The app that aims to tackle the chronic NHS midwife shortage

The findings of a new NCT report, which revealed that tens of thousands of women were having to seek help at accident and emergency (A&E) departments or with their GP because they cannot reach a midwife, do not come as a surprise to Hannah Harvey.

Harvey has been a midwife for five years. She says that while she and her colleagues care deeply about the women they look after, a nationwide shortage of midwives and government cutbacks to training bursaries mean they often struggle to provide the necessary support to new mums. According to the report by the NCT (pdf) and National Federation of Women’s Institutes, 36% of women who were not able to see a midwife as often as they required postnatally said that it caused them a great deal of concern while almost a third (31%) said that it resulted in a delay of a health problem (for them or their baby) being diagnosed and treated. The Royal College of Midwives (RCM) estimates England has a shortfall of 3,500 midwives.

“It’s really difficult,” says Harvey, who works in West Sussex. “Of course [as midwives] we want to provide round-the-clock care, to spend two or three hours with a new mum teaching her how to breastfeed, and offering the other support she needs, but there’s just not the capacity to do it. We’ve got to look at other ways of helping people.”

It was this challenge, alongside spotting a review that found high numbers of pregnant women use the internet to search for advice, that prompted Harvey to take matters into her own hands. In July 2016, she launched Ask the Midwife, an app that enables mums-to-be to contact midwives for advice.

“I [wanted to] create something where users could ask questions and get a fast response from a midwife, instead of using Google or parenting forums, where you’re not getting professional advice,” says Harvey.

“I saw it as a way of helping the women, [somewhere] they could go and access advice and the extra care they needed and they wanted. It’s also a platform to alleviate the pressure on the NHS and the midwives working in the community and the hospitals, who don’t have the time to spend with people who might want a bit more help with their newborn baby.”

Harvey initially used £10,000 of her own savings and raised £50,000 from friends and family to help develop and launch Ask the Midwife on iOS last year. Eight months after starting the business, the app has 4,000 users across the UK, and a network of 45 registered midwives. Harvey initially found the midwives by advertising for consultant positions, even receiving 500 applications in three days. Each midwife gets paid 25% commission per question or chat they answer. Many of the midwives still work for the NHS but use Ask the Midwife to earn extra money. Harvey estimates that 15-20% of conversations need to be escalated to an in-person consultation.

For the expectant mothers, there’s a small charge (from 99p) to ask a question, increasing to £19.99 a month for support during the nine months of pregnancy and up to 12 weeks postnatally. This includes unlimited use of the “ask” and live chat services, with responses from a registered midwife promised within an hour. Midwives are available seven days a week, 14 hours a day, with plans to make it a 24-hour service in the near future.

“We get a lot of early pregnancy questions, after someone goes to their GP but before they have their first midwife appointment at eight to 10 weeks. And then, postnatally, we get a lot of breastfeeding and feeding questions. If you’ve never had a newborn baby before, you don’t know what is normal.”

Digital technology is rising in popularity among expectant mothers. According to the NCT’s study, 34% of women are choosing to use an app to support their pregnancy – two thirds (65%) used apps to track milestones, such as when the baby kicked or to track contractions, and a third (32%) used digital technology to access information about diet, lifestyle or health issues. Popular apps include BabyBump, What to Expect (from the authors of What to Expect when you’re Expecting), and My Pregnancy Today, although the majority available have been developed in the US.

Jacque Gerrard, the RCM’s director for England says such digital technology can be useful, as long as the advice is backed up by evidence-based information and carries a health warning. “Women have access to mobile phones, the internet and they want instant answers, so I think [such digital technology] is a positive step,” she says. “But what I would say is it has to be used with caution. Sometimes women do need access to a midwife or a doctor and that’s got to be the first point of contact. The NHS does provide access to a midwife 24/7, 365 days of the year, no matter where you are in the country.” The RCM is itself currently developing a hub for pregnant women, including a live help function.

Harvey is in talk with NHS trusts who are considering piloting her service in their areas, and says she’d eventually like to be able to offer the service for free – although finding funding will be the first priority; she’s currently plotting an investment round with angel investors. There are also plans to expand into other countries once the market is established in the UK.

But it’s been a learning curve for the midwife, who still juggles working night shifts with developing the business. “It’s completely different to my NHS work,” she says. “I’ve never been an entrepreneur, but the fact that I’m getting that feedback from people saying this is something they want is keeping me going and giving me that drive and determination to make sure it succeeds.” Harvey says the feedback so far has been very positive and the app recently won best parenting app and best educational app at the Mumii Family awards.

“[Entrepreneurship] has been the best experience I’ve had,” she says. “I was at a baby show in London recently and somebody said she’d used my app in early pregnancy and it was the best money she’d ever spent. She had been really worried she was losing her baby, her GP hadn’t reassured her and she didn’t know where to go. She had a 10-minute chat with one of the midwives and felt really reassured. Then she realised I was the one she’d spoken to and she burst into tears, giving me a hug. That for me felt like the icing on the cake – this is why I’m doing it, this is why I’ve put all the hard work in.”

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The app that aims to tackle the chronic NHS midwife shortage

Doctors shortage left 4 million patients without cover last year

At least 4 million people were left without access to an out-of-hours doctor at some point last year because of inadequate staff cover and pressure on resources, it has been revealed.

The figures, which have raised alarm about patient safety in the NHS, were obtained by the GP’s magazine Pulse in a freedom of information request to 104 out-of-hours commissioners of care.

Ten of the providers, covering about 4 million people, admitted that on some occasions last year shifts had been left unfilled, leaving patients with no out-of-hours cover.

In the areas hit, patients were told to go to A&E, while services had to rely on non-medically qualified urgent health practitioners, or nurses and paramedics.

Pulse identified five of the areas worst hit in 2016 as:

• Peterborough, where there were nine shifts and 230,000 patients were left without access to an out-of-hours GP. All children under the age of four were “defaulted” to A&E, the magazine said.


• Tower Hamlets, east London, where no GP was available on 12 occasions. This meant a population of more than 250,000 was told to contact A&E or the “community night team”.


• Doncaster, where nurses and paramedics had to cover a population of 300,000 patients on three occasions, with no GP available by phone on one occasion.


• The Highlands, which has a population of 340,000, where there were 31 times when out-of-hours centres were closed due to lack of staff. Shifts there had to be covered by centres up to a 30-minute drive away.


• In southern and western Northern Ireland, the survey found that one GP regularly had to cover 370,000 patients overnight.

Many of the doctors in those areas spoke of their concern for the safety of patients.

Dr Frances O’Hagan, who works for the out-of-hours service in southern and western Northern Ireland told Pulse the system was “broken”. She added: “Having only one doctor on call used to be rare but is becoming the norm.”

Dr Dean Eggitt, medical secretary for Doncaste’sr local medical committee, said “the system is not safe”. He added: “I think 24-hours-a-day patients should be able to contact a senior clinician, a GP. If that is not available that is a very serious situation that must be remedied asap.”

Dr Alan Woodall, an out-of-hours GP in England and a GP partner in Wales, told Pulse: “The pressures on the out-of-hours service are approaching critical.

“I cover an area that stretches 800 sq miles on the evening shift because there is nobody else. It only takes two sick people at either end of the patch to result in doctors having to be pulled in from other patches, leaving their area uncovered. We are constantly trying to firefight demand.

“Because of the rota gaps and pressure on resources, we will have to employ a lot of urgent care practitioners and paramedics to help us cope.”
Other GPs told Pulse high insurance costs were a factor in why doctors turned down shifts.

Dr Emma Rowley-Conwy, who works in south-east London, said: “Indemnity is a deterrent as it costs about 10 an hour to get insurance from a defence organisation.”

The Royal College of GPs urged the government to do more to make out-of-hours working more attractive to family doctors.

Prof Helen Stokes-Lampard, chair of the organisation, said more GPs were needed to tackle a national shortage, but the high cost of insurance was also to blame.

She said patients should be able to access GPs when they need it, and that it “very concerning” that this was not always the case.

Stokes-Lampard said the Pulse report “hammers home how important it is for the government to make good on its promise to deliver 5,000 more extra GPs by 2020”.

Ruth Rankine, deputy chief inspector of general practice at the Care Quality Commission, said

“If we find on our inspections that staffing levels are leading to patients receiving unsafe care and treatment, including delays in response times, then we have a range of enforcement powers we can use to ensure that appropriate action is taken.”

Doctors shortage left 4 million patients without cover last year

UK midwife shortage leaves women feeling like cattle, report finds

A chronic shortage of midwives across the UK means women in labour are left feeling unsafe and frightened or as if they are being treated “like cattle” or “on a conveyor belt”, a new report has found.

In a study of 2,500 women who have given birth since 2014, half were found to have experienced at least one “red flag” event such as not getting timely access to pain relief due to insufficient staffing levels.

The research conducted by the National Childbirth Trust (NCT) and the National Federation of Women’s Institutes (NFWI) found that since a similar report four years ago there has been “scant progress” in women’s experiences of giving birth under the NHS.

A red flag problem is defined by the National Institute for Health and Care Excellence (Nice) as a “warning sign that something may be wrong with midwifery staffing”.

Problems include delays of up to an hour or more in washing or suturing, medication doses being missed, delays of 30 minutes or more in getting pain relief, or when one midwife is not able to provide continuous one-to-one care and support to a woman during established labour.

The report found 17% of women did not get such one-to-one care from midwives, while more than a third who required or received pain relief experienced a delay of 30 minutes or more. Some even reported suffering post-traumatic stress as a result of the way they were treated while giving birth.

Health experts said the findings should serve as a warning to the government that staffing levels are at crisis point. Elizabeth Duff, a senior policy adviser at the NCT, said: “Our research has exposed a crisis in maternity care. No woman should have to suffer a red flag event when bringing a baby into the world. Severe staffing shortages must be acted on so that every family receives an acceptable level of care.”

The study found that 89% of women saw between one and six midwives during their pregnancy with most seeing between one and four. While 88% of women had never met any of the midwives who looked after them during their birth, just over half of those said it did not make a difference to them, mainly due to the professionalism of the midwives caring for them. But 12% said this made them feel alone and vulnerable and 6% said it made them feel unsafe.

Some women wrote about feeling like cattle or a machine, while others reported that a negative birth experience had had a lasting impact on them. One said: “I received a very ‘robotic’ care. It wasn’t very personal and I felt like just another person on the conveyor belt.”

Another said: “I wasn’t treated as a human. I was just a product on a conveyor belt. I was not respected and my birth has left me suffering post-traumatic stress disorder.”

One pointed to staffing issues, saying: “My chosen hospital ward and adjoining birth centre were extremely busy, or so I kept being told on the phone, which resulted in me having an unplanned home birth.”

Another new mother expressed her disappointment at being unable to have the labour she wanted because of “staffing issues”. She said: “There was no room for me on the delivery ward. I ended up giving birth in the antenatal ward, which meant I couldn’t get either a water birth or an epidural.”

Once women had given birth, almost one in five (18%) said they had not seen a midwife as often as they needed, with 36% saying this had caused them great concern. More than a third of women said the diagnosis of a health problem had been delayed due to lack of postnatal care.

Marylyn Haines Evans, the chair of public affairs at the NFWI, said: “The findings from this report show that chronic midwife shortages, an estimated 3,500 in England alone, continue to undermine the delivery of high-quality care for women and their families.”

Louise Silverton, the director for midwifery at the Royal College of Midwives, said the report should be a “red flag event for this government”. She said: “The fact that half of women have experienced a red flag event is hugely worrying. It is a sign of services under too much pressure, with too few resources and not enough staff.”

UK midwife shortage leaves women feeling like cattle, report finds

Brexit could make NHS shortage of nurses worse, says report

Brexit is set to cause a severe shortage of nurses in the NHS, which is already facing a chronic lack of them in many hospitals, research suggests.

Britain’s decision to leave the EU could deprive the health service of nurses from countries such as Spain, Portugal and Ireland, from which it has recruited heavily in recent years, analysis by the Institute for Employment Studies found.

A growing reluctance among EU nurses to come to work in the NHS could pose serious difficulties for hospitals, some of which get as many as 20% of their nurses from the European Economic Area.

The potential of EU nurses could also prove problematic because it would coincide with a spike in demand for care caused by a growing number of over-85-year-olds in the population, putting even greater strain on the NHS, according to the IES.

“The current and projected shortage of nurses has left the NHS nursing workforce in England particularly vulnerable to any disruption to its recruitment pipelines, both from the EEA and outside of it,” says the study, which was led by Dr Rachel Marangozov.

“Whatever form Brexit eventually takes, it could well lead to a reduced supply of labour from the EU. Given the current uncertainty around the status of EU workers, many EU nurses may voluntarily choose not to take up positions in the UK, while those already working here could make plans to return home if they feel unwelcome or no longer see a future in the UK.”

Non-UK EU nurses make up almost 5% of the total NHS nursing workforce in England. Hospitals in London, the Thames Valley and east of England will be hardest hit by EU nurses no longer coming to Britain because they rely so heavily on them, the IES says.

For example, 20.3% of nurses at the Royal Brompton and Harefield specialist heart and lung trust in London are from the EU, as are 18.4% of nurses at Queen Elizabeth Hospital in King’s Lynn in Norfolk and 15.4% at Papworth, another heart and lung centre of excellence, in Cambridgeshire.

Jeremy Hunt, the health secretary, and NHS leaders have voiced deep unease about Brexit potentially exacerbating the existing big gaps across the health and social care workforce and have praised EU nationals’ contribution to the NHS in an effort to persuade them to stay.

The Royal College of Nursing said the findings showed that problems in nurse recruitment could reach “catastrophic proportions”. It said the NHS was facing a perfect storm of an ageing population and growing need for healthcare coinciding with Brexit and fewer nurses being trained at British universities in the wake of the government deciding to axe bursaries for student nurses.

Applications to study nursing are down 20% for next year. “Coupled with the effects of Brexit, this may become a double whammy for the nursing profession which could make NHS services nigh-on impossible to sustain,” said Stephanie Aiken, the RCN’s deputy director of nursing.

“Patients can be put at risk when there are too few staff,” she added. She called the big drop in nursing degree applications “a very worrying situation that could cause the staffing crisis to deteriorate pat the point of no return”.

A spokeswoman for the Department of Health said: “As the health secretary has repeatedly made clear, overseas workers form a crucial part of our dedicated nursing workforce. They are a crucial part of delivering safe staffing in hospitals, and we want to see their outstanding work continue as we meet the needs of a changing population.”

She said there were plans to train more homegrown nurses, with 51,000 nurses currently in training, to help deliver the government’s promised “truly seven-day NHS” by 2020.

Brexit could make NHS shortage of nurses worse, says report

NHS hospitals suffer from chronic bed shortage, surgeons say

The Royal College of Surgeons said there was a chronic shortage of NHS hospital beds in England, after occupancy rates for overnight stays topped 89% for a fourth successive quarter.

The maximum occupancy rate for ensuring patients are well looked after and not exposed to health risks, is considered to be 85%, a figure that has not been achieved since NHS England began publishing statistics in 2010.

From July to September this year the percentage of beds occupied in wards open overnight was 89.1%, compared with 87.0% in the same period last year. That was the last time it was below 89%.

The Royal College of Surgeons (RCS) said the figures, published on Thursday, made for alarming reading and indicated a failure to cope with the increasing number of older patients in hospital.

Ian Eardley, a consultant urological surgeon and RCS vice president, said: “The NHS has been able to reduce bed numbers as medical advances mean more modern surgery can take place without an overnight stay. However, these figures suggest bed reductions have now gone too far in the absence of sufficient social care or community care alternatives. We are now seeing increasing numbers of frail older patients in hospital because they have nowhere else to go. The lack of additional money in the autumn statement for social care and the NHS is only going to make this even harder.”

The chancellor, Philip Hammond, had been urged to increase funding for social care, amid warnings that it was in a critical condition, and to help plug current and future shortfalls at NHS trusts, but health providers were left disappointed.

The situation is set to deteriorate further with more beds expected to disappear under local sustainability and transformation plans designed to improve NHS services and ensure their viability.

Among the acute service beds at general hospitals set to be cut are 535 in Derbyshire, 400 each in Devon and West Yorkshire, and 30% of all beds in hospitals in Bristol, North Somerset and South Gloucestershire.

Eardley said: “NHS leaders need to think carefully about whether this is a good idea without first putting in place better care in the community.”

Last month the Nuffield trust warned that the statistics underestimated the problem because they took a snapshot of occupancy at midnight, so did not capture squeezes in availability of beds during the day.

Eardley said: “I and too many of my colleagues all around the country are regularly having to cancel patients’ operations due to a lack of beds and delays in transferring patients back into the community.”

NHS hospitals suffer from chronic bed shortage, surgeons say

New Zealand"s serious sperm shortage: "It has become a continuous drought"

When New Zealander Kathryn Heape realised the fairy tale of marriage and kids was taking its sweet time she took out an insurance policy and applied for donated sperm.

“Since I was 10 years old, I just expected to have a baby when I grew up,” she says.

“I’ve always wanted to be a mother, but the idea of going to a clinic for that never featured.”

With the encouragement of her family and friends, Heape registered with a clinic. What she didn’t realise was that the current waiting list was up to two years.

Kathryn Heape, 40, waited one year before finding a sperm donor. Photograph: Kathryn Heape

“I had no idea there was a shortage, that came as a real surprise. But it’s something out of my control, so I just tried to get on with life while I waited. I kept dating, still hoping to have a baby the traditional way.”

New Zealand is in the grip of a sperm drought, with fertility counsellors saying long waiting times are putting significant strain on already stressed prospective mothers.

“Increasingly we are hearing of New Zealand women travelling overseas for reproductive tourism,” said Dr Mary Birdsall, a fertility specialist with Fertility Associates.

“It’s a very challenging situation. It’s challenging to recruit donors, and it is tough on the women who are psychologically and biologically ready to start a family, but can’t.”

In 2004 the New Zealand government introduced legislation banning anonymous sperm donations and preventing donors from receiving any payment for their services.

Donors in New Zealand have minimal costs covered (such as travel to the clinic) but are not compensated for their time, which after rigorous medical testing and counselling, can be significant.

Under the new law, the sperm donor must also agree to being identified to any offspring when the child turns 18.

A decline in sperm donations following the introduction of the legislation coincided with a sharp rise in same-sex and single women applying for donated sperm.

Dr John Peek, general manager of Fertility Associates, New Zealand’s largest fertility clinic, said there is usually enough sperm in the country to treat about 80 families, but the number of people applying for the sperm is around four times that.

“New Zealand has had a shortage of sperm donors for a long time,” said Peek.

“I think rather than peaking it has become a continuous drought. Like climate change, it has become the new normal.”

Like climate change, [the sperm drought] has become the new normal.

Dr John Peek, ​G​general ​M​manager of Fertility Associates

Fiona McDonald, a counsellor for fertility clinic Repromed in Auckland, says the lengthy waiting list for sperm is added pressure on New Zealand women, at what should be an exciting and positive time of their lives.

“It is really hard for women whose biological clock is ticking and every month that goes past feels like an age,” she said.

“They might already be in the 40s age bracket and time is crucial. Even six months could make the difference between having a child or not.”

In 2015 Fertility Associates treated 300 women with donated sperm. Of those 35% were heterosexual couples with male infertility issues, 25% were lesbian couples and 40% were single women.

McDonald said single women now make up the largest group seeking donated sperm at Repromed – and the first process in their journey is often grief counselling.

“Some women feel a sense of shame at having to take this route to becoming a mother,” said McDonald.

In 2004 the New Zealand government introduced legislation banning anonymous sperm donations. Photograph: Sarah Jones (debut Art)/Getty Images

“One of the first steps is grieving, that life has not turned out how you hoped. You have not found a partner and you are having to embark on this journey towards becoming a parent on your own.”

Dr Guy Gudex, medical director of Repromed, said his clinic needed to “seriously investigate” importing foreign sperm, as the drought showed no sign of abating.

While Heape was on the waiting list Repromed advised her to approach her male friends about donating – to no avail. She also investigated New Zealand websites set up to acquire sperm, but found them “a bit dodgy”.

“They’re not very professional. They can be a bit creepy even. There are men on there saying ‘I’ll help, but it has to be the old-fashioned way’. That’s not sperm donation, that’s sex.”

In 2015 the Advisory Committee on Assisted Reproductive Technology (ACART) advised the New Zealand government that foreign sperm and eggs should be allowed into New Zealand and subject to the same rules that apply to local donors.

Comparable countries like Australia and England allow the importation of foreign sperm, and demand is growing from Kiwi women that New Zealand should follow suit.

The ACART report found many New Zealand women were already travelling overseas to procure sperm, but time, cost and murky trans-border legislation meant it was not a viable option for most.

The report was delivered to the health minister at the beginning of 2015. A spokesperson from the ministry

Peek said his clinic could not explore overseas options until the minister ruled on import and export legislation, but it was “difficult not to say yes” to women who were increasingly desperate.

Heape is supportive of New Zealand allowing the importation of foreign sperm, but says New Zealand men should be better educated about donation first – and better compensated for their time if they do donate.

After a year’s wait, Heape was given the choice between two sperm donors. She was attracted to one because “he was more open to being contacted” before the child’s 18th birthday.

On her first try earlier this year, Heape fell pregnant. She says she is “tired but ecstatic”.

So far, the process has cost her NZ$ 14,000 (£6,700).

“A few people said to me ‘have a one-night stand’ when thy found out about the waiting list,” said Heape.

“But I don’t want that to be my child’s conception story. When they arrive, I want them to know they were created in the best possible way, by two consenting adults.”

New Zealand"s serious sperm shortage: "It has become a continuous drought"

Hospital A&E wards "in crisis over shortage of emergency doctors"

Hospital accident and emergency wards are in crisis as the supply of doctors fails to keep pace with demand for them in A&E departments according to medics’ representatives.

The warning from the Royal College of Emergency Medicine came as an A&E in the east Midlands announced it may have to temporarily close its doors at night owing to a national shortage of emergency doctors.

United Lincolnshire hospitals NHS trust (ULHT) said that a “crisis point” had been reached and patients’ lives could be put at risk if action was not taken at Grantham and District hospital.

Management at ULHT said they were looking to reduce A&E hours because the department was facing a severe shortage of doctors.

The trust, which runs the A&E, as well as two others in the region, said that it had been seriously affected by a “national shortage of appropriately trained doctors to work in A&Es”, adding: “We have reached a crisis point and we may put patients at risk if we don’t act.”

Dr Suneil Kapadia, medical director at ULHT, said: “We haven’t made a final decision yet, and we hope to avoid this, but the reality is we will need to temporarily reduce the opening hours of A&E at Grantham. The quality and safety of patient care is the trust’s number one priority and we haven’t rested on our laurels.

“We have tried to recruit in the UK and internationally, and we have offered premium rates to attract agency doctors whilst investing £4m in urgent care services. Despite this, we have reached crisis point.”

Dr Clifford Mann, president of the Royal College of Emergency Medicine, said the “great efforts” made by doctors and nurses to help patients in under-resourced locations sometimes was not sustainable.

“As well as potentially putting patient safety at risk, placing an ever-increasing workload on overstretched staff can create a vicious circle in retention and recruitment with many overworked trainees simply choosing to leave the country or indeed the specialty altogether,” Mann said.

“The wider picture is there is a real crisis in emergency medicine as our workforce numbers are not growing fast enough to keep pace with rising numbers of patients attending A&E departments.”

Shortages of doctors and nurses have come into sharp focus at other hospitals recently. The chief executive of crisis-hit North Middlesex hospital left her post after NHS inspectors found its A&E unit was risking patients’ health by forcing them to endure “excessive” waits to see a doctor, it emerged last month.

Julie Lowe was replaced on an interim basis by a senior executive from another London hospital in the wake of a scathing report by the Care Quality Commission into multiple patient safety failings at the North Middlesex.

The NHS care regulator’s inspectors found that shortages of doctors and nurses in A&E were so acute, and the unit so busy, that untrained receptionists were judging which patients needed medical attention first. It is one of the busiest A&Es in London, treating 500 patients a day.

The report said: “Walk-in patients were seen by a receptionist, who decided if they were suitable for the urgent care centre or, with a more serious condition, needed to go to the main emergency department.”

Hospital A&E wards "in crisis over shortage of emergency doctors"

Meningitis C vaccine shortage prompts fears of key outbreak in Africa

A shortage of meningitis C vaccine is threatening to jeopardise the potential to cope with a likely outbreak of the condition in Africa, global public well being organisations, such as the World Overall health Organisation, have warned.

A Meningitis A vaccine launched in 2010, MenAfriVac, has substantially lowered incidence of that strain but type C infections have been growing and a cheap equivalent that would shield against meningitis C, between other strains, is still many years away.

In the meantime, the members of the Global Coordinating Group for Vaccine Provision for Epidemic Meningitis Handle, which also comprises the Worldwide Federation of Red Cross and Red Crescent Societies (IFRC), and Médecins sans Frontières (MSF) are attractive to pharmaceutical firms to support them by plugging the gap.

Related: Meningitis vaccine withstands African heat with no injury

At existing, they say pharmaceutical businesses have advised them they are unable to provide the newer, a lot more efficient conjugate vaccines, which supply longer lasting immunisation than the outdated polysaccharide vaccines.

Dr William Perea, coordinator of the management of epidemic ailments unit at WHO, explained: “The issue is that now that we have vaccinated 200 million folks there are no far more epidemics with [meningitis] A, but this 12 months was a shock to us because we had been not expecting such a large one particular [meningitis C epidemic] as occurred in Niger.

“What we have told the companies is we want the conjugate vaccine to be ready to prevent epidemics for longer periods but they will not make the vaccine in ample quantities at affordable costs.”

As nicely as the further safety afforded by the conjugate vaccines, they are also ideal for kids, in contrast to the polysaccharide version. Even so, according to WHO figures, they usually value at least ten occasions far more than polysaccharide vaccines, which are priced at about $ 4 to $ five. Even with the producers providing the conjugate vaccines at $ 25 a dose, for the five million doses needed that amounts to $ 125m as opposed to $ 25m for the polysaccharide vaccines.

Folks collect at the well being clinic in Lazaret, near Niamey, Niger, in April 2015, the place sufferers struggling from meningitis are being treated. Photograph: Boureima Hama/AFP/Getty

“Either they assist us have affordable conjugate vaccines or we’ll have to use an previous vaccine that does not supply us with the identical quality,” mentioned Perea.

Meningitis C can trigger serious brain injury and is fatal in 50% of cases if untreated.

There were twelve,000 circumstances of meningitis in Niger and Nigeria and 800 deaths in the very first 6 months of the 12 months but with cases increasing because 2013, the fear is that subsequent year’s meningitis season, which starts in January, could see a considerably larger quantity of instances.

The MenAfriVac stockpile, brought about by way of a public-private partnership, was produced in response to an outbreak of meningitis A in sub-Saharan Africa in 1996-97 that developed 200,000 situations and 20,000 deaths.

It is as well early to say whether or not the C strain will behave in a similar style to A, moving to other nations in sub-Saharan Africa, but Perera mentioned the fact that it had already expanded from Nigeria to Niger in a couple of many years meant that this was a situation it was crucial to put together for.

MSF’s global healthcare coordinator, Dr Myriam Henkens, emphasised the importance of a multivalent vaccine – one particular that covers distinct strains of the illness: “We want vaccine makers to prepare manufacturing of a multivalent vaccine now to let ample lead time and capacity to meet this demand.”

A GSK spokeswoman confirmed the business had been in talks with the WHO and mentioned: “We are evaluating if and how we may possibly be in a position to supply further doses.”

Sanofi Pasteur said it was trying to improve production of its polysaccharide vaccine which covers Meningitis C.

Meningitis C vaccine shortage prompts fears of key outbreak in Africa

To Finish VA Medical professional Shortage, Medicare Funding Demands Improve

As the nation grapples with the imbroglio at the Division of Veteran Affairs and a medical professional shortage cited in months-long delays at VA Hospitals, policymakers are focusing on methods to boost the nation’s doctor supply.

The repair might lie with the Medicare well being insurance coverage system for the elderly, which at the moment holds the purse strings. And that will begin to be addressed this week and next when the American Healthcare Association – the nation’s largest physician group – convenes at its annual meeting later on this week.

A major issue is Medicare offered the bulk of funding for graduate health-related training, known as GME, exclusively pays for residencies at the nation’s educating hospitals, and it hasn’t risen in almost two decades to allow far more training slots.  The AMA will talk about a report its members ordered up on doctor workforce issues and “GME financing” at its annual policy-creating Residence of Delegates meeting, which begins up coming weekend in Chicago.

The doctor shortage and funding for residencies wasn’t addressed in the Inexpensive Care Act however its supporters say the law emphasizes significantly less costly use of principal care medical doctors and allied well being professionals like nurse practitioners and doctor assistants.

According to the Association of American Health-related Colleges, which consists of far more of the nation’s academic health care centers who train tomorrow’s physicians, there will be a shortage of much more than 90,000 physicians by 2020.

Although more health care schools are opening and college students are flocking to these graduate plans, there may possibly not be enough residency slots to train these college students when they graduate.

The Balanced Spending budget Act of 1997 capped the amount of offered slots for residents coming out of health-related school as portion of the law’s reduction in spending on Medicare, which largely funds residency programs.

But Congressional gridlock is keeping the funding of doctor instruction plans off of any front burners in Washington. That, however, may adjust.

The AMA expects a complete-throated debate at its meeting Saturday through June 11. If the AMA develops a resolution or policy stance, it becomes portion of its lobbying agenda in Washington.

AMA leaders have stated the physician shortage could turn into even much more dire and have greater economic impacts. The AMA in the previous has mentioned healthcare residents and fellows contribute $ 8 billion in charity care to the U.S. overall health care method offered their lower wages and work they do as portion of their instruction that is not fully covered by insurance or when they deal with the poor.

“A report on the doctor workforce shortage and GME financing examines the need to have for far more doctors to meet the nation’s developing health care needs,” the AMA mentioned in a statement announcing the coming report as component of its annual meeting agenda. “Part of the equation is a lack of growth in GME positions funded by Medicare, which had been capped at 1996 levels by the Balanced Price range Act of 1997. In addition to nationwide efforts like the AMA’s Save GME campaign and latest congressional action to address the difficulty, the report gives a synopsis of what 17 states are undertaking to boost their doctor workforce or influence the specialty and spot options of doctors.”

 Wondering how Obamacare will affect the nation’s doctor shortage? The Forbes eBook Inside Obamacare: The Repair For America’s Ailing Health Care Program answers that query and more. Obtainable now at Amazon and Apple.

To Finish VA Medical professional Shortage, Medicare Funding Demands Improve

Activity shifting explained: a viable solution to health worker shortage?

Training community members to give HIV treatment method delivers a treatment to a shortage of educated wellness workers. Photograph: Siphwe Sibeko/Reuters

Job shifting is a lower-value solution to tackling gaps in well being providers in the developing world, for instance individuals in HIV and mental overall health treatment. The need to have for each is ever present.

Last month, a report showed that South Africa has the highest price of new HIV infections in the world, with in excess of 400,000 happening in 2012 – and only a third of people becoming handled with antiretroviral treatment (Art).

Meanwhile, the variety of folks impacted by mental illness globally is increasing, as humanitarian crises from conflict and natural disaster multiply – in Syria, South Sudan and the Philippines – but funding is hardly ever allocated to treat them. The WHO reviews that humanitarian emergencies enhance mild or reasonable mental ailments ( such as depression) by 5% to 10% and a lot more serious mental health issues such as schizophrenia by 2% to 3%.

“Funding is typically tough, as mental well being is not on the radar for donors,” says Inka Weissbecker, global psychological wellness and psychosocial adviser at Global Medical Corps.

What is task shifting?

Alternatively of lamenting the lack of qualified healthcare experts, activity shifting starts with a useful “we are are the place are” technique and helps make the most of the sources in the country. The WHO defines it as as “the rational redistribution of duties amid health workforce teams” including – in worldwide guidelines issued in 2008 – “particular duties are moved, the place appropriate, from hugely qualified overall health staff to wellness employees with shorter education and fewer qualifications”. Margaret Chan, director standard of the WHO, says she sees task shifting as “the vanguard for the renaissance of major overall health care”.

What is the downside?

A review of activity shifting in Mozambique and Zambia identified unhappy and overworked workers. The report concluded “process shifting alone cannot reply to the demands of poor countries, particularly if other problems are not addressed at the exact same time … staff have clear concepts about how to improve the availability of solutions it stays to be observed if choice-makers will listen to them.”

What do improvement groups say about it?

Weissbecker says activity shifting is an revolutionary answer to the scarcity of trained psychiatrists and psychologists in reduced cash flow countries. “The truth that a community well being worker can deal with an individual with depression successfully offers us a great deal of hope and encouragement,” she says. “Task shifting presents a sensible and sustainable solution to most African countries’ critical wellness worker shortage,” says African wellness NGO Amref.

A systematic evaluation of task shifting identified that it delivers “high-quality, cost-effective care to a lot more patients than a physician-centered model”. The study warned that the issues are “adequate and sustainable coaching”, but advisable that the approach must be regarded for “careful implementation” in which a shortage of healthcare human resources threatens programmes.

Read far more stories like this:

• How Africa’s researchers are solving Africa’s overall health troubles

• Energy to the folks: how open information is enhancing wellness service delivery

• Mental overall health demands sensible remedy – or we encounter decades of wasted time

Join the community of global improvement pros and experts. Turn out to be a GDPN member to get a lot more stories like this direct to your inbox

Activity shifting explained: a viable solution to health worker shortage?

Midwives shortage? You bet, my hospital advised me there could not be a midwife on duty when I give birth

Huh? I left feeling puzzled and concerned.

At my subsequent appointment with a hospital medical doctor, I raised the situation of the non-anaesthetist – “are you really telling me there’s a possibility there will not be any person to administer an epidural?” – and waited for her reassuring response.

“Oh,” she mentioned. “The problem’s not with the anaesthetists. It will probably be the case that there will not be a midwife close to.”

HUH? Come yet again? No midwife?

“Yeah, specially if you give birth in the wee small hrs of the morning, or at the weekend, there may not be any midwives to assist you.”

Forgive me if I’m becoming stupid, but aren’t midwives the only men and women that can actually supply infants? If there are not any around, what am I supposed to do? I can hardly say to my unborn boy, ‘hang on in there, darling, can you just wait until Monday morning previous 10am so there are loads of employees about to help’.

Knowing my luck I will go into labour on a Sunday morning at 4am, right when the hospital is at its most understaffed.

Immediate ideas of lying in hospital corridors becoming unattended to, in agony, filled my thoughts. Significantly, I asked, am I going to be left alone in a hospital corridor till a midwife turns up?

“Properly, in situations the place there are not enough midwives, we generally wait right up until the female is 8cm dilated, then assign a midwife,” she said, all matter of fact.

The cervix only requirements to go to 10cm before dilation is total. So I’m waiting in a corridor, in discomfort, with out a midwife, and with out an epidural, for probably hours and hours – days, even – ahead of the really ultimate phases of birth, when someone finally comes along who’ve I have in no way met ahead of, and delivers the infant?

The doctor just smiled and shrugged this situation off. But she gave me no convincing cause to feel otherwise. My birth previously sounds like a nightmare and it truly is nonetheless two months away.

But it appears I am not the only one particular. Nowadays, hospital chiefs have been accused of “burying their heads in the sand” in excess of midwife shortages.

Figures recommend that a quarter of NHS Trusts had not assessed their workforce wants for at least four many years. Eighty per cent of the 99 trusts responding to a Freedom of Info request by BBC Radio 4′s Woman’s Hour even now had vacancies in funded midwife positions.

This is despite births in England increasing by a quarter in the previous decade.

How is it, in this day and age, in the 21st century, in the West, the midwives shortage is acceptable? It is not. It is appalling.

And how dare hospital physicians place the worry of God into me so early on into my pregnancy? Like I say, I’ve been pretty relaxed about most items so far. But this will take the biscuit.

Dr Dan Poulter, responding to the midwives shortage story right now, said the NHS is a “protected location to give birth, with ladies reporting large ranges of believe in and self-confidence in workers”.

Properly I misplaced all self-assurance in this certain hospital and its workers. It might be ‘normal’, even boring, to them that births are not constantly as you picture them – with personnel shortages an daily truth of existence. To them, I am just an additional statistic. But to me, this is my initial little one. I want to make sure I get basic, normal care.

Needless to say, I transferred hospitals and am now at University University London Hospital a teaching institution that already appears a million miles ahead of the one I came from.

When I raised the problem of no anaesthetists or midwives at UCLH, a physician merely laughed. “No, you don’t want to fret about that here.” Phew.

But how can a single hospital be so different in support to another that is only a handful of miles down the road? 1000′s of ladies threat receiving inadequate therapy due to the fact they never know there are other alternatives out there. So, girls, when the time comes – feel free to store close to.

And as for the Government? We need yet another 4,800 midwives in England, in accordance to the Royal University of Midwives. Which is not a huge quantity, in the grand scheme of items. And yet a lack of midwives is a recipe for significant disaster. The females of Britain deserve better.

Are you pregnant? What type of support have you had from your NHS hospital? Are you worried about the midwives shortage? Have you been advised to put together for underneath-staffed labour wards? Join the debate on Twitter @louisapeacock and @teleWonderWomen

Midwives shortage? You bet, my hospital advised me there could not be a midwife on duty when I give birth

Hospital chiefs "ignoring midwives shortage rather than paying out to fill gaps"

The figures, compiled by BBC Radio 4’s Woman’s Hour, showed that 80 per cent nonetheless had vacancies in funded midwife positions. Even so, the rate was now at its lowest for three years.

Births in England have increased by a quarter in the previous decade, according to current statistics.

In the 99 trusts, there had been 561 vacancies at the flip of the 12 months, ranging from a 17.eight per cent vacancy price at West Hertfordshire Hospitals NHS Believe in to the entirely-staffed Hull and East Yorkshire Hospitals NHS Trust.

Cathy Warwick, the college chief executive, mentioned the figures on the delays in assessments have been “worrying”.

“Four in every single five NHS trusts say they have midwife vacancies, a scenario that we truly feel is obtaining worse, not better,” she explained. “This has to change.

“The stress on maternity units becomes worse when there is a combine of insufficient midwives to commence with. On top of this, midwifery vacancies are not getting filled.

“This is a recipe for disaster and can have a disastrous affect on staff morale, burnout and sickness prices, which only make a maternity services even much more short staffed.

“We hear from some heads of midwifery that trusts are not conducting suitable assessments of staffing specifications simply because they know they will not be in a position to afford to put into action the findings.

“So they bury their heads in the sand and stick with their out-of-date assessments that no longer bear relation to their requirements and the requirements of mothers and babies.

“Our evaluation is that we want close to four,800 a lot more midwives in England. The Government is escalating the amount of midwives, and that is welcome, but more wants to be carried out.”

Dr Dan Poulter, the health minister, explained: “The NHS is a secure spot to give birth, with ladies reporting high ranges of believe in and self confidence in staff.”

Hospital chiefs "ignoring midwives shortage rather than paying out to fill gaps"

Cuba"s condom shortage raises fears of imminent overall health crisis

From potatoes to deodorant, toilet paper and bottled beer, Cubans have come to accept continual shortages as an inevitable part of existence following more than half a century of communist rule.

Now a shrinking supply of condoms has upset residents of the Caribbean island nation and alarmed overall health officials who are concerned by the chance of an enhance in sexually transmitted illnesses and unwanted pregnancies.

Pharmacies in the central province of Villa Clara began operating out of condoms in the middle of final month, according to Cuban bloggers reporting on the crisis, with shortages spreading to other towns and villages, and suburbs of the capital Havana in recent weeks.

One of the worst impacted places, the observers say, is the city of Santa Clara, which presently has one of the highest costs of HIV infection on the island. They say that Cenesex, the state-run Cuban nationwide centre for intercourse schooling, which is headed by President Raul Castro’s daughter, Mariela, has ordered the dwindling supplies to be allocated to regions of greatest require, like acknowledged carriers of HIV.

As a end result, standard citizens going to pharmacies in search of condoms are obtaining empty shelves, according to evidence collected by Havana blogger Polina Martínez Shvietsova, who carried out an ad-hoc survey.

She stated referred to as a amount of pharmacy owners in many locations, who all advised her: “We really don’t have any, and we really do not know when we’ll get some.”

Other analysts warned of the overall health risk. “The men and women in the street, [those] generating enjoy in homes of lease, godforsaken corridors, in parks, these are sources of possible chains of infection,” explained one particular anonymous man quoted by Cubanet, a Miami-based independent network of bloggers and dissidents.

So far there has been no official reaction from the Cuban government to the reviews. One particular regional official blamed troubles with supplies from China in an interview with the Villa Clara newspaper Vanguardia this month but supplied no answer about when the scenario would ease.

But Juan Carlos Gonzalez, director of the state-run wholesaler Ensume, which is responsible for obtaining and supplying most of the nation’s government-subsidised condoms, told the newspaper there were far more than a million condoms in the company’s warehouses and that the difficulty was the end result of his workers currently being unable to meet demand.

He explained Ensume had struggled to preserve up with a ruling by the state’s regulatory health care agency Cecmed two many years ago that the 2012 expiration date on hundreds of thousands of condoms imported from China was incorrect and that the packages had to be relabelled 2014.

Gonzalez said the employees could only repackage 1,440 strips of three condoms per day whilst the demand in Villa Clara province alone was five,000 day-to-day. Consequently, the cost of a single condom has risen from just pennies to about $ one.30, a day’s wages for a common Cuban worker.

Till now, condom supplies have not been a difficulty in Cuba, which has often had an aggressive sexual wellness programme and has been praised by the Planet Overall health Organization as having a single of the lowest costs of HIV/AIDS in the western hemisphere.

But the WHO did note in a 2005 report that HIV infections had been increasing since of an boost in prostitution and intercourse tourism on the island.

The condom shortage, meanwhile, has also impacted people who use the prophylactics for non-sexual purposes. Anglers use them to give floats a glossy sheen eye-catching to fish, pigeon fanciers use their rubber rims to attach notes to birds’ legs and challenging-up thrill-seekers fill them with low cost rum to smuggle into nightclubs.

“Police in central Havana are pretty much on a war footing taking care of the brawls produced within the large crowds that aspire to buy the longed-for tuber,” wrote Cuban author Miriam Celaya in a tongue-in-cheek blog entry quoted by the Miami Herald.

Cuba"s condom shortage raises fears of imminent overall health crisis

Midwife shortage may be placing mothers and infants at threat, say MPs

The cross-get together group of MPs stated that much more than a quarter of birthing units had to shut to new sufferers for half a day or much more between April and September 2012. Photograph: Christopher Thomond for the Guardian

The safety of pregnant ladies and their babies during childbirth could be currently being put at threat by a lack of NHS funding and a nationwide shortage of 2,300 midwives, a committee of MPs has explained.

In a very essential report on the state of maternity care, the Commons public accounts committee criticised the Department of Overall health and NHS England for becoming unable to clarify who is accountable for ensuring that the NHS has sufficient nursing personnel qualified to deal with childbirth.

Margaret Hodge, who chairs the committee, said: “There is proof that many maternity solutions are working at a loss, or at ideal breaking even, and that the obtainable funding may possibly be insufficient for trusts to make use of sufficient midwives and consultants to provide higher good quality, safe care.”

The report explained: “Strain on personnel leads to low morale and practically one particular third of midwives with less than ten years’ operate expertise are intending to leave the profession within a 12 months. More than half of obstetric units do not utilize adequate consultants to guarantee appropriate cover at all instances.”

The committee was especially disturbed to hear that costs of infection between new mothers, infection to the little one and damage to the child were all greater at weekends.

The MPs said the DoH acknowledged that a seven-day-a-week support was necessary and that it required to operate out how to accomplish this in terms of employment contracts and affordability.

In spite of a new overall payment framework currently being launched for maternity care, the DoH has only “restricted assurance” that the funding is ample to provide key goals, this kind of as continuity of care for females.

The cross-party group of MPs stated that a lot more than a quarter of birthing units had to near to new individuals for half a day or more between April and September 2012, with 1 of the reasons currently being a lack of midwives.

Although several girls had excellent experiences, “performance and outcomes could be a lot far better”, the report said.

Rates of stillbirth and babies dying inside of seven days of birth have been nonetheless larger in England than other Uk nations and there was too much variation in the top quality of care provided by different trusts, MPs found.

Belinda Phipps, chief executive of the National Childbirth Trust, explained the numbers of midwives was only part of the recent issue within maternity companies.

“Numerous issues raised in the report could be addressed with better continuity of care, in which a woman’s care all through her pregnancy is offered by a midwife she is aware of and trusts,” she explained.

Dan Poulter, the overall health minister, said the NHS remained 1 of the safest areas in the planet to give birth and final results located that most females would advocate their maternity care to their pals and family.

Midwife shortage may be placing mothers and infants at threat, say MPs