Simon Stevens" NHS gamble is probably the right choice - but price could be high | Richard Vize

The NHS plan for the next two years represents a perceptible contraction of the health service’s offer to the public.

The proposals in Next steps on the NHS Five Year Forward View, published on Friday, are shaped by shortages of money and staff.

Simon Stevens, the NHS England chief executive, has burned through much of his political capital in disputing government claims about whether the NHS has been given all the money it asked for, so this was not an opportunity to push for further cash.

So in the face of the unrelenting pressure of the government’s austerity programme and barely controlled hospital debt, he is gambling that politicians and the public will stomach longer waits for routine surgery if the health service can deliver better performance on cancer treatment, A&E waits, mental health services and GP appointments.

In the wake of slipping cancer treatment times and the recent outcry over the death of a child waiting for urgent surgery, this is probably the right choice. But the price could be high.

Allowing elective surgery times to slide over many years was what led to hundreds of thousands of patients waiting months for operations by the time New Labour came to power in 1997, elected partly on its pledge to slash waiting lists. It would be a serious blow if the NHS returned to the days of people dying while waiting months for heart surgery, and many more forced to endure avoidable pain and disability.

Access to some of the latest approved drugs is also to be delayed – in breach of a commitment in the last Conservative manifesto to speed up access.

Stevens is anxious to reassure the public that performance will not slide back to that of the 1990s, but it is difficult to see how growing waiting times will be arrested and reversed in the coming years.

The plan makes some brave assumptions about the ability of the NHS to expand its workforce, including 4,000 more nurses through improving staff retention – turning round a recent trend – and up to 2,000 more nurses returning to practice.

There is yet another pledge to increase the number of GPs substantially, despite little discernible progress. However, concerns are growing that staff shortages will be exacerbated by EU staff heading back to the continent in the wake of the Brexit vote.

More promisingly, the plan may well mark the beginning of the end of the internal market. It names nine areas being considered as pioneering “accountable care systems”, with NHS organisations and local authorities working together as an integrated health system.

These areas will have considerably more control over how they deliver their healthcare, and will be effectively freed from the endless focus on contracts rather than patients imposed by the purchaser/provider split.

However, doing so will require ever greater legal contortions to simultaneously stay within the law while circumventing it. This is a necessary bodge, as it will be years before anyone attempts another NHS reform bill, but these workarounds cannot be sustained indefinitely.

Everyone will now be working in Sustainability and Transformation Partnerships, and NHS England makes clear that anyone who fails in their duty to collaborate can expect to be handled roughly.

In the absence of more money, the alternative to Stevens’ plan would be a steady atrophying of performance across the entire health service. Instead, NHS England is pushing forward on the key priorities of emergency care, cancer treatment, mental health and primary care, and allowing routine surgery to pay the price.

But many of its promises look optimistic, and there is a danger that the slide in surgical performance will eventually reverse years of progress.

For the time being this can be portrayed as a tactical move, but with austerity set to last well into the next decade, there is a risk that the NHS will cease to be a comprehensive service.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

Simon Stevens" NHS gamble is probably the right choice - but price could be high | Richard Vize

Families will pay high price for more fruit and veg to improve health | Letters

The idea that 10 items of fruit or veg a day will seriously improve your health is a bit intimidating (Five a day? Try 10 to live longer, say scientists, 23 February). I priced the array pictured with your article. In Sainsbury’s it came to around £2.16; in Lidl £1.88. These amounts don’t seem very big until you multiply by seven for a week (£15.12 and £13.16 respectively), and they start to look frightening. For a family of four, £60.48 and £52.64, respectively.

And buying them would be a logistical nightmare, since few of the items can be bought singly; they all come in different quantities, so you would run out of them at different intervals and probably have to shop several times a week. I wonder how a family on below average income is supposed to come by such large amounts of money, let alone the shopping time? The differences in health between rich and poor families begin to be more easily explained. (Incidentally, you’d have to be very careful about the orange juice since most varieties are loaded with sugar.)
Jeremy Cushing
Exeter

• Dr Jenny Goodman (Letters, 21 February) describes vitamin D2 as synthetic and far less useful than vitamin D3 (cholecalciferol). She is right in that it is less useful to humans than D3, which is the animal form of the vitamin. D2 is present in some lichens, fungi and alfalfa. This means strict vegans would be unable to get D3 into their diet and must make do with D2. We do get most of our vitamin D from sunlight, but in the UK the winter sun is never high enough to provide this. If your shadow is longer than you are tall, you won’t be getting vitamin D.

Goodman mentions the effect of vitamin D on our immune system. Another nutrient we need for this is zinc, which has been found to shorten cold symptoms. Again, vegans and some vegetarians will struggle to get enough, especially if they avoid dairy products and wheat.
Brian Curwain
Christchurch, Dorset

• While I try and eat plenty of fruit most days, the intake proposed by the Imperial College study of 800g a day of fruit and vegetables is far beyond my capacity. It is roughly my total daily food input. And why no potatoes, and where are the proteins and fat we need – albeit in smaller quantities than most of us should eat? Please don’t tell me I have to eat another half a kilo of stuff; to eat that much food I’d be grazing like a rabbit. Isn’t a bit of kale and quinoa with my burger and chips enough?
David Reed
London

• There is a serious problem with Dr Goodman’s proposal that food should be fortified with vitamin D3 as opposed to D2. Most D3 is currently produced from animal sources (lanolin and fish oils), making it unsuitable for vegans and, in some cases, vegetarians too. At present, many foodstuffs simply state that they are fortified with “vitamin D”, with no indication as to whether this is animal-derived D3, non-animal derived D3 (which is much rarer and comes from lichen) or D2. This forces many vegans to err on the side of caution and avoid such products. If more foods are to be fortified with vitamin D3, I would urge manufacturers to switch to the plant-derived version and that this be clearly stated on the product packaging so that vegans may also benefit from it.
Ben Martin
Animal Aid

• I feel sorry for Tony Naylor (How the shops spoiled posh pizza, 22 February) if he thinks that “no one will ever improve on Heinz baked beans by cooking their own”. Of course it’s subjective, and children will usually go for those that are laden with sugar and salt. But having cooked my own baked beans for years, the industrial varieties taste horrid to us – mushy and sweet.

It reminds me of the story about my hero Jane Grigson who, when Elizabeth David suggested she gave her daughter baked beans for tea, replied: “But they take so long to make.” (Even if it’s not true, it ought to be). I’m with Jane. I like to include molasses for sweetness, mustard rather than salt, and onions. Tony Naylor is welcome to try mine any time.
Jill Bennett
St Albans 

• Join the debate – email guardian.letters@theguardian.com

• Read more Guardian letters – click here to visit gu.com/letters

Families will pay high price for more fruit and veg to improve health | Letters

Families will pay high price for more fruit and veg to improve health | Letters

The idea that 10 items of fruit or veg a day will seriously improve your health is a bit intimidating (Five a day? Try 10 to live longer, say scientists, 23 February). I priced the array pictured with your article. In Sainsbury’s it came to around £2.16; in Lidl £1.88. These amounts don’t seem very big until you multiply by seven for a week (£15.12 and £13.16 respectively), and they start to look frightening. For a family of four, £60.48 and £52.64, respectively.

And buying them would be a logistical nightmare, since few of the items can be bought singly; they all come in different quantities, so you would run out of them at different intervals and probably have to shop several times a week. I wonder how a family on below average income is supposed to come by such large amounts of money, let alone the shopping time? The differences in health between rich and poor families begin to be more easily explained. (Incidentally, you’d have to be very careful about the orange juice since most varieties are loaded with sugar.)
Jeremy Cushing
Exeter

• Dr Jenny Goodman (Letters, 21 February) describes vitamin D2 as synthetic and far less useful than vitamin D3 (cholecalciferol). She is right in that it is less useful to humans than D3, which is the animal form of the vitamin. D2 is present in some lichens, fungi and alfalfa. This means strict vegans would be unable to get D3 into their diet and must make do with D2. We do get most of our vitamin D from sunlight, but in the UK the winter sun is never high enough to provide this. If your shadow is longer than you are tall, you won’t be getting vitamin D.

Goodman mentions the effect of vitamin D on our immune system. Another nutrient we need for this is zinc, which has been found to shorten cold symptoms. Again, vegans and some vegetarians will struggle to get enough, especially if they avoid dairy products and wheat.
Brian Curwain
Christchurch, Dorset

• While I try and eat plenty of fruit most days, the intake proposed by the Imperial College study of 800g a day of fruit and vegetables is far beyond my capacity. It is roughly my total daily food input. And why no potatoes, and where are the proteins and fat we need – albeit in smaller quantities than most of us should eat? Please don’t tell me I have to eat another half a kilo of stuff; to eat that much food I’d be grazing like a rabbit. Isn’t a bit of kale and quinoa with my burger and chips enough?
David Reed
London

• There is a serious problem with Dr Goodman’s proposal that food should be fortified with vitamin D3 as opposed to D2. Most D3 is currently produced from animal sources (lanolin and fish oils), making it unsuitable for vegans and, in some cases, vegetarians too. At present, many foodstuffs simply state that they are fortified with “vitamin D”, with no indication as to whether this is animal-derived D3, non-animal derived D3 (which is much rarer and comes from lichen) or D2. This forces many vegans to err on the side of caution and avoid such products. If more foods are to be fortified with vitamin D3, I would urge manufacturers to switch to the plant-derived version and that this be clearly stated on the product packaging so that vegans may also benefit from it.
Ben Martin
Animal Aid

• I feel sorry for Tony Naylor (How the shops spoiled posh pizza, 22 February) if he thinks that “no one will ever improve on Heinz baked beans by cooking their own”. Of course it’s subjective, and children will usually go for those that are laden with sugar and salt. But having cooked my own baked beans for years, the industrial varieties taste horrid to us – mushy and sweet.

It reminds me of the story about my hero Jane Grigson who, when Elizabeth David suggested she gave her daughter baked beans for tea, replied: “But they take so long to make.” (Even if it’s not true, it ought to be). I’m with Jane. I like to include molasses for sweetness, mustard rather than salt, and onions. Tony Naylor is welcome to try mine any time.
Jill Bennett
St Albans 

• Join the debate – email guardian.letters@theguardian.com

• Read more Guardian letters – click here to visit gu.com/letters

Families will pay high price for more fruit and veg to improve health | Letters

CVS to Offer 2-Pack EpiPen Alternative For $110 — a Fraction of the $600 Name-Brand Price

This article originally appeared on People.com.

CVS is stepping up to help consumers frustrated with the EpiPen’s price hike.

The drugstore chain announced Thursday that it reduced the price of an EpiPen alternative, Adrenaclick, to just $ 110 for a two-pack, compared to $ 608 for the Mylan-produced EpiPen.

“We recognized the urgent need for a less-expensive epinephrine auto-injector,” CVS says in a press release. “Patients with life-threatening allergies need immediate access to injectable epinephrine. But over time, the brand-name epinephrine auto-injector pens that make it easy to quickly and safely administer the medication have become increasingly expensive.”

The move comes just days after insurance company Cigna said it was dropping coverage for Mylan’s EpiPens. A Cigna spokesperson, Karen Eldred, applauded CVS’ decision in a statement.

“It is positive news for our customers,” said Eldred said, according to NBC News. “The generic version, available now in pharmacies, has the same drug formulation and device functionality as the branded medication, but at a substantial cost savings.”

Mylan is currently under investigation by Congress for raising the price of EpiPen by 500% since they took over production of the life-saving device in 2007. Amid the outcry, Mylan said they would introduce a generic version of the EpiPen, priced at $ 300 for a two-pack.

Mylan CEO Heather Bresch told Congress that the company “never intended” for the price of EpiPens to rise to this level, and claims the hike is due to taxes.

Mylan’s main competitor, Auvi-Q, had stopped production in 2015 because of a lack of name recognition compared to the EpiPen. The company announced in October that it would resume production, hoping to provide another epinephrine auto-injector at an affordable price.

“This is personal for us,” Eric Edwards, who created the Auvi-Q with his twin brother after growing up with severe allergies to nuts, eggs and shellfish, told Forbes. “I’m a patient who may have to respond with this product not only for myself but for my child, and we are committed to making sure that Auvi-Q is going to work during an allergic emergency.”

CVS to Offer 2-Pack EpiPen Alternative For $110 — a Fraction of the $600 Name-Brand Price

High-quality abortion services come at a price, so let’s pay it | Ann Furedi

Abortion today is an extremely safe, straightforward procedure, provided in a highly regulated environment. One in three women in the UK will have an abortion in her lifetime, funded by the NHS (except if she lives in Northern Ireland). This will usually take place within an NHS hospital or in a centre run by one of the independent charitable providers – the British Pregnancy Advisory Service (BPAS) or Marie Stopes International (MSI). But just because it is safe doesn’t mean corners can be cut, or providers can pick and mix from rules and regulations, as was unearthed in the course of the care quality commission’s investigation of MSI.

Some of the failings found at MSI have no implications for safety. The batch signing of abortion forms, for example, has no clinical significance – it is simply a legal requirement that all women have their abortion request legally authorised by two doctors. But the other problems uncovered – from clear deficits in clinical governance at the top level through to problems with safeguarding and consent, to the report of the appalling handling of a vulnerable patient – can leave us in no doubt that the CQC was not over-reacting when it requested MSI suspend its services over safety concerns earlier this year.

With NHS funds shaved, the price commissioners will pay is driven down

Clinical supervision and governance structures, training and upskilling staff and recruiting the right people to leadership positions takes time – and money. Adhering to legal requirements that have no clinical benefit may be irksome and expensive, but that’s life. If you operate in a highly regulated environment and believe women deserve high-quality care, these measures are not optional.

Abortion is an easy procedure when everything goes right – but you can’t run a clinical service on the assumption that everything runs to plan. The best doctors experience patients who develop complications, unexpected problems arise in the healthiest patients, clients need access to good counselling services and support. Research and innovation is essential to determine best practice. This costs – but it’s not just a matter of cost but of commitment, and focus on values.

The BPAS has been delivering not-for-profit services since the 1967 Abortion Act came into force, providing high-quality, compassionate care that the NHS either could not, or would not provide from its own facilities. It was founded by a former abortion law reformer who saw that the inability of the NHS to meet women’s needs would push them into paying extortionate sums for poor-quality care by private doctors.

In the 1970s, MSI joined BPAS as a charitable provider. Today some 200,000 women a year in the UK have an abortion. MSI provides about a third of all abortion care , BPAS a further third, and the remainder are performed in NHS premises.

In a parody of market economics, the two charities now compete with each other and with local NHS hospitals for regional contracts to provide NHS abortion services. With NHS funds shaved, the price commissioners will pay is driven down. In the current commissioning environment a cheaper service will trump a quality service almost every time.

We all deserve an honest and open discussion about how this essential women’s healthcare service is commissioned and provided in an environment of cost-cutting. On the brink of the 50th anniversary of the Abortion Act, BPAS is absolutely clear, abortion must be fully decriminalised and women finally trusted to make their own reproductive choices for themselves – and they must be able to exercise those choices in clinics providing safe, high-quality abortion care.

High-quality abortion services come at a price, so let’s pay it | Ann Furedi

Watchdog accuses Actavis of hiking price of lifesaving drug by 12,000%

Pharmaceutical company Actavis is facing accusations from the competition watchdog that it hiked the price of life-saving hydrocortisone tablets by over 12,000%, sending the annual cost to the NHS spiralling from £522,000 before 2008 to £70m by 2015.

The Competition and Markets Authority said the price rises took place after the patent lapsed on the drug. About 943,000 packets of the tablets – prescribed to people whose adrenal glands do not produce enough steroid hormones, such as those suffering from Addison’s disease – were distributed over the last year.

As the CMA set out its reasons why the company had broken competition law, the regulator’s senior responsible officer, Andrew Groves, said: “This is a lifesaving drug relied on by thousands of patients, which the NHS has no choice but to continue purchasing.

“We allege that the company has taken advantage of this situation and the removal of the drug from price regulation, leaving the NHS – and ultimately the taxpayer – footing the bill for the substantial price rises,” said Groves.

The watchdog is continuing other investigations into the pharmaceutical sector. The latest allegations come after last week’s £84.2m fine on Pfizer for increasing the cost of an anti-epilepsy drug. The drugs distributor Flynn Pharma was fined £5.2m for charging excessive and unfair prices in the UK for an epilepsy treatment.

Groves said the current findings against Actavis were provisional and that it was too early to conclude there had been a breach of competition law. “The CMA will carefully consider any representations of the parties under investigation before determining whether the law has been infringed,” said Groves.

Actavis – formerly Auden Mckenzie – is facing accusations about the prices of two forms of the hydrocortisone tablets. The CMA said the increase in price to the NHS for 10mg packs rose from 70p in April 2008 to £88 by March 2016 – a 12,000% rise. For 20mg sizes the price rise was 9,500% – increasing to £102.74 per pack by March 2016, compared with £1.07 when the treatment was still branded.

Once medicine and treatments are no longer branded – known as generic medicine – they are no longer subject to price regulation, a move that is usually expected to reduce the cost rather than inflate it.

Actavis did not immediately comment.

Watchdog accuses Actavis of hiking price of lifesaving drug by 12,000%

A luxury care home for people with dementia – but at what price?

Chelsea Court Place describes itself as the UK’s first luxury purpose-built and designed residential and daycare home for people with Alzheimer’s and dementia. Inside the building on the exclusive King’s Road in London, it feels more like a private members’ club or a five-star hotel than a care home, with its thick carpets, tasteful paintings and wall hangings.

There are none of the familiar smells of toilets, disinfectant or overcooked food that often rudely greet visitors to such establishments. Here, there is a private cinema, luxury spa and treatment rooms, and a library stocked with sumptuous coffee-table volumes. Its 15 elegantly furnished en suite “apartments” are set in a horseshoe shape around the central dining area, where a restaurant and 24-hour cafe for residents and visitors offer tailored food choices to suit individual nutritional needs.

Chelsea Court, which opened last month, also offers bridge evenings and outings to opera, tennis, golf and local attractions. The nursing team are all dementia specialists assisted by the latest technology. Each resident is tracked by “person-centred software”, which monitors progress through the day and offers staff an insight into why and when extra care or attention should be given if patients become agitated or confused. Dementia care mapping, an innovative observational technique, takes a complete history of each resident, offering insights into situations that can lead to mood changes.

Mwaya Siwale, the head of memory care, gives an example of a resident who gets “fidgety and anxious around 5pm”. “Relatives told us this was the time when she used to lock her shop. So at around five we have created a plan to reduce that anxiety. We also learned she is really attached to a particular carpet and does not like light-coloured curtains – so that carpet will be in her room and she will have dark curtains.”

Chelsea Court is the brainchild of hotelier and philanthropist Laurence Geller. His experience of seeing the impact of dementia on a relative drove his interest in improving care and treatment. Geller is co-chair of the Alzheimer’s Society appeal board, which aims to raise £100m a year for dementia research, and chancellor of the University of West London. Chelsea Court aims to champion research and innovation in partnership with the university, which is “spearheading new attitudes to dementia care, tailored medication and investing in research to help find a cure for dementia”.

Last week the Office for National Statistics announced that dementia has replaced heart disease as the leading cause of death in England and Wales. There are thought to be 850,000 people with dementia in the UK at an estimated cost to the economy of £26bn a year. With better diagnosis and rising life expectancy rates, numbers are set to reach two million by 2051, when one in three people over the age of 65 will have the disease and costs may treble.

The library at Chelsea Court Place. Photograph: Sarah Lee for the Guardian

People living in the elegant streets off the King’s Road have the highest life expectancy in the UK. It is one of the UK’s most affluent neighbourhoods where women can expect to live until 89 and men 85. But longevity has a price. The Royal Borough of Kensington and Chelsea is projected to have one of the biggest rises in new dementia diagnoses in London over the next 20 years – up 54% – equating to 700 people. This is in addition to the 1,335 residents already diagnosed. Yet the borough has one of the lowest numbers of dementia beds per resident in England.

Geller may have seen a gap in the market for the kind of bespoke dementia care on offer at Chelsea Court, but it does not come cheap. Rooms cost between £2,000 and £3,000 a week, putting it way out of the reach of the majority of people paying for their care, and of cash-strapped councils whose adult social care budgets have been slashed. The average care home cost paid by inner-London councils is £649 a week. But round-the-clock private home care in the capital can cost around £2,400 a week, and 24-hour nursing care £3,500 alone – before the cost of food, rent, and bills – whereas Chelsea Court guarantees a fixed-rate, all-inclusive pricing model, regardless of whether the level of care required increases. Its managing director, James Cook, says families come to him complaining that their parents get very little from home care. “We have a lot of older people in Kensington and Chelsea getting private or NHS home care who are getting almost no stimulation or activities, not even getting out of the house,” says Cook.

Lack of stimulation brings on problems such as depression, which adds to the toll on patients and families, says the general manager, Christine Bunce, a psychologist who has worked in mental health and elderly care. “Ensuring people are stimulated and engaged means that we can reduce the need for anti-depressants,” she points out.

Sadly such accommodation will be out of reach for the vast majority of families who struggle to afford appropriate care

New research by the Alzheimer’s Society reveals that only four in 10 home care workers have specialist dementia training in spite of government promises that all staff would be specialist trained by 2018. More than 400,000 people with dementia are believed to receive care in their own homes. The research found that poor-quality home care is leaving many people spending the day in soiled clothing, going without food or water, and ending up in hospital.

But inadequate care is not confined to home care. According to another new survey of UK local authorities by the Family and Childcare Trust, four in five UK local authorities have insufficient care for older people, particularly those with dementia, either in their own homes or in residential care homes. And only a third of councils said they had enough nursing homes with specialist dementia support. The findings come as horrific neglect exposed in two Cornwall nursing homes by an undercover investigation by BBC Panorama was broadcast on 21 November, where a resident with dementia was found to have a leg wound that had gone untreated. Less than 40% of care home staff in the the UK are trained to deal with the challenging behaviour often displayed by residents with dementia.

About 280,000 people with dementia are living in care homes. Bunce feels Chelsea Court can do much to improve dementia services and aims to produce a case study charting its course “from conception to capacity” to be used as an industry model of best practice for dementia care . “Our objective is to inspire other providers, including NHS and private, to adopt the concept and provide similar, much-needed services in the UK.” She adds that it would be happy to take residents whose payments could be topped up from their NHS personal budgets. Yet according to the Alzheimer’s Society, fewer than a third of people aged over 65 receiving care for memory and cognition problems have a personal budget that allows them greater choice over their state-funded care and support. West London clinical commissioning group, which runs the integrated dementia service for health and local authority social care in Kensington and Chelsea, says any personal budget it allocates for an individual’s care would take account of the market rates for care in the area. It describes its own MyCare, My Way service as bringing a “full range of physical, mental health and social support together in one [home] care package with support for carers, activities, physiotherapy and occupational therapy”.

A dementia patient being looked after in the intensive care unit of an NHS hospital. Photograph: Christopher Thomond for the Guardian

Experts agree that without a public funding system that truly meets the cost of care, it is almost impossible to match Chelsea Court levels of care.

Martina Kane, senior policy officer at the Alzheimer’s Society, says there is more choice than ever for people who can afford it. “While this is welcome because it raises the bar in terms of what the care sector should strive for, sadly the reality is that such accommodation will always be out of reach for the vast majority of families who struggle to afford appropriate care. We hear stories every day of people being asked for top-up fees for what should be council-funded care. Some loving relatives are now faced with borrowing money to pay for food in order to meet these fees.”

She says Chelsea Court levels of care and accommodation “should be a right, not a privilege, but to make this a reality we need a properly funded system. Additional funding for social care needs to be made an absolute priority in the forthcoming autumn spending review.”

A luxury care home for people with dementia – but at what price?

Breast cancer drug approved for NHS use after price cut

A drug that can help shrink breast cancer tumours before patients undergo surgery to remove them has been approved for use in the NHS, after the manufacturer agreed a substantial discount on the list price.

Perjeta, the brand name of pertuzumab, could be helpful in the treatment of 1,400 women a year who develop a particularly aggressive form of breast cancer, but it was initially turned down by Nice, the National Institute for Healthcare Excellence, because of the high price set by the manufacturer, Roche.

Nice said it was also uncertain that the drug treatment would help prevent the cancer coming back.

Prof Carole Longson, director of the centre for health technology assessment at Nice, said there was only limited evidence of how well the drug worked because it had been quickly licensed on the back of promising but early trial data.

She said Nice was glad Roche had agreed to drop the price, though she would not reveal by how much.

“The price discount means that, even with the uncertainties in the evidence highlighted by the committee, pertuzumab represents a cost-effective use of NHS money,” Longson said.

The list price of pertuzumab is £2,395 per 420mg vial (excluding VAT). The total cost of four cycles of treatment with pertuzumab – the maximum Nice says should be used – would be £9,580 before the agreed discount.

The drug is used in combination with two others, trastuzumab (Herceptin) and docetaxel (a type of chemotherapy), to shrink tumours prior to surgery. If it works well, it may mean some tumours that were previously inoperable could be surgically removed.

Pertuzumab has been developed to help treat the 10-15% of breast cancers that are HER2-positive, which can be particularly aggressive.

Nice pointed out that the decision was the third green light for a cancer drug in as many weeks. It has been criticised for failing to approve cancer drugs, which often come on to the market at high prices.

Mia Rosenblatt, assistant director of policy and campaigns at Breast Cancer Now, said it was a huge leap forward. “Perjeta is the first addition to primary breast cancer treatment to be approved by Nice since 2006 and marks the introduction of a new type of breast cancer medicine, to be used before surgery,” she said.

“For the small number of women eligible, this drug could mean an enormous amount. It could help shrink their tumours to reduce the extent of the surgery they require or even make inoperable cancers operable.”

Samia al-Qadhi, the chief executive of Breast Cancer Care, said: “This is an exciting turning point. Women with certain aggressive types of breast cancer will have access to an extra drug before surgery that can boost the success of shrinking the tumour. Crucially this may mean people’s long-term survival improves.”

Breast cancer drug approved for NHS use after price cut

Our children are paying a high price for society’s vision of success

Yet another report has been published showing frightening levels of mental illness among children and young people in England. The figure now stands at about a quarter of a million. I have written before, downplaying the phenomenon, usually along the lines of “children have never had it so good” and pointing to the increase in child-centrism, the boons of technology and the growth in living standards for most.

I can’t keep my head in the sand any longer. Something is going seriously wrong. Owen Jones, in an article in this newspaper, recited the usual suspects – overcrowded and poor housing, poor diet, lack of exercise, family conflict, the stresses of poverty and lack of state support. I am dubious about most of these explanations, largely because such matters have long been with us without an accompanying crisis of mental illness.

My explanation is that our children are having their childhood stolen from them, and at some level they know it. They kick against this with rage and frustration. But it is important to note that this is a rise in mental illness, not unhappiness. They are different things. Mental illness is an unhappiness that is unsanctioned, denied essentially. It is unhappiness that does not know itself. It is unhappiness that arises from confusion and double standards. Why this confusion? Chiefly, it is down to the idea that achievement and competition are all important. There is nothing wrong with this as an ethos, but achievement of what? Competition for what? And when does it end?

In the world I grew up in, when mental illness among young people was largely unheard of, achievement, although desirable, was not considered particularly important. Many people from my very ordinary background didn’t pass any important exams. Few went to university. And it wasn’t thought a big deal, because it was recognised that not everyone could be outstanding or high achieving. It wasn’t a failure to get a job in a local shop or factory, find somewhere OK to live and have a couple of kids. It was normal and many people embraced it.

But things have changed in the world of societal expectation. The myth seems to have arisen that individual striving and effort will always get you what you want – money, status or a satisfying career. A few generations ago, we were more realistic. The class structure of society, and our own individual limitations – such things were acknowledged then – meant that few of us could hope to hit the heights. But it didn’t matter as long as we had a reasonable job, our community, our homes, our families. Expectations were in line with reality.

Now that middle-class aspirational values have seeped and bled everywhere, this is no longer the case. Not only are we told that we can do anything if we want to, but that we should. We must all become middle class, or count ourselves a failure. Competitive narcissism runs rampant.

It is bad enough for those who come from a background that invests in this – the ambitious middle class. To get sucked in from a culture that does not invest in it, or have much of a chance in the race – well, no wonder some children are either rejecting education, or experiencing mental illnesses.

Achievement is healthy, but we don’t all have to hit the heights to feel good about ourselves. Society is made up of mostly low- or medium-achievers, and to make us feel ashamed of who we are is a great burden. Success should be redefined as achieving what you feel capable of, and what lies within the realm of possibility – not what society tells you that you must achieve in order to conform to a fantasy that, for most, only exists in glossy magazines and university prospectuses.

@timlottwriter

Our children are paying a high price for society’s vision of success

Turning back the biological clock comes at a price | Rhiannon Lucy Cosslett

The astute woman of child-bearing age develops a facility to tune out of alarmist headlines about the biological clock. But every now and again an expert comes along and offers the kind of soundbite that cuts through. The latest came courtesy of Gillian Lockwood, medical director of Midland Fertility Clinic, who last month said: “It may not be true that women should be having babies at the time of GCSEs, but they shouldn’t leave it much later than graduation. Age 25 is exactly the time when today’s young women have left university, are trying to get off on a good career, trying to find someone who wants to have babies with them, and trying to get on the housing ladder.”

Twenty-five? In a supportive society, women keen to conceive in their mid-twenties might find it realistic to do so. But not in the current climate, where the financial crisis, spiralling property prices, unstable employment, austerity and low pay have combined to trap many members of Generation Y in perpetual financial adolescence.

Millennials talk to their parents about drugs, sex and jobs

Last year I interviewed people in their twenties up and down the UK who desperately wanted children but felt their situation was too precarious. Many were living in rented accommodation or with their parents, faced low pay, unemployment or insecure work, and felt they had no chance of getting on the property ladder anytime soon. They are, essentially, priced out of parenthood.

It’s a depressing state of affairs that has left some wondering whether reproductive technologies might be the answer. What if you could freeze your eggs and put having a baby literally on ice until things were looking a tad more grown up?

In the US, the marketing of egg freezing as a kind of insurance policy for millennials is already in full swing. Facebook, Apple, and the US military now offer egg freezing as an employee benefit. Fertility company EggBanxx estimates that by 2018, 76,000 women will have frozen their eggs. EggBanxx, which describes itself as “Uber, but for egg freezing”, has slogans including “Smart women freeze” and “Lean in, but freeze first!” and throws “Let’s chill” events aimed at young women. Could the UK soon follow suit, as more and more women put off the decision to have children? Inquiries into egg freezing at private clinics in Britain reportedly surged by 400% between 2014 and 2015, and more than half of these came from women under-35.

In the US, the marketing of egg freezing is in full swing. Facebook and Apple now offer it as an employee benefit

Mehrunissa, 23, plans to freeze her eggs in the next two years. “Ambitious, career-driven women often find it difficult to settle down – in terms of finding suitable partners,” she says. “Other women, who feel more of a time pressure to have kids, feel like they’re in a desperate situation where they need to find a man and settle as soon as possible, so freezing your eggs makes you immune to that sort of pressure, and also puts you in absolute control of your life. I envisage that when I do decide to have kids it’ll be for the right reasons rather than a feeling of desperation or losing a battle against time.”

She seems far too young to be thinking about such an extreme course of action but then again, the younger a woman is when she freezes her eggs, the better the chances are of conception. Not that there are any guarantees, and it can very costly – at least £5,000 in some London clinics; the more cycles you invest in, the better is your chance of conceiving. As for Mehrunissa’s aim of being in “absolute control”, when it comes to fertility, there is no such thing. But in a world in which young people lack stability it isn’t hard to understand why the illusion of it can be seductive.

“Social circumstances have delayed a lot of things. It’s not just about not having children younger but about not having a job, or a stable career younger, or not having a home,” explains Angel Petropanagos, a research associate in impact ethics at Dalhousie University in Canada, who spoke at a recent debate in the UK organised by the Progress Educational Trust, asking “Can you put motherhood on ice?”

“There is all this financial and social instability that has contributed to delayed parenting,” Petropanagos continues, but “one of the challenges is that in the US, egg freezing is really targeting a particular demographic with their advertising … upper middle-class women who are already privileged. These are the kind of women whose parents and grandparents are paying for egg freezing as a graduation present.”

Related: I had my eggs frozen. I wish someone had told me how difficult it was | Eleanor Morgan

And this is one of the major problems with egg freezing: that it is being portrayed as an option available for all women to delay motherhood, regardless of their income, when in reality, the costs are prohibitive to many, especially younger women. But because the clinics are arguing that your twenties are what Petropanagos calls the reproductive “sweet spot” when your eggs are more likely to yield results, young women are buying into the dream.

Sarah Martins Da Silva, a consultant gynaecologist based in Dundee, points out that “social egg freezing is a personal choice, but you could argue that it actually discriminates against this [younger] demographic as egg freezing needs to be self-funded, and costs several thousand pounds.” She refers to a report by the Centre for Population Change which details how womenwho remain childless largely do so because they have never wanted children, or because they simply haven’t met the right person yet. “On that basis, I would say the target market is the 30 to 35-year-old career woman who has not met Mr Right, who recognises that they are at risk of fertility problems as they get older, and who wants to preserve better quality eggs and an option to use them in future fertility treatment.”

At 34, Natalie (not her real name) could be said to fit into that category. “I’m still very much living that ‘young professional in London’ lifestyle,” she says. “Although I am in my thirties I don’t feel stable enough in myself [to have children]. I part-own a house and earn a decent wage, but freezing my eggs just seems like it could potentially buy me some time. It’s pricey, though, which is why it’s still only a consideration.”

In the UK, young women are not yet being aggressively targeted by clinics offering egg freezing. But as it takes longer for them to get on the career and housing ladders, you do wonder how many others will soon be faced with the same choice, and how companies will take advantage of that anxiety. If egg freezing is hawked as a sort of “wonder solution”, it is surely only a matter of time.

Related: London hits record low for new affordable housing, figures show

The danger is that the overwhelming focus of this will be on the individual reproductive choices of wealthier women, when instead we should be addressing the social structures preventing young women on lower incomes settling down sooner and having children earlier. Lack of affordable housing and maternity and paternity pay, along with (in)flexible or unreliable employment and prohibitively expensive childcare are all factors in our reproductive choices. It would do all women an injustice to neglect to challenge these barriers because of egg-freezing technology’s seemingly miraculous allure.

Turning back the biological clock comes at a price | Rhiannon Lucy Cosslett

Poor Habits That Can Price You Your Task

Misrepresenting your credentials or intentionally plagiarizing, lying on time sheets or billable hrs, misusing cost accounts or abusing company credit cards, stealing the kudos for a co-workers’ accomplishments, or otherwise robbing your employers blind can all value you your occupation.

“The surest way for any of us to bring our career to a sudden and miserable finish is to have the habit of hedging the truth and lying in techniques small and large,” says Ann Kaiser Stearns, Ph.D., psychologist and very best-promoting author of Living By means of Private Crisis (Idyll Arbor Press, 2010). “Dishonesty is a slippery slope with a devastating crash waiting at the end,” she adds. “Whether we function in business or banking, academia or the army, publishing or philanthropy, housing or overall health care, the marketplace or the ministry, if we lack integrity and betray our employer, we don’t deserve to keep our jobs.”

Poor Habits That Can Price You Your Task

Vaccine price lower pledge not ample, critics inform Pfizer

The pharmaceutical company Pfizer has pledged to minimize the value of its new vaccine against a deadly disease by six%, but campaigners say the reduction is nowhere near enough.

Final week Médecins Sans Frontières named for a reduction of the price of the vaccine against pneumococcal ailment to $ five (£3.30) per little one, claiming the two firms manufacturing it had been producing huge revenue.

At a donor conference in Berlin hosted by Angela Merkel to increase funds for the international vaccines alliance Gavi, Pfizer supplied to reduce the price from $ three.30 a dose to $ 3.10. Each youngster needs 3 doses.

The other firm making the vaccine, the British drugmaker GlaxoSmithKline, mentioned it would freeze the price for ten years for middle-revenue countries that drop Gavi funding because of their escalating wealth.

But MSF mentioned the concessions had been not adequate. “Pfizer’s small price lower for the pneumococcal vaccine is inadequate. We require to see the two Pfizer and GlaxoSmithKline get bolder measures to minimize the cost of this vaccine in building countries so that a lot more youngsters can be protected towards pneumonia,” said Kate Elder, vaccines policy adviser for MSF’s entry campaign.

“Considering Pfizer has raked in practically $ 16bn for this vaccine in just 4 many years, we believe the firm can do significantly far more than a meagre six% discount.”

MSF also would like significantly greater transparency from organizations, complaining that they do not reveal the charges of studying, establishing and manufacturing vaccines nor the charges they charge in different countries. The Guardian launched a crowdsourcing exercise asking readers close to the world to aid fill in the gaps by finding out the value of the vaccine in which they dwell.

“Pfizer claims that it is generating the pneumococcal vaccine accessible to the poorest countries at beneath cost value, but we really do not know if that’s accurate,” Elder mentioned. “We require to see the two Pfizer and GSK opening up their books – being transparent for a adjust – on what the genuine costs of the study, development and production of this vaccine are. The secrecy that shrouds the vaccine industry helps make it practically impossible to have an educated discussion on sensible vaccine costs.”

Vaccine price lower pledge not ample, critics inform Pfizer

Atkins Ciwem environmental movie of the 12 months 2014: the toxic price of leather - video

On the banks of the Ganges River in northern India lies Kanpur, the largest producer of leather goods in the country. Its good results comes at important environmental and social price, with toxic chemical substances launched into neighborhood waterways poisoning farmland and causing residents an array of well being problems

• Supply: Sean Gallagher


• Length: 9min 05sec


• theguardian.com


• Thursday 26 June 2014

Atkins Ciwem environmental movie of the 12 months 2014: the toxic price of leather - video

GST on fresh food could price lives and include $1bn to wellness spending budget, say doctors

Scrapping the goods and companies tax exemption for fresh fruit and vegetables could expense lives and include a lot more than $ 1bn to the wellness spending budget, doctors have mentioned.

Analysis published in the Health-related Journal of Australia last yr estimated that fruit and vegetable consumption would decline by practically 5% if the GST have been broadened to include fresh meals.

“We determine that [this] could cost about a hundred,000 wellness existence-years above the lifetime of the 2003 Australian grownup population,” stated the University of Queensland authors Lennert Veerman and Linda Cobiac.

Feasible consequences included “an additional 90,000 cases of ischaemic heart illness, stroke and cancer” each year, rising healthcare fees by around $ 1.04bn.

Speaking on ABC radio on Tuesday, the Queensland Liberal senator Ian Macdonald named for the GST to be broadened to include fresh meals, in line with the unique model proposed by the former prime minister John Howard in 1998.

The idea was swiftly ruled out by Tony Abbott, who informed 2UE radio his view was that Australians “pay a lot more than ample tax already”.

The West Australian premier, Colin Barnett, final week also signalled his assistance for broadening the tax, saying it was “silly” to exempt fresh food from the GST whilst nonetheless applying it to foods in packages.

Public overall health advocates say a tax increase on healthier food would have “devastating consequences”.

“We know lower-income folks devote a massive proportion of their income on food, and it has the likely to be regressive at a time when the recent dietary survey showed that men and women are not eating almost ample fruit and vegetables,” explained Jane Martin, executive manager of the Obesity Policy Coalition.

“Price is a key driver around food determination-generating … We need to be delivering incentives for folks to eat far more healthily, not disincentives,” she said.

This was especially critical “given the cuts to prevention in the budget”, she mentioned, referring to the price range prepare to near the Australian Nationwide Preventative Well being Company.

In latest years poor diet regime and weight problems have overtaken tobacco as the leading trigger of condition between Australians.

GST on fresh food could price lives and include $1bn to wellness spending budget, say doctors

Price of dementia: the households struggling to get NHS support

Tenacious Ann Reid has fought hard to get Continuing Healthcare funding for her mother Peggy Belcher. Photograph: Sam Mellish/Age Uk

1000′s of relatives and carers of dementia sufferers are battling to obtain funding in direction of crippling care bills. Under the NHS Continuing Healthcare scheme, older men and women can qualify to have care and nursing property charges paid in total if they are judged to have persistent overall health wants. This funds can aid allieviate the burden for households who are otherwise forced to invest each and every penny and sell their home to meet the expense of care.

There is no ceiling on the quantity that can be paid out, no means test and it is not age related. However entry to this fund can be a specific struggle for people struggling from dementia.

Those acting on their behalf are typically forced through lengthy assessments and appeal processes.

“This is creating needless pressure and anxiousness for sufferers and their families, when all they want is access to healthcare,” says George McNamara, head of policy for the Alzeimer’s Society. “They shouldn’t be impacted by a program that isn’t working.”

As Dementia Awareness Week kicked off on Sunday, charities stated a lot more should be completed to enhance awareness of the troubles. “The care technique needs an overhaul to improve accessibility to funding,” says Ruthe Isden, overall health programme director at Age Uk. “It truly is extremely complicated, and folks struggle to know what they are entitled to.”

Peggy Belcher, 95, has suffered with dementia for 14 years. She is bedridden, unaware of her surroundings, struggles to communicate and receives round-the-clock care. Without having the tenacity of her daughter, Ann Reid, 68, she would not have acquired Continuing Healthcare funding.

Ann sold her mother’s two-bedroom property for £176,000 nine many years in the past to shell out for care home charges that have so far amounted to £222,000.

Peggy had some cost savings, but they had been swiftly employed to fund the £850 weekly price for the property in Bexhill-on-Sea, East Sussex.

“She is now on finish-of-lifestyle care,” says Reid. “The degree of care is exceptional. But every single penny has been put towards this.”

Collectively with nurses at the house, Reid applied for funding on behalf of her mother in February 2013. Despite describing the evaluation as a “bureaucratic nightmare”, she managed to get her mother’s care and accommodation fees funded, with payments backdated to December 2012.

Access is assessed by regional authorities and clinical commissioning groups (CCGs). “I had to invest 3 hrs answering inquiries,” says Reid. “It was a seemingly endless tick-box – but luckily I had a brilliant nurse to assist.”

She was asked about every little thing from her mother’s propensity to bed sores to no matter whether she could sit up or talk. “At the finish of it I would totally had enough. I burst into tears as the procedure was emotionally exhausting.”

The assessor told Reid she could appeal if the funding was turned down, but even then it wasn’t guaranteed. “I wouldn’t have taken no for answer – but I felt they have been attempting to put me off. I hear that a whole lot of individuals give up,” she says. “But you have to be prepared to challenge their decisions.”

Many people continue to be unaware of Continuing Healthcare. In accordance to charities this kind of as Age Uk and the Alzheimer’s Society, tens of 1000′s of individuals who may qualify are not applying. A single issue, they say, is that the NHS faces stringent financial targets. “It might be tempting for CCGs to prioritise their bottom line when the primary concern must be delivering seamless integrated care,” says McNamara.

There are all around 59,000 men and women acquiring Continuing Healthcare, according to the Division of Health. Nonetheless, the Alzeimer’s Society believes many far more could be eligible.

The possibility of good results depends significantly on in which you live. There is a “nationwide framework” which covers England and Wales, but it is relatively of a postcode lottery. Continuing Healthcare is accessible in Northern Ireland, but the eligibility criteria vary. Scotland is reforming its principles and funding may possibly be limited.

“There are huge variations in the quantity of people getting this in diverse elements of the country,” says Isden. “Various regions have responded differently to the monetary pressures that they face. The framework is not often followed appropriately with various eligibility criteria across distinct neighborhood authorities.”

Dementia is too frequently seen as a organic component of ageing, with the needs of sufferers failing to be correctly assessed.

“The method is fraught with issues, and a lot of flip to us for aid,” says Stephanie Rose, director of Solicitors for the Elderly. “It truly is a minefield with all the administration and limited money accessible – we are seeing growing numbers of men and women obtaining to appeal, which is a prolonged-winded procedure.”

If you get this route, several solicitors will offer representation on a no-win, no-charge basis. Alternatively, charities offer cost-free tips. To support your situation proof can be located in the information of care properties, hospitals and GPs. You can also inquire to see these beneath the Access to Healthcare Records Act.

A spokesperson for the Division of Wellness says: “Eligibility for NHS Continuing Healthcare is based on an assessment of an individual’s all round needs. It is not issue particular. We are operating with NHS England, charities and other organisations, to make certain individuals who should get this are in a position to.”

■ Dementia Awareness Week 2014 runs from 18-24 May. Find out a lot more at alzheimers.org.united kingdom/daw2014 or call the helpline on 0300 222 eleven 22. The Alzeimer’s Society has set up a volunteer group to assist with the appeal method for NHS Continuing Healthcare. For much more suggestions, you can also check out ageuk.org or call on 0800 169 6565. Make contact with Solicitors for the Elderly on 0844 5676173 or at solicitorsfortheelderly.com

You can get in touch with your regional CCG and request for an assessment for Continuing Healthcare. Particulars of these are obtainable on the NHS web site. “Or an evaluation may possibly be accomplished by a dementia group in a care home, or following a discussion with a local authority or GP,” says Isden from Age United kingdom. “Ideally, specialists should be initiating this, so the funding support is not passively waiting for someone to request for it.”

The regular expense of nursing care in England is £750 a week, or £39,000 a 12 months, according to Laing and Buisson. Turning to regional authority funding, anybody with financial savings above £23,000 (£23,750 in Wales) has to spend for residential care, until finally their assets fall beneath that threshold. Even with cash flow below this, a contribution might even now have to be produced.The government is introducing a £72,000 cap on charges in April 2016, but experts warn that this does not cover accommodation or foods payments. “The scenario with regard to prolonged-term care charges is only going to get worse – the system is in disarray,” says Rose from Solicitors for the Elderly.

Price of dementia: the households struggling to get NHS support

Melbourne could be soon be a smoke-free city but at what price tag? | Amy Gray

Melbourne city council has gone on its yearly well being kick and, alternatively of vowing to jog far more or investigate that whole clean consuming malarkey, commenced muttering about banning smoking from the city centre. It does this with tiresome regularity.

My council – Melbourne city council, a council so keen to nag it will actually flip up on my doorstep if I’m a day late to re-register my cat – wants to come in between me and my smoking. Their plan is to ban smoking all through the CBD with the exception of little shelters of smokey iniquity the place we are supposed to confine ourselves.

Degraves street in Melbourne. Photograph: Andrea Schaffer/Flickr

On the surface, this is similar to how Tokyo manages smoking, herding men and women into carcinogenic enclaves. In contrast to Melbourne, this measure is produced out of courtesy, to keep away from generating mess or accidentally burning other people with a dangling fag. The Tokyo method has a unique side effect: these smoking enclosures are regularly visited by police who enjoy harassing any individual lingering also extended in excess of a durrie. But Tokyo’s smoking community nonetheless has the alternative of bars and eating places that enable them to puff away.

Melbourne city council’s proposal is spectacularly stupid, as it is moralising towards a legal substance. It’s a totally unenforceable proposal that positions the public as police or will exist as a revenue-raising spree, like the occasional high-priced reminder we’re not permitted to jaywalk.

It also fails on the trigger-and impact sense test: for all the novelty of producing the world’s 1st smoke-free city, the council has efficiently ensured that Exhibition and Treasury Gardens will also turn into the world’s initial biggest heritage listed smoking lounges.

What Melbourne city council also fails to contemplate is that this will waste the hundreds of thousands spent attempting to convince men and women that the CBD is the ideal combine of retail, corporate, entertainment and residential precincts. Record numbers of people are moving to the CBD and it is set to double in the subsequent decade, with folks discovering it’s less costly to reside here than in the suburbs. Residential developments carry on at a speedy pace providing a wealthy variety of properties, from bland ghettoes for uni students to bland penthouses for the rich.

As this kind of, the city has changed to adapt, with an growing array of supermarkets, house retail and residential companies. It is the excellent city with options to get about, operate, amuse your self and grab a loaf of extremely overpriced bread on the way home. This has been deliberately encouraged by Melbourne city council.

However, despite all the inducements, the council now desires men and women to stop smoking. It is like asking everyone to come to a get together, promising it will be off the hook only to find it is actually a Baptist bake sale. You know, the individuals are nice and mean nicely, but you just can’t be oneself and have entertaining simply because it is completely distinct to what was sold.

Behind smoking, the second greatest (and also legal) killer in Australia is alcohol. Nevertheless we even now have 1 significant street in the CBD devoted to receiving bladdered and Melbourne bars are nearly as ubiquitous as Melbourne cafés. Or Pieface. Apparently some legal substances are far more tolerated and profitable than other folks.

Whatever attempts at prohibition from Melbourne city council, its residents will adapt. In fact, Melburnians are experienced at adapting with style to recreate an intriguing city regardless of the attempts of the council to curb our vices. The abortive and arbitrary lockout, which stopped individuals entering bars following 2am, affected smokers so a lot that rooftop bars were produced in response to evade the council’s nannying, allowing companies to prosper.

When it comes to arranging a city, Melbourne’s residents are equal (and possibly more effective) city planners who can skirt the prudish attempts of the Council. Melbourne’s rich laneway system is a wonderful example – a response to present interaction – and the ghost town status of Docklands an instance of poor options manufactured disconnected from its population – a precinct to response a need no one expressed.

So, if Melbourne city council are seeking for a way to destroy off its entertainment and residential possibilities but quicker than cancer, it is going the appropriate way. And although I can nonetheless (barely) afford cigarettes, the council should inquire itself: can it afford this?

Melbourne could be soon be a smoke-free city but at what price tag? | Amy Gray

A fantastic loved ones medical professional is a treasure past price

The impression was of a gentler, more innocent healthcare age, now vanished in the mists of nostalgia – if, without a doubt it ever existed: the era idealised in Mrs Dale’s Diary and Dr Finlay’s Casebook, when doctors, like the parish priest or the dear previous loved ones solicitor, have been kindly, twinkling authority figures.

That such loved ones medical doctors existed outside the imaginations of novelists and radio scriptwriters is beyond doubt. For the 1st decade of my lifestyle I had one of my very own. Dr Chalmers was a pale, befreckled Scot with a manner of infinite charm. I was a sickly kid, so I had plenty of opportunities to visit him at his practice, with its magical smell of surgical spirit and anything much more ominous – formaldehyde? Ether? I loved him so a lot that for many years afterwards, getting sick had a particular glamour – until finally a succession of incompetent medical professionals briskly cured me of that harmful misapprehension.

The age of the beloved family physician is lengthy gone – overtaken by group practice, NHS reforms, and the extraordinary pressures on the general practice infrastructure, not to mention the peremptory sense of entitlement felt by contemporary patients and the corresponding decline of the GP as an authority figure.

Dr Hughes’s practice manager remarked that he was “like your old-fashioned medical doctor, who would go out of his way to do property visits and to get to know everyone personally”. That dedication to duty meant that his appointments overran, and frequently stored him at function till 11pm. As an individual effort, it is heroic. As a model for basic practice, it is not sustainable.

Yet there is a universal message in what Dr Hughes said about his career: “I have never disliked anyone I met… There are thousands of stories that I will get with me, and all of them so individual.”

That sense of being a part of his patients’ existence stories is undoubtedly the high quality that inspired the 4-hour queue of affectionate tributes. At some basic level, a healing curiosity in the narratives of other people should be the spark that ignites the ambition of everyone who chooses to qualify as a doctor. And though that idealism is effortlessly eroded by targets, spending budget constraints, political exigence and the sheer grind of seeing sick men and women, not all of them grateful or appealing, day soon after day, in the extremely very best medical professionals the spark remains alight.

Because my 1st family members physician retired I have noticed innumerable GPs. Some have been type. Some have been terrible (the girl who dismissed my ruinously detached retinas with the brisk tips that I’d see completely well if I acquired my hair out of my eyes lingers in the memory). Most produced me feel much better, at some point. But the very ideal of them had a high quality of humanity for which I, too, would queue around the block to say thank you.

A fantastic loved ones medical professional is a treasure past price

Overall health Insurance Giants To Unveil Price tag Information In 2015

The elusive aim of offering buyers more transparency about prices will be the aim of a collaborative effort of overall health insurance giants Aetna Aetna (AET), Humana Humana (HUM) and UnitedHealth Group UnitedHealth Group (UNH), the 3 confirmed nowadays. 

A nonprofit organization the three operate with known as Health Care Value Institute mentioned the insurance companies will build and give shoppers “free access to an on the web instrument that will offer you shoppers the most thorough data about the cost and quality of wellness care solutions.”

The wellness insurers, who will carry on to provide their personal info via their very own web web sites, will offer details to the Institute, which will sustain and deal with access to the details in a safe portal. The information on costs will also contain info about quality and other info in an energy to help health care turn into more transparent.

“Consumers, employers and regulatory agencies  will now have a single supply of steady, transparent well being care information primarily based on the most reputable data obtainable, which includes actual charges, which only insurers at present have,” David Newman,  the Overall health Care Expense Institute’s executive director stated in a statement issued this morning. “Voluntarily producing this info obtainable will be of immeasurable value to buyers and other well being method participants as they seek out to manage the price and top quality of care.”

Pondering how Obamacare will influence your wellness care? The Forbes eBook Inside Obamacare: The Fix For America’s Ailing Well being Care Program answers that question and more. Obtainable now at Amazon and Apple.

Old Income Register (Photo credit: Jo Jakeman)

Overall health Insurance Giants To Unveil Price tag Information In 2015

Minimum alcohol price tag not in the public curiosity, says overall health company

Australian drinkers ought to not be forced to pay a minimum cost for alcohol even although the move would almost certainly reduce booze-fuelled harm, the Nationwide Preventive Wellness Agency (NPHA) has stated.

In its long-awaited report, the NPHA concluded a floor value for alcohol was very likely to cut “crime and violence, alcohol-relevant disease and productivity losses”, but stated all round the policy was not in the public interest.

That is primarily simply because a minimal price tag, unlike a tax, would lead to alcohol retailers raking in greater revenue as an alternative of a lot more income going to the government to “be utilised to additional reduce or deal with alcohol-connected harm”, the NPHA said.

“Cost increases in the industry … would movement solely to the private sector under such regulation,” it stated in the report, launched on Thursday.

In the United kingdom, the company explained, it was estimated a minimal alcohol value of 45 pence per standard drink would boost retail earnings by in between €700m ($ 1.05bn) and €2.2bn.

“Hence, the company advises the commonwealth government that a minimum (floor) value for alcohol should not be launched nationally at this time,” the NPHA explained.

The NPHA also said there was robust assistance for alcoholic drinks to be taxed in accordance to alcohol power, not cost, under a “volumetric tax” method.

In addition, the agency urged the government to appear at the wine equalisation tax, which it explained “outcomes in price tag distortions in the alcohol marketplace in certain in favour of inexpensive wine”.

Yet another essential recommendation was for more alcohol data collection, which includes on cider consumption.

The report said a minimum price of about $ one.50 would have the most significant affect on the expense of cask wine, whilst beer and most other types of alcohol would not be affected.

The report has come amid speculation the NPHA is 1 of a quantity of well being agencies marked for abolition in the federal government’s commission of audit.

The audit, due to be unveiled on Thursday, is explained to include 86 suggestions and urge massive cuts to the size of government.

The NPHA was established in 2010 to forestall preventable persistent ailment by targeting well being issues, including obesity, tobacco and alcohol.

Minimum alcohol price tag not in the public curiosity, says overall health company

NHS understaffing might have result on child mortality price, says prime medical doctor

Britain’s leading obstetrician says it is genuine to request whether or not understaffing of maternity care and labour wards is contributing to Britain’s stubbornly high costs of child death and brain harm.

Dr David Richmond, president of the Royal University of Obstetricians and Gynaecologists, has voiced alarm that practically 300 infants a yr are dying during or soon right after birth with a more one,200 ending up with brain injury or other serious well being problems.

The infant deaths, Richmond explained, were due to a variety of concerns. But with maternity units struggling to cope with a baby boom above the previous 10 many years and a shortage of each midwives and physicians, Richmond explained it was “a genuine query to ask” no matter whether stress on assets was contributing to the tragic toll.

“We require to appear at the possibility that understaffing, labour wards that are below pressure and occupied, and stretched facilities may be a factor in some of these poor outcomes,” Richmond told the Guardian in his 1st interview since taking up the publish.

The obstetrician, who represents the UK’s 6,000 maternity medical doctors, also conceded that errors by medical professionals and midwives have been to blame for some of the horrible outcomes.

There have been situations the place personnel produced “tiny, relatively innocuous blunders [which], when combined, lead to a disaster”, he added.

Richmond also mentioned that Britain’s substantial fee of stillbirth – nearly four,000 a 12 months or about 10 a day – was an “appalling” and largely preventable reduction of lifestyle. He voiced specific concern about the 144 babies who died in the course of labour in 2009, the final year for which figures are obtainable, and the 134 who died within the week after birth, regardless of not having a key congenital anomaly.

The United kingdom had the highest stillbirth fee of all but two other individuals amid 35 substantial-earnings nations, in accordance to a review in the health-related journal the Lancet in 2011. Although the numbers have gone down somewhat, “it really is still a good deal of mums in the 21st century that are losing their infants unnecessarily”, he additional.

Workplace of Nationwide Statistics data show that there were 4.9 stillbirths for each one,000 reside births in England and Wales in 2012.

The royal college’s new president mentioned the 22% rise in births above the final decade signifies maternity units are being “squeezed” simply because midwife and physician numbers have not increased at the exact same rate.

Labour wards are getting to cope with as well couple of midwives and 800 fewer consultants than is required to offer the 24/seven care in the 62 units which handle at least five,000 births a 12 months in which problems come up in pregnancy.

“If you need to have to have a advisor there at three in the afternoon, why is it not equally important to have a advisor there at three o’clock in the morning? In my view it is,” Richmond added.

But the NHS’s tight finances indicate there is no reasonable probability of consultant numbers rising from two,200 to the excellent of 3,000, he explained.

Action is also needed to decrease the 1,200 of yearly “close to misses”, Richmond stated, in which complications arise during labour and birth that frequently depart the child temporarily but dangerously deprived of oxygen. The issue, which doctors call “severely hypoxic”, involves infants facing the threat of brain harm and profound lifelong disability.

“These are babies that are born in really poor situation and could have a extremely slow heartbeat or really restricted breathing or not respond to stimulation,” he stated.

Every single such situation can leave the NHS getting to find millions of lbs in compensation to pay out for the significant expense of delivering lifetime care for the child.

The loss of life and quite significant health care consequences for newborns in all these deaths and close to-misses, totalling almost one,500 a yr, constitute “an ongoing tragedy involving probably avoidable extremely serious outcomes” and represents “1,500 person tragedies”, mentioned Richmond.

Asked why the child deaths occur, Richmond replied: “The ideal analogy is to describe them as plane crashes.

“Tons and tons of girls travel by way of pregnancy and labour safely but occasional tragedy occurs. These tragedies are always ‘multifactorial’ and require thorough investigation to establish why. It is not unusual that a series of tiny fairly innocuous mistakes, when combined, lead to a catastrophe.

“There are often no straightforward fixes. The challenge is to be inclined to share these experiences, learn from each other and invest in security.

“There is a big variation: flights are often cancelled for safety motives – health-related emergencies for the duration of pregnancy and labour can not be cancelled,” Richmond mentioned.

Sands, a stillbirth and neonatal deaths charity, mentioned the NHS’s frequently persistent shortage of midwives, in which some hospitals have virtually one particular in five posts unfilled, and probably inferior care at weekends, when frequently less experienced physicians are on duty, have been elements in the UK’s relatively higher child death rates.

“It is a travesty that so a lot of infants die every single year in labour in the United kingdom, devastating the lives of households”, stated Charlotte Bevan, the charity’s senior investigation and prevention advisor.

“In several instances these are tragedies that take place at term, when the baby is prepared to start new life outdoors the womb, and they must never happen. We need to have far more midwives so that women can have continuity of care in pregnancy and 1 to one care in labour.”

The NHS had to offer “a maternity services that functions as effectively at the weekend as it does throughout the weekday, that can react to an increasingly complex pregnancy population”, she added.

Dr Dan Poulter, the overall health minister, stated childbirth on the NHS was protected and perinatal mortality was declining.

“The numbers of stillbirths and infant mortalities are at the lowest amounts given that 1993, but there is nevertheless much more to do. The NHS is a protected spot to give birth, with females reporting large amounts of trust and self-assurance in workers,” explained Poulter, who is also an obstetrician.

The NHS in England has much more than one,500 much more midwives than in 2010 and a record 6,000 far more in instruction, he added.

Because 2012 the NHS has measured hospitals on their progress in decreasing stillbirths and infant deaths, and is making an attempt to much better determine unborn babies who are small for gestational age, simply because many who are stillborn are of beneath regular size.

NHS understaffing might have result on child mortality price, says prime medical doctor