Desperate hospitals beg doctors to take on extra shifts – at £95 an hour

Desperate hospitals are so short of doctors they are pleading with them to take on extra shifts, with some offering up to £95 an hour to cover gaps in medical rotas to maintain patient safety.

Hospitals are so chronically understaffed they have been hiking pay rates in recent weeks and bombarding doctors with urgent emails and text messages in a bid to ensure standards of care do not suffer.

On Tuesday, Peterborough City hospital raised the pay available for working overnight that night in its “extremely busy” A&E to £95 an hour for a 10-hour shift to try to attract recruits.

“Exceptionally, we approved a maximum hourly incentivised rate for our senior trust doctors. This will ensure safe medical staffing levels and enable the department to continue to give high quality care to all our patients,” said Neil Doverty, the North West Anglia NHS foundation trust’s chief operating officer.

Hospitals often scramble to make 11^th hour arrangements to fill rotas. Last Monday the Dudley Group NHS foundation trust in the West Midlands was forced to increase the fees for senior house officers in its A&E from £60 an hour to £70 an hour for shifts lasting 10 and 12.5 hours.

The Guardian has seen messages sent by dozens of hospitals across England and Wales to doctors which paint a picture of near panic as many of them struggle, often at the last minute, to have enough medics on duty.

Many hospitals have been struggling to find enough doctors to work over the Easter weekend, with some trying more unorthodox approaches to get staff in. West Middlesex hospital in London, which is facing problems staffing its rotas despite having a well regarded bank of staff and paying high locum rates, this week offered any doctor working over the holiday weekend an Easter egg as an incentive.

Faced with an acute shortage of A&E doctors last month, the John Radcliffe hospital in Oxford sent scores of doctors an email entitled “help!” which said: “I am sorry to be sending so many messages but I am in real need here. I am practically begging at this point. I really need some help.

“Can ANYONE help out for any length of the shifts needed this weekend? It really is a matter of keeping the department safe.” The email was sent on 16 March by Brigid Greaney, the medical staffing administrator for the hospital’s emergency department.

This week Lewisham hospital in London, in its search for doctors to staff its general medicine department, sent an email that said: “We are struggling with the cover for on-call shifts this week. Please let me know if you can help.” It offered to cover doctors’ day shifts if they agreed to work nightshifts.

Doctors’ leaders say the problem is getting worse, blaming NHS workforce planning and the pressure of coping with the growing number of patients needing care.

“Hospitals should not be reduced to begging, but what other option do they have when the NHS is so chronically under-resourced? This should set alarm bells ringing right through the NHS,” said Dr Liam Brennan, the president of the Royal College of Anaesthetists.

Dr Mark Holland, the president of the Society for Acute Medicine, said: “Rota gaps are common – very common. I would be surprised if any hospital anywhere has a full complement of staff. There are some trusts under huge stress and where putting a workforce in place is very challenging, I would be surprised if there wasn’t a sense of desperation to get doctors on the shopfloor.”

Hospitals are sometimes being forced to pay well over the normal rates for hard-to-fill shifts because “there is a pan-NHS workforce crisis. This isn’t about greedy doctors,” Holland said.

The emails and text messages show that almost every branch of medicine is experiencing acute shortages of doctors in at least some hospitals. They range from surgery to cardiac care, anaesthetics to A&E and general medicine to intensive care. For example, Manchester Children’s hospital last Tuesday solicited volunteers for 19 “long days” and 26 nightshifts this month in its paediatric intensive care unit “to be paid at the enhanced rate of £60 per hour”.

Some hospitals facing acute shortages are advertising scores of shifts at a time. Milton Keynes hospital this week notified doctors of 52 shifts over 20 days this month in its A&E. Worcestershire Royal hospital in Worcester has so far only filled five of the 69 shifts it is seeking to fill between now and early August.

A doctor at Chesterfield Royal hospital, who asked to remain anonymous, said: “The rota gaps problem here is insurmountable and, frankly, rather dangerous. The quality of my life has been greatly impaired by the busiest winter we had on record followed by no real drive by the trust to recruit more doctors to anticipate this deluge of patients. The biggest culprit is A&E which is almost entirely staffed by locums, most of them being long-term [locums], followed by the emergency medical unit, which is very short on nights and weekends.”

Despite hospitals’ best efforts some shifts are still going unfilled, which puts extra pressure on other staff. A trainee surgeon at a major London teaching hospital said: “I’ve had occasions where instead of having two on-call senior house officers to hand over to, I’ve had to cover both shifts, after already working 12 hours.

“Working locum shifts in short-staffed departments often feels like juggling with your medical licence as your clinical decisions are affected by time pressures and bed shortages more than your assessment of the patient in front of you.”

Hospital bosses warned that endemic understaffing is threatening patient safety.

“Along with high levels of bed occupancy, gaps in rotas can mean patient safety is put at risk. Fewer medical staff on shifts create intolerable workload pressures for all staff. This is bad for morale which has a further impact on the quality of care,” said Saffron Cordery, the director of policy and strategy at NHS Providers, which represents hospitals.

“Workforce pressures are fast becoming the number one concern for many NHS trusts, including hospitals, mental health, community and ambulance services. These are particularly difficult over holiday periods. All types of trust are affected but we know that this can be very challenging in rural areas and in specific specialties. Patient safety is always the top priority and every trust wants to guarantee safe care. The steps described here are an indication of just how seriously they take this,” Cordery added.

A Department of Health spokesperson said: “Staffing is a priority – that’s why we have invested in the frontline and there are over 31,400 more professionally qualified clinical staff including over 11,200 more doctors, and over 12,100 more nurses on our wards since May 2010.

“With over 52,000 nurses in training we will continue to make sure we have the staff available to give patients high-quality care as part of a safer NHS seven days a week.”

Desperate hospitals beg doctors to take on extra shifts – at £95 an hour

Womb cancer risk grows with extra waist weight, study suggests

Women who have a higher waist to hip ratio could have an increased risk of womb cancer, a study suggests.

Researchers writing in the British Medical Journal (BMJ) found that for every increase of 0.1 units in the ratio between waist and hip, the risk of developing the disease increased by 21%.

Experts from the World Cancer Research Fund (WCRF), which part-funded the study, said the results showed a strong relationship between cancer and carrying extra weight around the waist.

The waist to hip ratio is worked out by dividing waist circumference by hip measurement. For example, a person with a 28-inch (71cm) waist and 40-inch (102cm) hips would have a ratio of 0.7.

A woman with a ratio of 0.7 which then increased to 0.8 would have a 21% greater risk of developing womb cancer, the study suggests. For the person in the example above, this would be the equivalent of an increase from a 28-inch (71cm) waist to a 32-inch (81cm) waist, with the hip measurement remaining the same. Another 0.1 increase would raise that risk even further.

A ratio above 0.85 for women or 0.90 for men is a sign of obesity.

The WCRF estimates that about 25,000 cancer cases could be prevented every year in the UK if people were a healthy weight.

Prof Konstantinos Tsilidis, from Imperial College London, said: “These results demonstrate how important it is for women to make sure they maintain a healthy weight in order to reduce their cancer risk.”

Dr Panagiota Mitrou, director of research funding at the WCRF, said: “We know that extra weight around the waist increases the risk of a range of health conditions, such as diabetes, but this important study is helping us shine a light on how body fat around the waist could affect cancer risk.

“It is incredibly important that people are aware of the dangers of excess body fat, particularly around their waist. After not smoking, maintaining a healthy weight is the best thing people can do to help prevent cancer.”

The study also found associations between waist to hip ratio and bowel and pancreatic cancer, although these were not as strong.

Womb cancer risk grows with extra waist weight, study suggests

NHS forced to provide 4,500 extra beds a day

Hospitals had to provide 4,500 extra beds a day at the height of the pressures this winter to avoid “a full-blown crisis”, NHS bosses have revealed.

That is the equivalent of creating more than eight extra hospitals to cope with unprecedented demand in recent months when large numbers of patients were stuck on trolleys and in the back of ambulances outside A&E units.

The NHS in England came under such intense pressure that patients found hospitals “distressing and potentially dangerous”, according to a report from NHS Providers.

The organisation, which represents the majority of NHS trusts in England, claims hospitals are close to “breaking point” as they become overcrowded all year round.

Its analysis of NHS England data on how hospitals performed during December, January and February shows they had to add sometimes dozens of “escalation” beds at short notice so they could admit every patient who needed to stay in. Some used rehabilitation gyms and other areas not usually used for patients.

Chris Hopson, the chief executive of NHS Providers, said: “This has been the busiest winter ever for the NHS. Be in no doubt, these figures show a system running hot and – in particular times and places – overwhelmed by the demands placed on it, risking patient safety.”

In the NHS’s busiest week this winter, between 30 January and 5 February, hospitals opened up a total of 32,558 additional beds. They created almost as many overflow beds in the first half of February, when cold weather added to existing pressures.

Patients had to be diverted from one hospital A&E unit to another 476 times over the winter – almost double the 266 of last winter, NHS Providers says.

“As pressure continues to grow, the likelihood of more trusts reaching and moving beyond breaking point increases,” said Deborah Gulliver, a senior research analyst with NHS Providers. “For patients these difficulties are distressing and potentially dangerous. They are also demotivating and demoralising for the clinical workforce. It is thanks to the extraordinary efforts of frontline staff that we have made it through this winter period without a full-blown crisis. However, trusts are telling us that it was a close-run thing.”

The heavy demand on the NHS all year round was leading to worryingly high levels of bed occupancy, she added. Bed occupancy reached 96% this winter, above the 85% considered safe.

“So the resilience of trusts to deal with unexpected spikes in pressure, such as flu outbreaks and norovirus, is compromised. We cannot afford to ride our luck indefinitely,” Gulliver said.

Jonathan Ashworth, the shadow health secretary, said: “This stark warning from NHS Providers makes clear this has been an NHS winter like never before.

“Theresa May’s refusal to take seriously the twin threat of NHS underfunding and rising demand has pushed services to the brink. The direct result of the prime minister’s stubbornness has been a collapse in standards of patient care, with the worst performance on record for A&E and most hospitals dangerously overcrowded.”

NHS Providers is urging Jeremy Hunt, the health secretary, to order a review of how the NHS coped this winter in order to learn lessons and prevent hospitals from coming so close to not coping in future. The current situation is “not sustainable” for the NHS or patients, it argues.

Meanwhile, a poll of 96 MPs of all parties by the Royal College of Emergency Medicine, which represents A&E doctors, has found that only 33% of them believe A&E departments have enough money and staff to provide safe care. More than six in 10 MPs believe A&E departments need more money, said the college.

NHS forced to provide 4,500 extra beds a day

BMA calls for extra £10bn a year for NHS in Hammond"s budget

The British Medical Association has urged the government to increase health spending by £10bn a year to bring funding into line with other leading European economies and shore up the NHS.

The union for doctors said increasing health spending to a proportion of GDP that matched that of the 10 leading economies across Europe could pay for at least 35,000 extra beds a day and several thousand more GPs.

In a letter to the chancellor, Philip Hammond, before Wednesday’s budget, the BMA council chair, Dr Mark Porter, wrote: “Our members report that services are truly at breaking point, with unprecedented rising patient demand met only with financial restraint and directives for the NHS and social care to make huge, unachievable savings through sustainability and transformation plans (STPs) across England.

“We are not calling for more than other comparable nations, we are simply calling for you to match the average spending of other leading European economies. Based on our analysis of the figures available, this would, in 2015, have equated to an increase of £10.3bn for NHS funding; an increase which is desperately needed.”

The BMA’s call for substantial extra investment comes at a time when the NHS is feeling the strain amid rising demand, staff shortages and pressures on its finances. The service is supposed to be seeking to achieve £22bn in efficiency savings by 2020, which NHS England chief Simon Stevens said would still leave the service with an £8bn funding gap.

However, the health service in England is on course to overspend by £1bn by the end of the current financial year after running up a deficit of £2.45bn in the previous 12 months.

The BMA has been a vocal critic of the STPs, claiming they are unworkable and will not secure the sustainability of the NHS as they are intended to do but threaten it by reducing services on a drastic scale.

The reference in the letter to Hammond to the number of beds that could be funded is particularly emotive as several thousand beds in acute district general hospitals face being axed under STPs submitted by 44 areas.

Additionally, lost bed days due to patients being unable to be discharged because of constraints on community or social care, have hit record levels in recent months.

They were also partially blamed for a deterioration in NHS finances in England in the last three months of last year as providers lost income from elective operations because of a lack of capacity.

The BMA’s analysis suggests that the 10 leading economies across Europe spend an average of 10.4% of their GDP on health in comparison with the UK’s 9.8%, using the current definition from the Organisation for Economic Co-operation and Development. According to this, the UK’s spending on health in 2015 should have been £10.3bn higher than it was.

Porter said if the government matched its peer group it could recruit an extra 10,000 GPs, along with other healthcare professionals, and improve surgeries so that practices could host more staff and deliver additional appointments to patients.

It could also reverse cuts already made to the public health budget rather than introduce further reductions of almost 4% up until 2020, he added.

“The crisis currently facing the NHS and social care is well known and becoming increasingly severe – the government cannot remain a bystander any longer,” Porter wrote.

“An entire system under such strain is not due to frontline financial mismanagement, or individual chief executives’ poor decision making, it is due to the conscious underinvestment in our health service.”

A Department of Health spokeswoman said: “We are committed to the NHS, which is why total health spending is above the OECD average as a percentage of GDP, and why we are investing £10bn in the NHS’s own plan for the future, including almost £4bn this year.

“What’s more, the NHS was ranked the best and most efficient healthcare system in the world by the independent Commonwealth Fund, showing that we make every bit of spending count.”

BMA calls for extra £10bn a year for NHS in Hammond"s budget

NHS will need £88bn extra by 2067, says OBR forecast

The NHS budget will need to increase by £88bn over the next 50 years, meaning governments could have to raise taxes or cut spending in other areas to fund it, the Office for Budget Responsibility (OBR) has said.

The soaring costs threaten to render public finances generally “unsustainable”, according to the OBR’s latest fiscal sustainability report. It says the government could find it hard to deliver on its pledge to balance the budget during the next parliament.

The NHS’s budget will need to increase from £140bn in 2020-21 to about £228bn by 2066-67 in order to keep pace with the rising demand for healthcare, according to the OBR’s projections.

It says the budget will need to rise by an average of 2% each year over that period – much more than the 1% annual rises the NHS has had since the coalition took office in 2010, but barely half the 3.8% annual real-term rises it has seen since 1978-79.

The rising costs of providing healthcare in coming decades could force ministers to increase the proportion of GDP going into health from the 6.9% expected in 2020-21 to 12.6% by 2066-67. That 12.6% would equate to about £228bn in today’s prices, the OBR confirmed.

Norman Lamb, the Liberal Democrats’ health spokesman, said: “This analysis confirms that spending on the NHS and on care services will either have to rise significantly or the system will collapse. We will see an end to the NHS as we know it.

“Current levels of care cannot be sustained with the fall in real-terms spending per person which is currently envisaged.”

The NHS England chief executive, Simon Stevens, has said that under the government’s current spending plans, per capita health funding will fall in real terms in 2018-19, the year the NHS will turn 70.

Last September the OBR set out how the growing number of older people in coming decades would oblige governments to spend more on healthcare, though it did not say how much more.

Its latest figures detail how much will be needed in light of three factors it did not analyse then: the emergence of new technology that will boost patient care, the development of new drugs and a rise in the number of people with chronic long-term conditions, such as diabetes and cancer.

Prof John Appleby, the chief economist at the Nuffield Trust health thinktank, said that although the OBR’s projected £88bn rise sounded huge, “we shouldn’t get too carried away. In reality, the increase in health spending it projects would be very gradual – at today’s GDP, an increase of less than 2% of the NHS budget each year.

“These are projections, not forecasts. We will have many opportunities to choose a path of more controlled spending or somewhat higher taxation over the coming decades,” he added.

Richard Murray, director of policy at the King’s Fund, said: “The OBR’s acceptance of the need for a larger long-term increase in the proportion of GDP we spend on health is a welcome dose of realism, but also highlights the current pressures on the NHS.

“Given that plans for the rest of this parliament will see health spending fall as a proportion of GDP, it is another reminder that it is unrealistic to expect the NHS to continue to operate within spending plans at the same time as continuing to offer the same level of service.”

A government spokesman said it had made “significant progress in repairing the public finances – reducing the deficit from 10% of GDP to 4% over the last six years. At the same time, we are committed to the sustainable funding of our health service which is why we are giving the NHS an extra £10bn per year by 2020/21, including almost including almost £4bn this year to transform services and improve standards of care for patients.”

NHS will need £88bn extra by 2067, says OBR forecast

People may be ready to pay extra penny on tax for NHS, Tim Farron says

People may be ready to pay an extra penny on income tax to fund the NHS and social care, Tim Farron, the leader of the Liberal Democrats, has said.

Farron said voters had reached the stage of not believing the NHS’s problems could be solved through efficiency savings and might be willing to pay more if they were convinced it would go to the health service.

He said he did not want to pre-empt the conclusions of an independent panel formed by the Lib Dems, which will look at possible taxes to help the NHS.

But asked if he believed people would be happy to pay an extra penny on income tax to improve health services, Farron said: “Yes, potentially, if people see this as the way of solving a problem that is increasingly apparent to people.

“Health and social care personal crises in families are growing by the week. If we can convince people this is the way to meet those needs in a tangible way, then yes, I think so. I think we’ve gone past the time where we can pull the wool over people’s eyes where somehow it can be sorted out by efficiency; it can’t.”

Norman Lamb, the party’s health spokesman, said: “The expert panel I’ve set up is looking at a hypothecated health and care tax and whether we need to increase tax. We’re prepared to do both if it makes sense to do both.

“One option is to base it on national insurance – to reform national insurance to make it more progressive and fair intergenerationally. Another is to base it on income tax and separate out the money you need on income tax.”

The Lib Dems became the first major political party to examine a dedicated new tax to help rescue the NHS from its deep financial problems at their party conference this autumn.

Lamb told delegates the party would examine the wisdom and practicalities of introducing a ringfenced tax that would involve a 1p increase in either income tax or national insurance.

It has recruited a panel of senior doctors and NHS experts to advise it on how a “dedicated NHS and care tax” would help ease the health service’s decade-long financial squeeze. It includes David Nicholson, the former chief executive of NHS England.

Speaking after a visit to St Helier hospital in Sutton, south London, Farron said it was an example of a hospital that was working effectively with social care providers to reduce elderly and vulnerable people staying too long in medical care.

But he said more money was needed to solve the problems in the NHS throughout the whole country.

“They really are being efficient but there is no way given the crisis in social care that really exists that you can provide the care you would do if it was properly funded,” he said. “We should be proud of the NHS and the staff in it but we don’t have comparable funding now to many other countries we would consider to be on a level or even behind us.”

They also highlighted research by ITV News in October suggesting 70% of people would happily pay an extra 1p in every pound if that money was guaranteed to go to the NHS.

Almost half of those surveyed said that they would pay an extra 2p in the pound to bolster NHS funding, according to a survey of 1,000 people conducted by Survation.

People may be ready to pay extra penny on tax for NHS, Tim Farron says

Promised £8bn extra for NHS is not enough, says hospitals boss

Theresa May will have to rip up the government’s financial plans for the NHS and commit more than the promised £8bn extra by 2020, a hospitals boss has said.

Chris Hopson, the chief executive of NHS Providers, said ministers must come up with a new plan to fix the health service’s crumbling finances or risk it becoming unable to function properly.

In a submission to the Treasury before next week’s autumn statement, NHS Providers, which represents 96% of NHS trusts in England, says a rethink is necessary because the calculations underlying the government’s £8bn pledge are flawed.

It says demand for care is rising faster than envisaged in the blueprint drawn up by NHS bosses in 2014, the Five-Year Forward View, and social care has deteriorated.

Hopson said: “Some of the key assumptions in the Five-Year Forward View, on which the current financial and NHS delivery plans for this parliament are based, have turned out to be wrong. There is now a clear and widening gap between what is being asked of the NHS and the funding available to deliver it.

“The NHS simply cannot do all that it is currently doing and is being asked to do in future on these funding levels.”

Andrew Lansley, the health secretary from 2010 to 2012 in the coalition government, recently said the NHS needed a “Brexit bonus” of £5bn on top of the £8bn already pledged, given the widespread public demand for higher NHS funding revealed by the EU referendum.

NHS Providers does not specify how much more it wants invested. But Hopson said more than £8bn was justified because “demand for care is a lot higher, social care is in a much worse state, general practice is turning out to be more unstable, and the starting point for the deficit among hospital, mental health, community and ambulance trusts has turned out to be much larger.”

He said the overall health budget would go up by only £4.5bn by 2020, not the £8bn ministers pledged last year, because money was being taken from key areas such as public health in order to give the NHS its promised increase. Independent experts agree £4.5bn is the true increase that healthcare will get.

The NHS’s inability to deliver the £22bn of savings it had promised to make by 2020 – a target that had always been “too ambitious” – further underlined the need for more money to be found before the end of this parliament, said Hopson.

May has been under pressure recently over her repeated claims that the government is giving the NHS £10bn more, and more than the NHS England chief executive, Simon Stevens, asked for in 2014. Sarah Wollaston, the Conservative chair of the Commons health select committee, and other members of the committee wrote to the chancellor Philip Hammond to say the claims were untrue. Labour has asked the UK Statistics Authority to rule on whether the £10bn claim is justified.

Jeremy Hunt, the health secretary, has subtly distanced himself from the £10bn figure and said the NHS will need a lot more money after 2020, at the end of its unprecedented decade-long budget squeeze.

Ministers have already told Stevens that the NHS will not receive a funding boost in the autumn statement. But NHS and local council leaders hope the chancellor may find some extra money to prop up the ailing social care system.

“NHS funding increases from next year onwards are not enough to maintain standards of care, meet rising demand from patients and deliver essential changes to services,” said Richard Murray, director of policy at the King’s Fund thinktank.

“If additional [NHS] funding is not forthcoming later in the parliament, the government will need to be honest with the public about the impact on quality of care and access to services.”

The Department of Health did not respond directly to Hopson’s comments. A spokesman said: “This government has taken tough economic decisions that have allowed us to invest in our NHS, which is meeting record patient demand whilst improving standards of care. We have prioritised funding for the NHS with £4bn extra this year.”

Promised £8bn extra for NHS is not enough, says hospitals boss

No extra money for NHS, Theresa May tells health chief

Theresa May has told the head of the NHS that it will get no extra money despite rapidly escalating problems that led to warnings this week that hospitals are close to breaking point.

The prime minister dashed any hopes of a cash boost in next month’s autumn statement when she met Simon Stevens, the chief executive of NHS England, senior NHS sources have told the Guardian. Instead she told him last month that the NHS should urgently focus on making efficiencies to fill the £22bn hole in its finances and not publicly seek more than the “£10bn extra” that ministers insist they have already pledged to provide during this parliament.

She told him the NHS could learn from the painful cuts to the Home Office and Ministry of Defence budgets that she and Philip Hammond, the chancellor, had overseen when they were in charge of those departments, according to senior figures in the NHS who were given an account of the discussion.

Senior Whitehall sources have confirmed that Hammond’s statement on 23 November will contain no new money for the NHS, despite increasingly vocal pleas from key NHS organisations and the public’s expectation of extra health spending if Britain voted to leave the EU.

NHS Providers, which represents 238 NHS trusts, last week accused ministers of perpetuating “a bit of a fantasy world” on how well the NHS is doing after the worst-ever performance figures for key waiting time targets for A&E care, planned hospital operations and cancer treatments led to warnings that it was starting to buckle under the strain of unprecedented demand.

Health experts warned that the NHS would have to ration treatment, shut hospital units and cut staff if it gets no extra money soon.

Nigel Edwards, chief executive of the Nuffield Trust health thinktank, said: “If the government has firmly decided not to revisit NHS funding, this underlines that the health service faces four very difficult years. In particular, balancing the books in 2018 and 2019 when funding will flatline looks all but impossible with the current level of services.

“If more money from tax or borrowing is ruled out, the only choices left may be even less attractive, including reducing access and services, closures and reductions in staff,” he said.

Jeremy Hunt, the health secretary, and Jim Mackey, the chief executive of the health service’s financial regulator, NHS Improvement, also attended the 8 September meeting, which was Stevens’ and Mackey’s first encounter with the prime minister.

“No 10’s message at the meeting was quite blunt and stark, that there will be no more money. Theresa May and Philip Hammond say that they presided over big efficiency programmes at the Home Office and MoD and didn’t whinge about it. Their view is that the NHS is already doing very well, but that’s head in the sand stuff,” said one NHS insider who was among those briefed on the meeting.

NHS leaders privately fear that May’s remarks indicate that she will be much tougher on the service’s pleas for more cash than David Cameron and does not appear to appreciate the extent of its deepening problems. She is said to be sympathetic to the view of many senior Treasury officials that, as one NHS source put it, “always giving the NHS more money is throwing good money after bad, like pouring water on to sand”.

May’s stance raises questions over the future of Stevens, who is preparing to give evidence on the NHS’s finances to the Commons health select committee on Tuesday. The NHS boss, who had a close relationship with Cameron and George Osborne, has recently irritated No 10 by publicly questioning the accuracy of the government’s claim – which May repeated at prime minister’s questions on Wednesday – that the NHS will receive £10bn extra by 2020.

He told the public accounts committee last month: “The government would record it as £10bn. The health committee recorded it a little differently. There is an apples and pears issue there.”

Stevens has welcomed the fact that the £8bn boost Osborne pledged during last year’s general election campaign was “frontloaded” to give the NHS £3.8bn more this year, a rise of 1.7%, as he had requested. But he highlighted that the service had not got the sums it needed for 2017-18, 2018-19 and 2019-20. On current plans, it is due to receive increases of just 0.6%, 0.2% and 0.1% respectively, even though demand for core NHS services such as A&E care is rising at 3% or 4% a year.

Chris Ham, chief executive of The King’s Fund thinktank, said that any policy of providing no more money was unwise, “simply not credible” and would threaten standards of NHS care. “If these accounts are true, then it is clear that Downing Street does not yet fully understand the impact on patients of the huge pressures facing the NHS.

“The view from the top of government appears to be that the NHS has been given the extra money it asked for and should deliver what is expected of it. But this misses the point that demand for services is rising rapidly and the NHS is managing with the lowest funding increases in its history,” he said.

A Downing Street spokesman said he could not comment on what May, Stevens and Mackey had discussed because it had been a private meeting .

No extra money for NHS, Theresa May tells health chief

Delay to curbs on toxic shipping emissions "would cause 200,000 extra premature deaths"

A push by the shipping and oil industries for a five-year delay to curbs on toxic sulphur emissions would cause an extra 200,000 premature deaths from lung cancer and heart disease, according to an unpublished International Maritime Organisation (IMO) study.

Fatalities from illnesses such as asthma were not covered by the leaked paper, which was based on shipping satellite data and modelling work.

The shipping industry is by far the world’s biggest emitter of sulphur with SOx levels in heavy fuel oils up to 3,500 times higher than those in current European diesel standards for vehicles. A single large cruise ship can reportedly burn as much fuel as whole towns, and emit more sulphur than 7m cars.

At the end of October, an IMO meeting in London will decide whether to cap the sulphur content of shipping fuels by 2020 or 2025. Current levels can reach 3.5% but the cap would limit them to 0.5%.

The 2020 deadline faces fierce resistance from the oil and gas industry association, IPIECA, and Bimco, a global shipping group, which argue that there is not enough low-sulphur fuel available to meet the global demand that the measure would spur.

The EU has thrown its weight behind 2020, unilaterally imposing the new IMO standard from then. With China enforcing similar emissions control zones, the new benchmark for 2020 is thought likely to pass, although the US and large flag states’ positions remain wildcards.

James Corbett, one of the report’s lead authors, told the Guardian that any slippage on the 2020 start date risked grave consequences.

“An IMO policy implemented on time in 2020 could reduce the health burden on coastal communities, particularly in Asia, Africa and Latin America,” he said. “The inverse is also true. A delay would ensure that health impacts from sulphur emissions persisted in coastal communities that are exposed, where shipping lanes are most intense and communities most densely populated.”

Egypt, Panama, Japan, India, Singapore, the Philippines and China would be among the countries hardest hit, Corbett added.

Sveinung Oftedal, Norway’s lead negotiator at the IMO, said that domestic health concerns had now overtaken fears about the acidifying effects that sulphur has on Scandinavia’s lakes and rivers.

“Air pollution from shipping is not just a local or regional, but a global, problem,” he said. “The question is whether we can really continue to accept its effects, and the answer is: no, we cannot. The 2020 deadline is needed and it is achievable.”

But resentment in the beleaguered shipping trade is unmistakeable, and a sign of future fights to come in the IMO over shipping’s CO2 emissions, which roughly equal those from aviation.

“Most shipping companies are not turkeys voting for Christmas,” an industry source said. “They’re under the impression that a decision to delay to 2025 would be of collective economic benefit. In the real world, shipowners are bleeding money. There is total depression in the industry.”

Thousands of container ships belonging to Hanjin, south Korea’s biggest shipping firm, were left adrift on the world’s oceans carrying a £14bn cargo, after the firm filed for bancruptcy last month.

The International Chambers of Shipping (ICS) says that imposing the new benchmark in 2020 would cost industry an additional $ 50-100bn a year, owing to the cost of low-sulphur fuels.

Ships today mostly run on cheap blends of the residues and remainders left over from the refining and distillation of crude oil for aircraft jet fuel and automobile diesel.

Bimco argues that a premature move to low-sulphur fuels could have knock-on inflationary effects for other fuels, as increased diesel demand overwhelms supply.

Lars Robert Pedersen, Bimco’s deputy secretary-general, told the Guardian: “Quite frankly, if the IMO decides to ignore these very concrete facts, ships will start to use other fuel streams and there will then obviously be a shortage in those streams and a potential disruption in the flow of energy to supply world markets.”

Corbett estimates the total cost of the measure at $ 30bn, compared to a value of seaborne trade approaching $ 5tn in the South China Sea alone. Supporters of an early sulphur cap say that its effect on commodity prices such as shoes or bananas would be little more than a few cents.

Crucially, a second IMO report seen by the Guardian finds that enough refineries will be available in 2020 to guarantee the future availability of a low-sulphur fuel supply for all the world’s ships.

“In all scenarios, the refinery sector has the capability to supply sufficient quantities of marine fuels with a sulphur content of 0.5% m/m or less … to meet demand for these products, while also meeting demand for non-marine fuels,” it says.

A capacity shortage in 2020 would be the only grounds for IMO delegates to delay the proposal, under its terms of reference, which some fear could then be extended indefinitely.

In a reflection of differing opinions in the sea freight trade, the ICS is neutral on the timeline for phasing out sulphur, while calling for a speedy resolution of the issue.

The oil industry too is ambivalent. One analyst with close knowledge of the issue said: “Major oil companies such as Shell and BP don’t have a problem with a move to cleaner fuel in the shipping sector because they have advanced refineries which could sell higher value fuels and increase their revenues and potentially, their profits.”

Later this month, a global CO2 data collection system for ships will be launched. Neither shipping nor aviation firms are covered by the Paris climate agreement, although the ICS has called for the UN’s climate pledging system to be extended to the industry.

Delay to curbs on toxic shipping emissions "would cause 200,000 extra premature deaths"

Cold-induced thermogenesis: How many extra calories can it help you burn away?

As soon as our bodies cool down, even if just by a few degrees, they start burning away more calories to keep us warm. This process is also known as cold-induced thermogenesis^[1].

Thermogenesis basically means means the generation of heat in our bodies, and cold is just one of the many triggers that can start this process.

In this article, I’ll go over the science that shows indoor and outdoor temperatures can have a big influence on how many calories we ultimately burn away through cold-induced thermogenesis.

I’ll also give you a couple of ideas you can use to boost thermogenesis in your own body.

Let’s jump right in.

Outdoor temperatures and your calorie burn rate

Here’s one study^[2] that looked at people who engaged in outdoor activities under cold conditions (around 15°F / -10°C) and under hot conditions (around 75°F / +25°C). When people were active in a cold environment, they burned away an amazing 1500! extra calories per day.

Even in less extreme temperatures (between 50°F / +10°C and 70°F / +20°C), some studies^[3] have shown that higher outdoor temperatures are connected with bigger waistlines.

Now, even that big of a calorie burn boost probably won’t be enough to convince you to move to some cold and desolate place. But there’s still things you can do to trigger some cold-induced thermogenesis.

As the very first thing you can do, is try to spend more time outside. Especially on colder days, or in the mornings/evenings when temperatures are lower. You can also wear less/lighter clothing. I’m not suggesting anything extreme, I’m just saying there’s no need to layer up as soon as the temperatures drop by a few degrees.

Also, try to be as active as possible as you spend your time outside. Working, running, even walking at a quick pace will not only help you feel warmer, but can boost your calorie burn rate even further.

Indoor temperatures can keep you overweight too

Just like outdoor temperatures, indoor temperatures can boost (or slow down) the creation of heat in your body.

A study^[4] of over 1,000 people has shown that higher indoor temperatures can lead to bigger waistlines as well.

So, what can you do?

Turn down your thermostat by a few degrees. If that’s not an option because of people who share your living space with you, you can again resort to wearing less/lighter clothes.

Another good tip is to keep your bedroom cooler than the rest of your apartment. You can also use a thinner blanket or sleep only in your underwear.

No need to go overboard with any of this, but getting used to sleeping in a cooler bedroom is definitely one of the easiest calorie burning wins out there.

But ok, how many calories can all this stuff realistically help you burn off?

How many calories can cold-induced thermogenesis help you burn?

This question is pretty tough to answer, mostly because a lot of factors can affect the thermogenesis in your body.

For example, your clothes and your body fat can provide extra insulation. If you expose yourself to cold while wearing layers upon layers of clothes, your body won’t really burn away a lot of calories to keep you warm. The kind of foods you eat, the type (and intensity) of exercise you do, how well your body adapts to cold, air humidity, etc. All these things can influence the number of calories you’ll ultimately burn through thermogenesis.

Plus, most of the science I saw was done under extreme conditions. This automatically makes it highly unlikely that people like you and me are going to burn off calories this way. I don’t know about you, but I’d probably rather stay overweight than keep exposing myself to extreme cold on a daily basis.

However, I did manage to find one study that was done under normal conditions. They measured how many calories people burned away at 72°F (22°C) or 81°F (27°C) while wearing the same clothes, eating the same food, and performing the same activities.

The people in the study burned away about 160 calories more per day at 72°F (22°C) than at 81°F (27°C) ^[5]. Burning off an extra 160 calories per day comes down to losing (or keeping off) almost 17 lbs (8 kilograms) of pure body fat per year.

Time to wrap this article up.

Conclusion

The bottom line is, plenty of scientific evidence exists that cold exposure can boost your calorie burn rate. That’s even if you don’t do any of the extreme cold stuff.

Anything from wearing lighter clothes, spending more time outside on a cold day, bringing down the temperature in your home/office can all help you burn off some extra calories with cold-induced thermogenesis.

And while any of these small changes might not be a major needle mover on its own, over time they can work together to bring you a lot closer to your weight loss goals.

But like I said, there are a lot of other factors that influence how many calories you’ll ultimately burn away.

Check out this guide to see what else you can do to boost thermogenesis in your body except yourself to some cold every now and then.

Cold-induced thermogenesis: How many extra calories can it help you burn away?

UK workers consume 800 extra calories a week while commuting

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Royal Society for Public Health study finds snacking on junk food largely to blame for additional consumption on work journeys

The average UK commuter consumes nearly 800 additional calories a week while travelling to and from work, often as a result of unhealthy snacking, a study has found.

The Royal Society for Public Health (RSPH), which commissioned the research, said longer commutes are potentially shortening lives by increasing stress, limiting sleep and physical activity, and encouraging unhealthy eating.

Related: Meet the supercommuters: how to survive five hours of travel every day

Continue reading…

UK workers consume 800 extra calories a week while commuting

Extra excess weight causing one in ten deaths, top medical doctor warns

She explained she was notably concerned by scientific studies exhibiting that most mothers and fathers of obese young children did not believe their offspring weighed as well considerably.

The Government’s principal healthcare adviser writes: “It is worrying that research present some folks who are overweight feel they are about the right bodyweight. This normalisation is even much more worrying when it comes to kids. In 1 study, 77 per cent of mother and father of overweight kids did not recognise that their little one was overweight.”

In the previous two decades, the variety of obese adults has almost doubled, from 13.2 per cent among males in 1993, to 24.four per cent now, while among females it has risen from sixteen.4 to 25.1 per cent.

In March, in her yearly report on the well being of the nation, Dame Sally explained she was concerned that the use of more substantial mannequins in clothes outlets, and “size inflation” – when outfits of the exact same size label grow to be more substantial – have been normalising the notion of being overweight.

Ten days in the past, the Nationwide Institute of Well being and Care Excellence (Good) provoked controversy with its advice that two thirds of the population be sent to state-sponsored slimming courses.

Wonderful said all obese patients need to be offered totally free spots on programs run by firms this kind of as Excess weight Watchers and Slimming World, with spaces identified for people who were obese exactly where possible.

Dame Sally writes: “While the advice has prompted a great deal of debate, we can’t get rid of sight of how crucial it is that individuals get the right assistance they want to tackle excess excess weight. If they do not, we will all be choosing up a much larger bill in the potential.

“The most current estimate of the price to the NHS of obese or weight problems-related circumstances is £5.1 billion every single yr and there is a wonderful price to society and the wider economy. Then there is the cost to the person.

Weight problems is the leading lead to of severe conditions such as Type two diabetes, heart illness and cancer, and it is estimated that about 10 per cent of all deaths every yr in England can be attributed to becoming overweight and obese.”

Last month, Simon Stevens, the new head of the NHS, explained he would like to see organizations introduce economic incentives for workers who get actions to improve their heath and decrease their Entire body Mass Index (BMI).

Dame Sally urged households to do their part in reversing prolonged-term trends in kid obesity.

She writes: “As children consider their very first measures by way of the school gates, one particular in ten is currently obese. By the time they depart primary school, this number has grown to one particular in five. Basic modifications to diet regime and physical exercise can make such a difference.”

Extra excess weight causing one in ten deaths, top medical doctor warns

Call for £2bn extra well being and social care integration funding

Sir Merrick Cockell mentioned 2015-sixteen would be ‘the crunch year’. Photograph: Sean Smith for the Guardian

Councils and the NHS need to have an additional £2bn “transformation fund” to support integrate companies, says the chairman of the Neighborhood Government Association.

Sir Merrick Cockell said the added funding was necessary on leading of the Better Care Fund, the £3.8bn undertaking to carry with each other overall health and social care providers. He also referred to as for the fund to grow to be a 5-yr dedication, rather than the year it is officially scheduled to last.

Speaking at conference organised by the King’s Fund thinktank in London, Cockell stated a transformation fund would “ease the brief phrase disruption to residents and to individuals”, and that it would have to be a “important” sum of added income in direction of the £2bn mark.

Even so, Cockell’s common perspective in the direction of the Greater Care Fund seemed to be one particular of self-assurance, calling it “our best reply to the inquiries asked of us in these testing times”.

The Greater Care Fund relies on pooled funding from local authorities and the NHS, with the intention of reducing pressure on hospitals by supplying far more care and support in people’s properties.

Nevertheless, the chief executive of the Basis Believe in Network, Chris Hopson, told conference delegates that the fund carries “significant risks”. Even though commenting that it is a “great prompt in terms of bringing people collectively”, Hopson stated the fund was not an investment.

“It is £1.9bn much less across the NHS and regional government than what we are currently paying in 2014-15, so that carries risks,” he mentioned.

The fund launches following April, and Cockell described subsequent yr as “the crunch yr in all respects … we merely can not fall apart in that 12 months”.

Why not join our social care community? Turning out to be a member of the Guardian Social Care Network means you get sent weekly e-mail updates on policy and greatest practice in the sector, as effectively as unique gives. You can signal up – for free – on the web here.

Call for £2bn extra well being and social care integration funding

Nasal Strips Will Give California Chrome Extra Kick At The Belmont Stakes

Nasal Strips Will Give California Chrome Extra Kick At The Belmont Stakes

Dr Le Fanu"s On the internet Well being Clinic Extra

Today I still use Metatone, though some special ingredients have been removed since it was first produced (probably laudanum/alcohol!)

Dear Dr Le Fanu,

You asked about ingredients of tonics. My sister had one in about 1950. It was bright red/pink, sweet, and I believe that it contained a very small amount of strychnine. It is long time ago so I could not swear to it.

Best wishes, Bernard L, FRSM

Dear Dr Le Fanu,

Re your letter about a tonic (Daily Telegraph 28/4/14)-

My father was a rural GP, initially practising before the NHS was formed. He did his own dispensing and I remember a red thick liquid known as Parrish’s Food being doled out by the gallon to those needing a “tonic”. I believe that it was a concoction of iron phosphate presumably to counteract anaemia, mixed with syrup or malt, to hide the hideous taste. In spite of the sweetener the flavour was sufficiently repulsive to convince the patient that some good was being done to them! I have a pharmacopoeia of 1894 which mentions it, when it was also known as Squire’s chemical food-”a general tonic, specially indicated in scrofula and rickets.”

Dear Dr. Le Fanu,

Back in the 1970′s when I worked for Fisons Ltd (better known in those days for their fertiliser), they used to sell Sanatogen tonic wine. A link showing a very old advertisement is www.gracesguide.co.uk/Genatosan

I don’t know if this is what your correspondent is referring to?

Kind regards

Ref. your query about a tonic dispensed in the forties, was it ‘Metatone’, sold in brown bottles ? I remember receiving it in the fifties onwards, but as an otc medicine.

Yours,

Nick P

Dear Dr Le Fanu.

As an octogenarian pharmacist, who qualified in 1950, I was interested in Harry Leeming’s query regarding “tonics”. In times gone by, patients would often feel deprived if their doctor did not prescribe them a bottle of medicine ( a mixture) at a consultation. The most frequently prescribed “tonic” was the mixture “Potassium Bromide and Nux Vomica” (Mist Pot Bom et Nux Vom) This was a bright red liquid, due to the inclusion of a red dye stuff, Amaranth, in its formula. The formula was Potassium Bromide, Tincture of Nux Vomica and Solution of Amaranth, in a base of Chloroform Water. With regard to his comment about “mind over matter”, I am sure this was the case! The two active ingredients had opposing properties! Potassium Bromide being a sedative, whilst Nux Vomica was a stimulant

As late as the 1970′s there were still over 400 formulae for mixtures included in Martindale’s Extra Pharmacopoeia. How medicine and pharmacy have changed!

I enjoy your column in the Telegraph very much.

Best regards,

Don E, M.R.Pharm.S.

In response to Harry Leeming’s query in your column, tonics haven’t stopped being around and are still around today. I buy a bottle from the chemist to help recuperate after illnesses such as colds. Metatone is one brand but others are available. Principal ingredients include sugar, caffeine and vitamins. It’s like taking liver salts after sickness – it helps restore your natural equilibrium.

Kind regards

Vivien

Tonics were very commonly prescribed and requested in the forties.Some of the most common were the following.

Mixture of potassium bromide and nux vomica this was said to stimulate the appetite and act as a mild sedative

Mixture gentian and alkali this was said to aid digestion

Mixture ferr et ammon cit this had a small amount of iron and would help with mild anaemia

Most tonics were used for their placebo effect .

I have all the formulary commonly used from about 1930 to the present.

J F, retired pharmacist

With regard to the query about ‘coloured medicine’ as a tonic. Mist Nux Vom and Pot Brom was coloured red. We used Latin abbreviations in those days, so it is Nux Vomica and Potassium Bromide Mixture.

The Potassium Bromide was a slight sedative (it was assumed) and the Nux Vomica Tincture contained a small amount of Strychnine which was (assumed to be) an appetite stimulant.

Another was Mist Gent Alk – Alkaline Gentian Mixture. The alkaline part was a little Sodium Bicarbonate to relieve any slight gastric discomfort and the Gentian part was a little Tincture of gentian, another appetite stimulant.

If someone wanted similar today, I’d suggest Metatone. This does not contain any of the ingredients already mentioned, but it is intended to stimulate appetite and a tonic for the nerves – the Glycerophosphates are supposed to do this, and there are a few vitamins.

I am a former pharmacist who is old enough to remember making 2L stock bottle of the mixture so that they could be dispensed in 8floz or 12w floz amounts as prescribed.

All of the above should be taken about half an hour before food – I suppose that is so that they do stimulate the appetite for the next meal!

I forgot to mention that this foul-tasting mixture was coloured bright red. The placebo effect was, I suppose, of the colour and the taste made it work. “If it doesn’t taste bad it can’t do you any good.

Yours sincerely,

I think Valerian is meant. I should like to have £1 for every bottle of Mist Pot Brom et Valerian I dispensed during my 44-year career as a pharmacist (1947-91). And it was brown in colour.

Dear Dr Le Fanu,

I am an 85 year old retired pharmacist, I believe that the tonic which you wrote of on 28.4.14 was an old favourite, “Mist. Pot.Brom. et Nux Vomica”which was in the N(W)F 1943,(National (War) Formulary) and then in subsequent N.F.s until the 1950′s or 1960′s.

It contained potassium bromide and Tincture of Nux Vomica, the bromide for its sedative effect and the for its “tonic” effects of the Nux Vom’ s strych nine. Someone once said that strychnine was the only true tonic.He was speaking of the muscle tone,of course. Ask anyone who has taken an overdose.

Any further details are available at the library of the Royal Pharmaceutical Society.

My experience of tonics was as a pharmacy apprentice in the early 1950′s.

‘Tonics’ were prescribed by doctors, prepared and dispensed by chemists, to treat patients’ perceived needs – not always well defined.

A chemical ingredient might often be sodium bicarbonate to reduce excess gastric acid – with perhaps sodium salicylate as an analgesic.

Natural ingredients might include infusions of gentian or valerian to improve digestion and so add to the patients well-being.

Colour of the mixture was also important- amaranth could be added to give a powerful looking red effect.

Smell was also part of the equation – valerian infusion had a most striking and unpleasant odour – this of course could be taken as proof of the mixture’s potency and ‘tonic’ properties.

‘If it smells that powerful, it must be doing some good’ was a common reaction among patients – my own parents used this rule of thumb – or nose?

The only proof I can recall was the success of a Continental over the counter speciality, brand name ‘Gabails Elixir’. Very high valerian content and corresponding odour- and potency? A deodorised version was introduced, which stood next to the original on the shelf, which is all that it did, it certainly didn’t move during my 2 year apprenticeship.

From Anthony S

SPL / Barcroft Media

The Raspberry colour tonic of yesteryear

Dear Dr. Lefanu,

Further to the request about the red tonic one time prescribed by Doctors, I vividly remember as a child in the early forties, at the end of a consultation, my Irish Doctor in Earlsfield, London, disappearing into his dispensary, and reappearing with a bottle of the said tonic. Two teaspoons to be diluted with water, and drunk every morning. It tasted like Raspberryade, and was lovely. Now at that time a consultation was 7/6d, which was a large hole in an income of less than £5 a week, probably nearer £3 10s. and you perhaps had 2 or 3 children to keep on it. Really the Doctor could do little for you, so to make it seem value for money you were sent away with a bottle of “Red Tonic”, for your 7/6d., in modern parlance, “Added Value”. There may have been iron added, as sometimes it was a bit bitter, after all you are not supposed to like medicine.

Much later in life, perhaps 20 years ago, my brother in law, asked me if the shop near the Elephant & Castle, London, which sold “Sarsaparilla” was still there, to my astonishment it was, and I came away with ½ Gallon of neat “Sarsaparilla”, which you diluted with water to drink. My first mouthful distinctly reminded me of the tonic our Doctor dispensed 50 years previously. So I suspect that the Red Tonic was in fact “Sarsaparilla”, possibly with things like iron added for effect. I think “Sarsaparilla”, is supposed to have some medicinal benefits anyway, homeopathic presumably. It was no problem for my Doctor to send his Chauffeur to get a new supply, from the Elephant, and everyone was happy.

Putting “Sarsaparilla” into a search engine, brings up a multitude of answers to it’s alleged tonic values & it’s origins .Whether the shop still exists at the Elephant, I’ve no idea. By the way, that Irish Doctor recommended Guinness to my Father as a tonic, which Dad immediately took to, it’s got iron in yer know!

” Regards, ”

Dave B

Your item about “a tonic” dispensed by doctors decades ago reminded me of “tonic” which our Shropshire village doctor used to dish out all over the place.

When anyone was ill from anything at all the doctor would give the patient a bottle of rose-coloured liquid described by the locals as “jallup”.

It must have done some good because people did recover!

But I would caution against anyone taking it nowadays as a website tells me that it is a purgative drug.

The Shropshire potion could have contained anything as people in them thar olden days deep in the countryside used nettles, rosehips and elder flowers and all kinds of hedgerow herbs in medicines and cooking.

Yours

Ron K

Hello Dr Le Fanu

I began my apprenticeship in pharmacy the year the NHS started – 1948

By far the most popular tonic prescribed in those early was a product called Metatone by Parke Davis.

Though it was available OTC, when prescribed we dispensed it in 8 or 10oz bottles from 80oz winchesters.

I’m sure that is the tonic your correspondent , Mr Harry Leeming pines for.

He can get it from Boots, but he has to be over 16 before he can buy it.

Regards

Eddie McC

Dear Dr Le Fanu,

Your correspondent, Harry Leeming, was probably prescribed something called Metatone. I have no idea what it contained although I took it as a “sickly” child in the 1950s. It was prepared by the Pharmacist and was a bottle of coloured liquid which must have done me good as it tasted vile!

I do enjoy your articles,

Best wishes,

David J H

Dear Dr.Le Fanu,

I have been following the comments about placebos with great interest, and it has reminded me about a tale which my late Father used to tell.

He was a pharmacist at The London Hospital in the 1920′s.

He used to make up a prescription of coloured water, and his was always red.

When my Father went on holiday, another pharmacist made up this particular prescription, but his was yellow.

When the patient next saw the consultant, the patient told the consultant in basic English, that the yellow medicine was no good. !!

Regards,

P.H

Dr Le Fanu"s On the internet Well being Clinic Extra

Three drinks can scupper the diet plan leading to extra calories and excess weight achieve, authorities warn

It identified that soon after 9.three units of alcohol, participants tended to make unhealthy selections, consuming an added four,305 calories that evening in food and drink and an additional 2,000 calories the following morning.

Half of people who passed their tipping level cancelled exercise and sport the following day, preferring to sit in front of the Tv, remain in bed or play on social media and so exacerbating their prospective for weight obtain.

Half of these in the survey acknowledged this pattern was standard for an typical weekend.

The survey was commissioned by Slimming World, which has known as on government to highlight the website link among alcohol and obesity.

The tipping point was at close to 10.5 units for guys and eight units for females. It is advised that guys drink no much more than three to four units per day and ladies no a lot more than two to three with two alcohol cost-free days per week.

Chips were the favourite foods soon after passing the tipping level, followed by pizza, kebab and hamburger.

Dr Jacquie Lavin, Head of Nutrition and Study at Slimming World mentioned: “There is at the moment not enough advice for the public on how consuming much more than the suggested amount of alcohol can affect on fat.

“Alcohol stimulates appetite, can make us want to consume much more unhealthy foods and lowers our inhibitions, all of which can lead to us creating unhealthy choices – without even realising how several much more calories we’re consuming.

“With the regular tipping stage generally happening soon after only three to 4 drinks it is clearly very straightforward for people to drink adequate alcohol to knowledge these adjustments in their behaviour.

“Alcohol doesn’t only include calories that really do not fill us up as food does, it also can make us feel hungrier and weakens our resolve to make healthful options. Generating people a lot more conscious of this will give them the details they want to take individual duty for their weight.”

Bridget Benelam, Senior Nutrition Scientist at the British Nutrition Basis said: “Alcohol has a quick result on the brain and seems both to make food more enjoyable and to inhibit the sense of satiety when consuming, so can have a dual function in stimulating us to eat a lot more.

“In addition, for men and women who are consciously restricting their food consumption in buy to management their excess weight or stick to a wholesome diet plan, the results of alcohol make this more difficult to keep to.

“It’s actually crucial to be conscious of the results of alcohol on foods consumption because it’s so straightforward to consume a lot a lot more than you suggest to when you have been drinking.”

A Division of Wellness spokesman said: “We are critical about tackling obesity and alcohol misuse and are previously creating progress. We have offered all nearby authorities £5.four billion of protected funding so that they have the electrical power and freedom to tackle public overall health concerns in their nearby regions. Nonetheless, everybody has a function to play.

“The Change4Life campaign provides tips to families on how to improve their diet and life-style, such as tips on alcohol consumption. We are doing work in partnership across the meals and drinks sector to empower shoppers to make more healthy choices.”

Three drinks can scupper the diet plan leading to extra calories and excess weight achieve, authorities warn

Could generalists lead the war towards extra in the NHS?

Numerous elderly individuals suffer from several chronic diseases. Photograph: Alamy

Specialisation is a consequence of the expansion of information. In healthcare it is regarded evidence of disciplinary maturity and excellence in analysis and practice. It has led to much more powerful remedies for significant diseases. It has also eroded the status and function of the generalist. But there is a paradox: the security and quality of healthcare stays uneven. Creating new expertise is, evidently, significantly less difficult than translating it into far better care. Could the pendulum have swung also far in the route of specialisation?

Patients often complain of several persistent illnesses, the new standard, specifically in an ageing population. What is optimal care for a single situation, typically gets to be a risk issue in the presence of other problems and therapies. Medicines that subdue abnormal physiological measures could make everyday lifestyle a minor more miserable. Good quality of existence objectives may be more important to sufferers than submitting to each and every conceivable attempt to defy decline and death.

There is growing recognition of these realities and a consequent renewal of curiosity in generalism. The central thought is that patients need to have holistic and steady care. That must be the task of a major care technique capable of dealing with this complexity and keenly attuned to the preferences of patients. There will be a require to seek the advice of with and refer to experts, but the main locus of care must be the main care group. By international standards the NHS has been a leader in principal care enhancement and nurse-led continual disease management in the neighborhood.

These developments increase an important query. Is the function of generalism to do what is now completed, only in a much more co-ordinated fashion and maybe more value-efficiently, or is it to do items differently? It appears clear that a much more robust, properly-supported generalism simplifies care for sufferers, lowers the risks of poor communication and conflicting suggestions amid providers, and increases prospects for a real partnership with individuals. These are self-evidently desirable as long as generalists recognise what they don’t know and enlist experts when they need to have to. Provided the cultural bias that equates specialisation with excellence, the danger of false optimistic referrals stays far higher than a generalism whose attain exceeds its grasp.

A more intriguing facet of a new generalism would be to do items in a different way. Healthcare is fond of military metaphors: illnesses strike bodies are invaded we declare war on cancer we fight insomnia. The critical is to counter aggression with superior force, a health-related arms race against nature’s indifference to individual struggling and the inevitability of decline and death. Accommodation and acceptance are in this view defeatist it is our moral obligation to rage, rage towards the way of all flesh.

Probably we are seduced by an overly optimistic framing of the troubles, and generalism may possibly provide the needed corrective. Quality authorities seem to have reached a provisional consensus that about 30% of care in wealthy nations is either useless or hazardous. The elderly eat staggering amounts of medicines, numerous combinations of which land them in hospital. Skyrocketing CT use and its attendant radiation exposure triggers a great deal of cancer.

Generalism can assist individuals articulate their very own preferences, recognize the dangers as effectively as positive aspects of treatment options, and physical exercise affordable scepticism the place warranted. Healthcare is a combination of science, hope, and hype. It will gobble as considerably of the GDP as we are ready to lavish on it. We want to fight the war against excess, and that war may be greatest led by the generalists. The final results would be much more patient-centred care and very probably, reduced costs. It truly is an selection well really worth pursuing by the NHS.

Steven Lewis is adjunct professor of overall health policy at Simon Fraser University in Canada he will be speaking at the Nuffield Trust Health Policy Summit on seven March.

This report is published by Guardian Expert. Join the Healthcare Professionals Network to obtain standard emails and exclusive delivers

Could generalists lead the war towards extra in the NHS?