compared with 721 million in 1980, data from 187 countries shows.

The rise is linked to population growth, researchers told JAMA.

With the Earth's population having more than doubled in the last 50 years to seven billion, there are simply more people to take up the habit.

http://www.bbc.co.uk/news/health-25641030

A medical superglue has been developed that has the potential to patch heart defects on the operating table or stop bleeding on the battlefield.

The new adhesive may eventually replace stitches and staples in heart, gut and blood vessel surgery, says a US team.

Lung transplants

TRANSPLANT CHECKS

All organs must be free of apparent disease before transplantation.

A person cannot donate if they have been diagnosed with HIV or the fatal brain disease CJD (Creutzfeldt-Jakob Disease). Physical condition, not age, is the deciding factor.

The medical history of the donor is looked at - including a review of any past investigations like chest x-rays

Before lung transplantation, a small camera may be used to look for any inside trauma

Matches are made on blood group, tissue type, and if the size of organ fits the recipient

The waiting list is prioritised by need, greatest benefit and length of wait

Last year NHS Blood and Transplant said doctors should tell patients in advance if there is an increased risk because of the donor's personal history - such as smoking, disease or being elderly.

But if patients decline these so-called 'marginal organs' they would have to wait for another match - and that could be even longer if, say, they wanted organs from a non-smoker

Four in 10 lung transplants involve organs taken from a smoker

Despite the increased use of higher risk organs, patients' outcomes are improving year on year

Currently 217 patients are on the waiting list for lung transplants in the UK

http://www.bbc.co.uk/news/health-25650352

A campaign group has been formed to reduce the amount of sugar added to food and soft drinks in an effort to tackle obesity and diabetes in the UK.

Action on Sugar has been set up by the team behind Consensus Action on Salt and Health (Cash), which has pushed for cuts to salt intake since the 1990s.

The new group aims to help people avoid "hidden sugars" and get manufacturers to reduce the ingredient over time.

Sugar is a widespread presence in our food and it's often found in unexpected places,

It's probably no surprise that a can of cola contains nine teaspoons of sugar.

But some tins of tomato soup and bottles of flavoured water have four teaspoons of sugar crammed inside. And seemingly healthy fat-free yoghurt often has a high sugar content.

The NHS says most children and adults in the UK are consuming too much sugar.

The primary concern is obesity - being high in sugar means being high in calories.

Nearly two thirds of people in the UK are overweight or obese - leading to other health problems such as type 2 diabetes and heart disease.

Some argue that the problems with sugar are even deeper than the calorie content, and that high doses of the sweet stuff can increase the risk of diseases such as a fatty liver.

http://www.bbc.co.uk/news/magazine-25652991

One factor may be that alcohol is becoming more difficult for young people to get hold of, says Jonathan Birdwell, senior researcher at the think-tank Demos and author of two reports on UK alcohol trends.

Pubs and clubs are also getting better at challenging under-age drinking, he adds. Retailers have more of an incentive to check IDs after the government doubled the fines for those caught selling alcohol to young people to 20,000.

Recent awareness campaigns about daily alcohol guidelines, the arrival of "drink aware" labels on bottles and an increase in negative media stories around binge-drinking culture may have all played their part.

Straitened economic circumstances may have also played a part, Birdwell suggests. "With the rise of tuition fees, young people going to university want to get more out of their experience to make sure they are competitive in the labour markets."

Demographic trends also appear to have contributed. Britons from a Muslim background are less likely to drink for religious and cultural reasons, and Muslims now make up 8% of the population under 16 in England and Wales - up from 5% in 2001.

Research has also found that pupils who go to more ethnically diverse schools are less likely to drink, whatever background they come from personally, Birdwell says.

Relevant too is the growth of technology allowing young people to socialise with friends and keep themselves entertained,

http://www.bbc.co.uk/news/health-25403302

Emily was diagnosed with the most common childhood cancer, acute lymphoblastic leukaemia (ALL) in May 2010. Unfortunately her case, like 15 per cent of sufferers, was resistant to traditional treatment.

She was put forward for an experimental therapy known as CTL019.

In certain cancers, including the type of ALL that Emily was battling, a subset of cells in the immune system become leukaemia. These are called B cells.

Another set of cells in the immune system, called T-cells, normally recognise and attack invading disease. But in cancers like ALL, the abnormal leukemia cells fly under the radar of the normal T-cells that are meant to kill them.

In the experimental treatment, her T-cells were collected from her blood, then re-engineered in a lab to recognise and attach to a protein called CD19 that is found only on the surface of B cells.

To do this they used a gutted HIV virus, called a lentivirus, to carry special receptors into the T-cells.

There is no risk of HIV infection from a lentivirus.

When the re-engineered cells were put back they dispersed throughout the body to find and kill cancerous B cells.

Emily had an additional drug used to treat rheumatoid arthritis to tackle a side-effect of the therapy and has been in remission for seven months.

--

Targets, or the failure to hit targets, was a dominant theme at the end of last year, and 2014 has begun in similar fashion.

Results like these are certain to keep the performance of the Welsh NHS under the spotlight. David Cameron was among those who led the criticism.

It's not just referral times, there have been problems with ambulance response times, waits at accident and emergency departments and cancer treatment.

The Welsh government has said it's reviewing some of these targets.

Opposition parties branded the review a cynical attempt to gloss over failures.

But ministers insist that clinicians have told them they're inappropriate in some cases and don't reflect clinical priorities.

In fact, following the advice of health professionals has become one of the main defences by the Welsh government as it carries out a major restructuring of many parts of the health service

--

Junior doctors who decide to work in Wales could get their student debts paid off under proposals unveiled by Plaid Cymru.

The idea is based on similar schemes elsewhere including one in New Zealand, to encourage doctors to work in hard-to-staff areas. Their student debt is wiped in exchange for a commitment to work in Wales for a set period of time.

Plaid Cymru says a similar scheme was successful in recruiting new dentists when it was in coalition government with Labour.

The party says the NHS should do more to attract funding for research such as clinical trials to attract top-calibre staff.

It also wants to increase the number of places at the three medical schools in Cardiff, Swansea and Bangor.

It would consider making studying at medical school free for Welsh children.

The party says there should be bursaries for Welsh speakers and guaranteed places for those who speak the language and achieve the required grades.

She defended the proposal to tax sugary drinks, saying: "It's a well-understood principle that substances that are harmful to individuals are taxed.

"[Sugary drinks] are probably doing some harm and I think that's accepted now as we discuss the obesity crisis in Wales and the western world.

"Sugary drinks are a significant contribution to that and we could look in Wales at lowering our dependence on [them] and raising revenue."

Some states of the USA already imposed such a tax, she added.

--

The extra money the NHS was given in the summer, for winter planning, was meant to alleviate just this by helping to provide extra support in the community, such as boosting district nursing and social care, to stop people becoming acutely unwell in the first place.

---

Now a government public health expert has claimed that the current law is outdated and wrong. A substantial minority of under-16s are now having sex, said John Ashton, yet NHS workers are sometimes wary of talking to them too openly about contraception and sexually transmitted infections. His solution? Lower the age of consent to 15.

And a representative of the childrens charity NSPCC warned that a change in the law could endanger vulnerable young people: Predatory adults would be given legitimacy to focus their attentions on even younger teenagers and there is a real risk that society would be sending out the message that sex between 14 to 15-year-olds is also acceptable.

Another study published this week added weight to these concerns. According to an official report by the Childrens Commissioner, some children as young as 11 are routinely subjected to sexual abuse by their peers.

Besides, international comparisons suggest that people in countries with lower ages of consent actually tend to start having sex later.

Nine women in Sweden have received womb transplants from living relatives in a pioneering trial.

locum a&e http://www.bbc.co.uk/news/health-25731218 Spending on locum doctors to plug the gaps in A&E units in England has risen by 60% in three years, figures show.

"It is not an efficient way of spending NHS money and can be damaging for morale when doctors work alongside other, sometimes less qualified doctors, who are earning much more.

"But this has really been building for the past decade. There has been a lack of job planning and it is now very hard to attract doctors to this speciality."

In other words many young doctors are choosing to work elsewhere in the NHS to avoid the pressures and demands of A and E.

Research by the college has suggested half of trainee posts are going unfilled.

It believes the unsocial hours and pressures on A&E departments have made it less attractive than other areas of medicine.

The college has recently worked with Health Education England to draw up plans to tackle the problem, including more flexible working patterns, extra holidays and more training opportunities.

He said is it was important that improving the work-life balance of A&E doctors was part of the the government's plans when re-negotiating its contract with doctors. http://www.bbc.co.uk/news/health-25713374

A fostering scheme where families will be paid to take elderly people into their homes is to be tried in Leicester.

Carers will be paid 224 a week and Leicester City Council will pay for modifications to their homes.

Age UK warned that potentially vulnerable people could be placed in homes with strangers.

But the council said carers would be vetted before being approved, and care would be closely monitored.

In October, the council confirmed plans to close or sell off eight of its care homes.

But the council said fostering is not intended to replace care homes.

Nearly a third of a million people are being diagnosed with cancer each year in the UK, according to the charity Cancer Research UK.

The rise is due to more people living to a ripe old age.

Meanwhile, research by the University of Exeter suggests patients want cancer symptoms to be checked out more quickly than NHS guidelines recommend.

Age is the biggest risk factor for cancer.

And as life expectancies have increased in the UK, so too has the number of people being diagnosed with cancer.

"It shows for the first time that there's a strong preference for diagnostic cancer testing, even if the risk is very low.

Staff bullying concerns raised about largest NHS trust

Continue reading the main story

Related Stories

Largest NHS trust gets finance help Queen visits Royal London Hospital Delays in surgery 'unacceptable'

Staff members at all levels and across all sites of England's largest hospital trust have expressed concerns about being bullied, a report has shown.

The Care Quality Commission (CQC) found "staff morale was low" at hospitals run in central and east London by the Barts Health NHS Trust.

Why do doctors drop out? One possible explanation is the dramatic increase in the number of female medical students, who make up at least half the intake to medical schools, many of whom later leave to have children.

They believe shifts have become more demanding because of the EU working time directive which was introduced into the NHS last summer and limits the working week to 48 hours.

She pointed out that virtually all the training posts in the NHS were filled - there are always more medics in training than there are training posts to ensure a healthy competition for places.

And she added while the government was looking at how the working-time directive had been introduced there would be no return to "tired doctors working excessive hours".

WHY DO SO MANY WOMEN DIE IN PREGNANCY AND BIRTH?

A tradition for early marriages and a lack of effective family planning mean women often have babies very young and very frequently, which can increase the risk of health complications such as eclampsia -- fits caused by high blood pressure.

One Afghan woman in 11 will die of causes related to pregnancy and birth during her childbearing years, the WHO says.

Girls who give birth before age 15 are five times more likely to die in childbirth than women in their 20s, United Nations figures show.

A weak economy and decades of conflict have hit public health provision, so clinics and hospitals, while state-funded, are few and often limited to urban areas. There is also a lack of trained midwives, although this is slowly being addressed.

The geography of Afghanistan and poor infrastructure mean it can be physically difficult to get women from home to the hospitals that do exist. With car ownership still low, women are transported by motorbike, donkey or even wheelbarrow to clinics.

Medical intervention in birth is still regarded with some suspicion. A liking for big families means some women prefer not to undergo procedures like caesarian sections, which can limit them to just three or four babies -- a small family by Afghan standards, where the average is just over five.

Women's families often favor taking them to village elders or traditional birth assistants for help. Among them, even basic healthcare skills can be lacking.

Villagers say traditional birth assistants often don't wash their hands before deliveries, and have been known to sever the umbilical cord with broken glass or the edge of a shoe.

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"I would hope to see more collaboration between industry, including the private sector and universities, to bring innovations in medicine into everyday practice in hospitals.

"This is the only way we can overcome the financial and workload challenges in the NHS

"The problem is the government are wasting tens of millions of pounds on these contracts, money that should be spent on front-line patient care.

"These companies have a record of just walking away when things go wrong and dumping the problems back on the NHS as we saw with the PIP breast implants scandal

Director Mark Georgevic says private sector involvement will be good for patients.

"I'm sure if there are other services that could be easily provided on the High Street they will benefit.

"Patients like it. They don't want necessarily to have to go to a hospital environment.

"Being in the community is very important. We're still an NHS provider, based on clinical need and not necessarily the ability to pay."

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Should HIV test be made mandatory in hospitals?

Yes

-Pose risk to doctors, health care staff and patients

-BUT Need to make sure thesults are kept confidential - do not declare it in public.

-Patients need counselling. treatment to prevent spread of infection.

Early detection, early treatment better now late. Prevent fatal illness in later life. Make it more manageable.

The doctor under the Hippocratic Oath is duty bound to treat a person, but under the same Oath he also pledges to guard his life and art. A doctor too has a Right to Live as fundamental right.

No

-Follow up actions in hospital may be expensive = a lot of material patient come contact with needs to be incinerated.

-Mandatory testing is not cost-effective and is rather counterproductive. Voluntary screening after counseling on identified high risk group is more effective and productive for behavior change and case management. Routine mandatory HIV testing should not be undertaken for the benefit of the health care workers.

- Why not hepitatus B too ? Other tests.

- Could get refused treatment eg surgery? Or doctor unwilling to treat?

should be voluntary.

Why are infections increasing? - use of drugs. Better ways of testing. More people aware of the problem.

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Legal

NHS England alone spends more than 200m a year on the drugs - used to treat Parkinson's disease, epilepsy, depression and insomnia - but Home Office minister Norman Baker has told parliament that "very little" legal trade in the medicines takes place

Another substance identified as a legal high, ODT, is a metabolite of the pain relief tablet Tramadol. NHS England spent 33m on such pills in 2012.

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Wales

It has been a very challenging year for the NHS in Wales.

It is under intense pressure, with services being reorganised, financial constraints acute and many targets being missed throughout the year.

Also trust in the service has been dented on occasions after several concerns emerged about poor care.

Hospitals were overwhelmed. A&E consultants warned of a meltdown. Ambulances queued and hundreds of planned operations were postponed.

As the biggest measles outbreak in recent history subsided around Swansea, cases of Clostridium difficile (C. diff) in north Wales exposed big concerns about standards of care.

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Up to a fifth of the NHS's work does not benefit patients and could cause harm, the health minister has said.

In a speech Mark Drakeford called on the Welsh health service to adopt a policy of "prudent medicine" prioritising resources on proven care.

It could mean surgery like tonsil removal may not be offered if it was considered of little benefit and antibiotics prescriptions could be cut.

It has led to criticism that the policy could see health services rationed.

But one of Wales' most eminent doctors warned the NHS faced financial collapse unless changes were adopted.

It could mean limiting the amount of drugs used for chronic pain management and reducing the number of antibiotics prescribed by GPs.

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Changes to the way GPs are paid will allow them to spend more time with patients, says the health minister.

Mark Drakeford claims a new contract negotiated with doctors' leaders removes a "treadmill of bureaucracy".

The money GP surgeries received until now depended on how they performed against 969 different measures.

Under the new contract 300 measures will be cut, reducing form filling to free more time with patients, says the British Medical Association (BMA).

There will also be new financial incentives to encourage surgeries located close to each other to work together.

The new contract also aims to provide better care for people with early-stage cancer, for those at the end of their lives or the frail or elderly.

The Welsh government says the changes should also help reduce the pressure on hospital A&E departments.

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GPs in England will no longer have to offer appointments lasting at least 10 minutes under changes agreed with the government.

It is one of a number of requirements being removed in the latest round of contract negotiations between the government and doctors' leaders.

NHS England says consultations last on average for around 12 minutes.

It added this change should mean GPs have greater flexibility over how they organise their appointments,

"GPs should have the flexibility to decide how long an appointment needs to be and how many patients they can see in one day, using their clinical judgement, on a case-by-case basis, based on the needs of their patients."

"Some patients just need a quick five minutes with us while other patients need much longer because of the complex nature of their health problems."

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NAMED GP

The million most frail patients in England are to be identified and given a named GP to co-ordinate their care.

The move has been agreed by the British Medical Association and NHS England in talks over next year's GP contract.

Ministers had been pushing for doctors to take greater responsibility for the most vulnerable patients in society to relieve pressure on hospitals.

An analysis by NHS England showed many of the winter pressures on A&E came from frail elderly patients.

Contrary to common perception, it found that summer was the busiest time for A&E units in terms of numbers, but winter was when the difficulties arose because of the rise in the numbers of elderly patients needing care.

A third of emergency admissions are among the over-75s - many of which could be avoided if they received earlier and better care in the community.

"We are bringing back the named GPs for the vulnerable elderly. This means proper family doctors able to focus on giving elderly people the care they need and prevent unnecessary trips to hospital."

In return, doctors have been freed from what they considered some of the most burdensome aspects of the form-filling they had to do for their performance-related pay.

This means requirements such as having to annually ask men with diabetes if they experienced erectile dysfunction at their check-ups will be removed, as will the need to ask those with high blood pressure in detail about their activity levels, with what doctors say were often irrelevant questions.

"People will still face the frustration of phoning the surgery at nine o'clock in the morning, being told there's nothing available for days and then some having to turn to A & E."

Mr Hunt will say the changes are crucial because the failure to care for the elderly round the clock by GPs has led to a crisis in NHS emergency care, with patients going to A&E out of hours, putting a strain on hospital resources.

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GP charges

But if people had to pay to visit their GP, many would go less often for minor illnesses and, instead, use self-help therapies. There is a significant danger that cost would deter the most vulnerable people from attending, especially early on in their illness when medical interventions could be more successful.

Unfortunately, use of the 111 service has directed more patients to the emergency services, at a time when A&E departments are already at breaking

point. GP charges could exacerbate the problem as many patients would go to A&E instead.

work in a practice with a real mix of patients; some affluent, others less so. Those on small budgets find even prescription charges a struggle.

We need more receptionists, nurses and doctors to cope with the rising demand. Year on year there is no real increase in NHS funds, and patients will have to wait longer for GP or hospital appointments, and will be refused many "non-essential" surgical procedures or new drugs.

So the answer lies not in introducing charges, which goes against the founding principles of the NHS, but in more innovative ways of managing resources.

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Older cancer patients should not be "written off" as too old for treatment, a charity has warned.

Macmillan Cancer Support said decisions on care should be made based on a patient's fitness, not their age.

It's wrong to write off older people as too old for treatment," said Macmillan Cancer Support's chief executive Ciaran Devane.

"With a proper assessment and appropriate treatment, our research shows that many older cancer patients can live for a long time and can even be cured.

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Experts say it is not yet known what harm the tobacco-free devices could inflict and that their contents could be damaging young people's health.

An estimated 1.3m people in the UK use e-cigarettes which were designed to help smokers quit.

Ministers also plan to make it illegal for adults to buy traditional cigarettes for anyone under 18.

Continue reading the main story

While smoking rates have fallen to their lowest ever level, experts fear the electronic substitutes could be encouraging teenagers to take up the habit.

Electronic cigarettes mimic the effects of real cigarettes, producing a vapour that is potentially less harmful than cigarette smoke and free of some of its damaging substances, such as tar.

The vapour does often, however, contain nicotine, the addictive substance that provides the "hit" in cigarette smoke.

The jury is still out about just how safe e-cigarettes are, and nobody knows what their long-term impact is on health.

There are plans to licence e-cigarettes as an aid to quitting smoking from 2016, but at present they are not available on the NHS, unlike other smoking cessation aids such as nicotine patches.

Because they are not regulated, the contents of e-cigarettes can vary. Some have been found to contain toxic chemicals which are also found in tobacco, and have been linked to cancer.

There is also only sketchy evidence that e-cigarettes help people to give up smoking.

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Patients have been urged to adopt a pushier attitude to get doctors to prescribe the drugs they need.

Prof David Haslam, chairman of the National Institute of Health and Care Excellence (NICE) told the Daily Telegraph people should see themselves as equal partners with their doctors.

NICE decides which drugs can and cannot by prescribed on the NHS.

Prof David Haslam said patients had a "legal right" to medicines once they had been endorsed.

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