Experts raise alarm over declining effect of last-line antibiotics

Last-line antibiotics against serious pneumonia and bloodstream infections are under real threat in Europe as resistant strains of bacteria emerge, experts are warning.

A new report from the European Centre for Disease Prevention and Control (ECDC) reveals that resistance has continued to increase across Europe in spite of attempts to raise global awareness of the danger to the fundamentally important antibiotic class of drugs. Without them, some infectious diseases could become untreatable and some forms of major surgery would again become perilous.

The report shows that antibiotic resistance continued to increase between 2012 and 2015 across the EU for most of the bacteria and drugs that are being monitored.

Particularly worrying is the increase in resistance to antibiotics considered the last line, where there are no new drugs to treat patients with certain serious infections.

In the Klebsiella bacteria, which is responsible for dangerous pneumonia infections, resistance to the antibiotic class called the carbapenems increased from 6.2% in 2012 to 8.1% in 2015. Combined resistance to carbapenems and polymyxins, such as the antibiotic colistin, was reported in some countries.

Antibiotic use went up in hospitals across the EU, although it went down in community settings in six countries.

Vytenis Andriukaitis, the European commissioner for health and food safety, said: “Antibiotic resistance is one of the most pressing public health issues of our time. If we don’t tackle it, we can go back to a time when even the simplest medical operations were not possible and organ transplants, cancer chemotherapy or intensive care even less so.

“The European commission will launch a new action plan next year so that we can, together with our partners in the EU member states and internationally, continue to ensure that the prevention and control of antibiotic resistance is strengthened within a one-health approach.”

There are concerns about the rise of strains of E coli that are resistant to antibiotics. The bacteria is a frequent cause of infections to the bloodstream and urinary tract, which could become harder to treat.

Widespread publicity about the dangers of the “superbug” MRSA (methicillin-resistant staphylococcus aureus) and efforts to increase hygiene in hospitals brought the levels down between 2012 and 2015, but eight out of 30 countries still have levels of resistance of 25%, making it a public health priority.

Dr Andrea Ammon, the acting director of the ECDC, said there was a lot of variation in the picture around Europe, but generally the proportions of resistant bacteria were higher in the southern and southeastern European countries.

“Multidrug resistance is worrying,” she said. “We also have some reports of combined resistance against so-called last line antibiotics.”

These drugs, which include the carbapenems and colistin, are usually kept in reserve for infections that other drugs can no longer treat.

There have been single reports of resistance to the last-line antibiotic colistin in the Czech Republic, France, Germany, Greece, Italy, Poland and Romania.

“It is not a large problem but it exists. Whenever we have something like this and don’t take good care, it spreads,” she said.

New classes of antibiotic drug are needed, butAmmon said: “We know what can be done and what should be done right now regardless of what new drugs come along. We must try to do the utmost to make the current antibiotics last as long as possible.”

That meant using them prudently and only when necessary and at the right dosage, as well as careful hand hygiene control, especially in hospitals.

Experts raise alarm over declining effect of last-line antibiotics

Alarm at NHS plans for closures and cuts to tackle growing deficit

Opposition politicians and NHS campaigners have expressed alarm after it emerged that health service bosses throughout England are drawing up plans for hospital closures, cutbacks and other radical changes to meet spiralling demand and close gaps in their finances.

An investigation by the Guardian and the campaign group 38 Degrees has revealed that the NHS at local level could be facing a financial shortfall of about £20bn by 2020-21 if no action is taken.

In an attempt to head off the crisis, NHS England has divided the country into 44 “footprint” areas, with each asked to submit a cost-cutting “sustainability and transformation plan” (STP).

The Guardian has seen the detailed plans for north-west London, while 38 Degrees, a crowdfunded campaign group, commissioned the consultancy Incisive Health to collate and analyse proposals from across the rest of England. Also collected are figures showing the projected financial deficits in 2020/21 that will have to be plugged by cost-saving reorganisations.

Projected deficits

The shadow health secretary, Diane Abbott, called the report “a damning indictment of this government’s underfunding and mismanagement of the NHS”.

She said: “It reinforces all the concerns highlighted by the recent NHS Providers report and the King’s Fund survey of trusts’ NHS finance directors. Emergency closures of vital units across the country testify to a real crisis.”

There are proposals in the Leicester, Leicestershire and Rutland region to reduce the number of acute hospitals from three to two. In the Black Country region of the West Midlands there is a proposed reduction of the number of acute units from five to four and closure of one of two district general hospitals.

More general plans include reducing the number of face-to-face meetings between doctors and patients in north-west London through the use of more “virtual consultations”, and a proposal to give patients coaching to help them manage their own conditions.

The Liberal Democrat health spokesman, Norman Lamb, said STPs made some sense in principle. He added: “However, it would be scandalous if the government simply hoped to use these plans as an excuse to cut services and starve the NHS of the funding it desperately needs.

“While it is important that the NHS becomes more efficient and sustainable for future generations, redesign of care models will only get us so far – and no experts believe the Conservative doctrine that an extra £8bn funding by 2020 will be anywhere near enough.”

However, Stephen Dalton, chief executive of the NHS Confederation, denied that the changes meant the NHS would “indiscriminately close services”.

He told BBC Radio 4’s Today programme that there had long been a reluctance by political leaders to address the NHS’s cumbersome organisation, and that local discussions were better than having a single plan for the whole country.

But Chris Hopson, chief executive of NHS Providers, which represents frontline NHS leaders, said a “glut” of hospital services could shut down.

He said: “Our members tell us that they are struggling to keep services open because of workforce shortages and they therefore face really difficult decisions about do you close down something either permanently or temporarily because you cannot staff it safely?”

NHS bosses were asking managers to identify “marginal acute services where you are trying to prop up what is really an unsustainable rota”, he said, adding: “So we would expect to see a bit of a glut of those kinds of decisions going forward because our guys have been specifically asked to identify them.”

Some of the proposals are likely to be given the go-ahead as soon as October, though consultation would then have to take place locally.

Last year’s Conservative manifesto pledged an extra £8bn a year for the NHS by the end of this parliament, as demanded by the NHS chief executive, Simon Stevens, in his 2014 “five-year forward view”. But Stevens made clear that was the minimum money needed, and radical reforms to the way healthcare was delivered would also be necessary to ensure the NHS stayed within its budgets.

A spokeswoman for NHS England said the health service needed to make major efficiencies. She said:“We need an NHS ready for the future, with no one falling between the cracks. To do this, local service leaders in every part of England are working together for the first time on shared plans to transform health and care in the communities they serve, and to agree how to spend increasing investment as the NHS expands over the next few years.

“It is hardly a secret that the NHS is looking to make major efficiencies and the best way of doing so is for local doctors, hospitals and councils to work together to decide the way forward in consultation with local communities.”

North-west London’s draft plan highlights risks to the implementation of the programme, including a failure to shift enough acute care out of hospitals, a possible collapse of the private care home market, and a failure to get people to take responsibility for their own health.

Two local authorities in north-west London, Hammersmith & Fulham and Ealing councils, have refused to sign up to the draft plans because of concerns about hospital closures. Officials claim that pressure was exerted on them to sign off an executive summary of the draft plans quickly without seeing the full document. NHS officials have denied this.

A spokeswoman for NHS North West London insisted the policies were based on evidence, saying: “There is a whole body of clinical evidence, research and best practice that clinicians are using to deliver better clinical care for patients.”

Alarm at NHS plans for closures and cuts to tackle growing deficit

NHS sounds compensation alarm right after £120,000 attorney bill for £5,000 claim

A third of the £1.1bn paid out by the NHS in compensation final year was handed to attorneys, with one company submitting a £121,700 bill following a £5,000 declare.

The value to the taxpayer is expected to rise to £1.4bn next year, with the NHS conceding that it faced an “increasingly hard task” in managing the degree of payouts.

In its annual report, the NHS Litigation Authority (NHS LA) added that the behaviour of numerous law companies was leading to concern, with massive bills getting submitted and a large quantity of unjustified claims becoming created.

Ian Dilks, the chair of the NHS LA, said: “The fees of litigation are placing a burden on NHS finances of a magnitude that was never ever imagined when the NHS LA was established.”

Associated: Clampdown on lawyers overcharging NHS in clinical negligence situations

The NHS LA also raised worries about the coalition government’s overhaul of legal help, saying it had “influenced the behaviour of some claimant lawyers” and led to growing legal costs in numerous situations.

The authority highlighted one case the place an NHS trust agreed to pay out £5,000 for the failure to diagnose a patient’s tumour on the kidney. Even so, right after the provide of £5,000 was accepted, the patient’s solicitors claimed expenses of £121,700.

More evaluation of the bill revealed that the company was claiming a price of £400 an hour, despite the fact that a important sum of the operate was carried out by unqualified staff. The company then claimed a one hundred% achievement charge on leading of this, raising the hourly charge to £800.

The NHS ultimately had the declare struck out.

In yet another situation, the NHS agreed to spend £2,000 to settle a declare. The claimant’s solicitors then presented a bill for £53,529.60 – even though the ultimate amount paid by the NHS was reduced.

The report explained that it was “impossible to justify” the increasing quantity of situations exactly where substantially much more funds was billed by claimant solicitors for legal expenses than was paid in compensation.

Due to law firms’ actions, the legal charges of smaller claims have risen substantially. Where sufferers get damages of up to £100,000, the typical claimant’s legal expenses are now much more than 50% of the total payment.

By tough charges, expenses have been reduced by an average of 33%. The Department of Health is currently thinking about programs to cap the fees charged by attorneys in clinical negligence claims.

Connected: Legal support overhaul – what the adjustments will indicate for you

After the introduction of the legal support legislation, the NHS LA anticipated to see a fall in the quantity of circumstances. Alternatively, it discovered that solicitors had been finding other ways to enhance costs.

“We are seeing an escalating variety of plainly excessive and disproportionate costs expenses, the presentation of which coincides with the banning of success charges and the reduction of the recoverability of the full value of following-the-occasion (ATE) insurance coverage against the defendant,” mentioned the report.

The NHS LA additional that it continued to obtain a significant amount of unjustified claims, generating no payments at all for far more than 46% of clinical claims.

The NHS LA’s chief executive, Helen Vernon, warned that it was turning out to be more difficult to make sure that patients acquired fair compensation even though reducing the inappropriate claims produced on the NHS.

“The emergence of non-expert attorneys coupled with extreme claims for legal charges by some firms has essential a modify in approach,” she mentioned in the report.

In order to end unjustified claims, the NHS LA is tough far more claims for expenses and contesting far more situations in court. The quantity of instances in which no compensation is paid has nearly doubled in five years, from two,533 instances to 4,909.

In 2014-15, the authority mentioned that it had saved much more than £1.2bn for the NHS by rejecting claims that had no merit.

NHS sounds compensation alarm right after £120,000 attorney bill for £5,000 claim

Prime 10 substantial achievers who boast of beating the alarm clock

one) Angela Ahrendts, the former Burberry CEO and new retail chief at Apple, says on most days she gets up – without an alarm clock – at four.35am, insisting she suffers from headaches if she sleeps for far more than 6 hours. Before dawn, she says, is her “inspirational time, my time to locate peace, to view the sun rise”.

three) The US billionaire Donald Trump is another who eschews the pleasure of a good lie-in. “How does someone which is sleeping 12 and 14 hrs a day compete with somebody that’s sleeping three or 4?” he asked.

four) Gordon Brown is one particular of numerous politicians notorious for burning the midnight oil. It has been advised that throughout his time as Prime Minister he went to bed at 3am only to rise two hrs later. His aides have denied this, though one particular former Downing Street aide did declare Brown would have been a greater Prime Minister if he had permitted himself a decent night’s rest.

five) Heather Rabbatts, who sits on the board of the Football Association, says she is typically out of bed by 6am, but wakes earlier. “I have constantly been an early riser. I adore that sense of quiet first point in the morning as the world (well, those of us on GMT) wakes up.”

6) Marrissa Mayer, the CEO of Yahoo, has talked extensively about her need for just 4 to 6 hours of rest a evening – catching up by taking week-lengthy holidays each 4 months. “I don’t think it is true that you burn up out sooner or later if you perform 80 hours a week, as long as you hold the factor that’s crucial to you sacred.”

seven) Baroness Thatcher was a tireless employee and 1 of the most notorious non-sleepers in British politics, claiming “sleep is for wimps”. In accordance to former press secretary Sir Bernard Ingham: “She slept 4 hours a night on weekdays.”

8) Duncan Painter, the former EMAP CEO, was recorded in an inner video in 2012 praising the positive aspects of waking up at four.30am. “In every other enterprise I’ve run, at half previous four in the morning I would go down to my office, fire up my laptop and search at the benefits. And then I’d figure out who I’ll be phoning at half previous 6 to inspire on their income a bit. Then I get on my physical exercise machine and exercise for an hour.”

9) Winston Churchill aimed to pack 1-and-a-half day’s perform into each and every 24 hours. In purchase to maintain going by means of the night, at 5pm each and every day he poured himself a whisky and soda and appreciated a two hour nap.

ten) Tim Armstrong, the CEO of AOL, says he normally get up at five or 5:15am. “Historically, I would commence sending emails when I acquired up. But not absolutely everyone is on my time schedule, so I have experimented with to wait till 7am.”

Prime 10 substantial achievers who boast of beating the alarm clock

Top ten substantial achievers who boast of beating the alarm clock

1) Angela Ahrendts, the former Burberry CEO and new retail chief at Apple, says on most days she gets up – without an alarm clock – at four.35am, insisting she suffers from headaches if she sleeps for much more than 6 hrs. Before dawn, she says, is her “inspirational time, my time to find peace, to view the sun rise”.

3) The US billionaire Donald Trump is one more who eschews the pleasure of a respectable lie-in. “How does somebody that is sleeping twelve and 14 hours a day compete with someone that’s sleeping three or 4?” he asked.

four) Gordon Brown is 1 of several politicians notorious for burning the midnight oil. It has been recommended that in the course of his time as Prime Minister he went to bed at 3am only to rise two hrs later on. His aides have denied this, although 1 former Downing Street aide did declare Brown would have been a much better Prime Minister if he had allowed himself a decent night’s sleep.

five) Heather Rabbatts, who sits on the board of the Football Association, says she is usually out of bed by 6am, but wakes earlier. “I’ve usually been an early riser. I really like that sense of quiet first point in the morning as the planet (well, those of us on GMT) wakes up.”

six) Marrissa Mayer, the CEO of Yahoo, has talked extensively about her need for just 4 to 6 hrs of sleep a night – catching up by taking week-lengthy holidays every 4 months. “I never feel it really is real that you burn out sooner or later if you function 80 hrs a week, as prolonged as you preserve the thing that’s essential to you sacred.”

seven) Baroness Thatcher was a tireless employee and one of the most notorious non-sleepers in British politics, claiming “sleep is for wimps”. According to former press secretary Sir Bernard Ingham: “She slept 4 hours a night on weekdays.”

eight) Duncan Painter, the former EMAP CEO, was recorded in an internal video in 2012 praising the positive aspects of waking up at four.30am. “In each and every other organization I’ve run, at half past four in the morning I would go down to my workplace, fire up my personal computer and look at the results. And then I’d figure out who I’ll be phoning at half previous 6 to encourage on their product sales a bit. Then I get on my exercising machine and physical exercise for an hour.”

9) Winston Churchill aimed to pack one-and-a-half day’s work into every single 24 hours. In purchase to hold going by way of the evening, at 5pm each day he poured himself a whisky and soda and enjoyed a two hour nap.

10) Tim Armstrong, the CEO of AOL, says he generally get up at five or 5:15am. “Historically, I would begin sending emails when I received up. But not absolutely everyone is on my time schedule, so I have tried to wait until finally 7am.”

Top ten substantial achievers who boast of beating the alarm clock

Age United kingdom sounds alarm more than cuts to care for older people

Age Uk laments the ‘distressing human cost’ of loneliness, isolation and upset. Photograph: Jeremy Sutton-Hibbert/Alamy

About 168,000 older people have stopped acquiring help with vital duties this kind of as eating, washing and obtaining dressed as a outcome of deep and continuing cuts to social care below the coalition government, a report from Age Uk says.

Far more and much more vulnerable pensioners are getting denied assistance to help them proceed living at home, which also contain meals-on-wheels and visits to daycare centres, the charity says.

It laments the “distressing human value” concerned, including loneliness, isolation and upset for individuals impacted and a higher caring burden for their households.

The dwindling availability of social care has been going on since 2005-06, when Labour was in electrical power, but has increased with deep coalition cuts to the budgets of England’s 152 nearby councils, Age Uk discovered in its Care in Crisis 2014 report, which is primarily based on official figures.

In 2010-eleven, a total of one,064,475 people aged 65 or over obtained some form of social care solutions in England. That quantity fell by 73,000 the following yr, and yet another 95,000 in 2012-13 to a complete of 896,000 – which is 168,000 (15.eight%) fewer than in 2010-11, a single in 6 of all these who were aided in that year. A complete of one.231 million folks received help from social care companies in 2005-06 – so that number has fallen by 335,000 in 7 many years.

The deterioration in social care has come regardless of the fact that the variety of pensioners rose by more than a million in between 2005-06 and 2012-13 and quantity of in excess of-85s by thirty% throughout that time.

“The figures we have uncovered in this report [going back to 2005-06] are catastrophic”, stated Caroline Abrahams, Age UK’s charity director. “Older folks who want help and who are now not receiving it are being positioned at considerable threat and families who care for loved ones are going through intolerable strain.”

NHS leaders complain that some of the increasing overcrowding in emergency departments and a important proportion of bedblocking are due to the inadequacy of local social care provision, simply because people in hospital are unable to reside semi-independently at home or be discharged there, regardless of getting medically fit to go.

“If older people do not receive the care they need and as a consequence end up in A&ampE units and hospital wards, we have simply shifted folks around the method at excellent economic price and developed distress and disruption for older men and women in the method. This make absolutely no moral or economic sense,” explained Abrahams.

Liz Kendall, shadow minister for care, and older individuals said: “Age UK’s devastating report demonstrates the accurate scale of the care crisis unfolding under this government. The failure to supply respectable care and assistance for elderly men and women is simply unacceptable in the 21st century in one particular of the richest nations in the planet.”

A lot of councils have pared back their provision of social care above current many years by tightening their eligibility criteria. Only three of the 152 councils nonetheless help individuals with “low” requirements and only 16 supply providers to people with “reasonable” requirements. The vast bulk – 130 councils – only give help for in excess of-65s with “substantial” or “crucial” wants, although 3 only do so to individuals in the latter class.

The Regional Government Association, which represents councils, explained: “Substantial cuts to council funding and a quickly developing ageing population have taken their toll on the system, but satisfaction charges for people obtaining care are nevertheless all around 90%. Except if social care funding is place on a sustainable footing, social care solutions will stay substantially underfunded and the great intentions of the fund and wider care and help reforms will endure as a consequence.”

The government programs to tackle the variability of social care via the care bill, letting the health secretary set national eligibility criteria for the very first time. These criteria are very likely to consequence in assist only for people with “substantial” or “reasonable” needs.

Norman Lamb, the care and support minister, said: “Social care is a priority for this government which is why we have currently allocated an added £1.1bn to councils from the NHS to protect services. But both our overall health and social care services require to operate in a different way to reply to the requirements of our ageing population – we require to concentrate on trying to keep individuals properly and living independently for as long as possible.”

The new, £3.8bn-a-yr, NHS-funded Better Care Fund, which commences in April 2015, would assist by funding joint local council and NHS care initiatives driving the integration of health and social care and help hold vulnerable individuals safely at residence, Lamb mentioned.

Age United kingdom sounds alarm more than cuts to care for older people