News

Seven days in medicine: 8-14 February 2017

BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j802 (Published 16 February 2017) Cite this as: BMJ 2017;356:j802

Patient safety

Warning over another Mid Staffs-type scandal

Robert Francis QC, who led the UK public inquiry into Mid Staffordshire Hospital after more than 400 excess deaths occurred from 2005 to 2008, warned that another such hospital scandal is “inevitable.” Francis told the Health Service Journal, “Let’s make no bones about it, the NHS is facing an existential crisis . . . The service is running faster and faster to try and keep up and is failing, manifestly failing. The danger is that we reach a tipping point, we haven’t reached it yet, but there will come a point where public confidence in the service dissipates.”

Brexit

MPs vote against NHS amendment

MPs voted down an amendment to the UK government’s Article 50 Bill on leaving the European Union that would have required the government to publish a report on the effect of EU withdrawal on national finances, particularly health spending. Proposed by a Labour MP, Chuka Umunna, the amendment followed claims by Leave campaigners that withdrawal from the EU would allow an extra £350m (€412m; $434m) a week to be spent on the NHS.

New cancer drugs could be delayed by two years

UK patients are likely to wait longer for access to new cancer drugs after the UK leaves the European Union because drug companies will prioritise winning approval for access to the larger European market ahead of the UK market, a former chair of the Medicines and Healthcare Products Regulatory Agency, Alasdair Breckenridge, warned on BBC Radio 4’s Today programme. David Jeffreys, vice president of the Japanese drug company Eisai, commented, “The early innovative medicines will be applied for in the USA, in Japan, and through the European system, and the UK will be in the second or indeed the third wave—so UK patients may be getting medicines 12, 18, 24 months later than they would if we remained in the European system.”

Cancer drugs

Universities should take drugs to market

To make new drugs more affordable universities and academics should take greater control of the drugs they discover, researchers said—for example, by partnering with private enterprises to trial and market drug discoveries to create competition. Paul Workman, chief executive and president of the Institute of Cancer Research in London, UK, said, “If we’re to end this era of $100 000 [£80 000; €95 000] cancer drugs, we’re going to have to make some radical changes to the whole way drugs are discovered and developed. We need academic organisations to become braver at moving new treatments into clinical trials and onto the market.”

GPs are unaware of tamoxifen benefits

An online survey of 928 GPs in England, Northern Ireland, and Wales found that only half (51.7%) knew that tamoxifen can reduce breast cancer risk, and only a quarter were aware of the National Institute for Health and Care Excellence guideline recommending its use. Results published in the British Journal of General Practice showed that the willingness to prescribe tamoxifen was significantly lower among GPs asked to initiate a hypothetical prescription than in those asked to continue a prescription initiated in secondary care (69% v 85%). (Full story: doi:10.1136/bmj.j772)

NHS performance

More patients wait longer for treatment

By the end of 2016 some 367 877 patients were waiting longer than 18 weeks for treatment, NHS England figures showed—100 000 more than in 2015. The government’s target for 92% of patients to be treated within 18 weeks has not been met since February 2016. Neurosurgery is the worst performing specialty, as 83.2% of treatments were yet to start within 18 weeks in December 2016, down from 87.4% in December 2015.

Rise in delayed discharges

Delayed discharges totalled 195 300 days in December 2016, up 27% from 154 000 in December 2015. The proportion of delays attributable to social care increased over the past year to 36% in December 2016, up from 32%. The main reason for social care delays was patients awaiting care packages in their own home, which accounted for 37% of all social care delays in December 2016, a rise of 53%.

Organ transplants

Vatican faces outcry for inviting Chinese official to summit

Doctors and medical ethicists strongly criticised the Vatican for inviting a Chinese health official to a summit on organ trafficking despite claims that China still sanctions the removal of organs from executed prisoners and minority ethnic groups. Huang Jiefu, a former health minister and chair of China’s national organ donation and transplant body, dismissed suggestions that the practice was ongoing. “That is a rumour,” Huang told The BMJ outside the summit hosted by the Pontifical Academy of Sciences. “I am the person who arranged to stop using prisoners’ organs from January 2015.” (Full story: doi:10.1136/bmj.j729)

Asthma

Third with COPD have asthma symptoms

More than a third of adults with newly diagnosed chronic obstructive pulmonary disease (COPD) also have asthma symptoms, a general practice study in Primary Care Respiratory Medicine found. GPs in Denmark recruited 3875 consecutive patients aged over 35 with a history of tobacco use, at least one respiratory symptom, and no previous diagnosis of obstructive lung disease and found that 700 (18.1%) had COPD. More than a third of these (38%) had indications of asthma-COPD overlap syndrome. (Full story: doi:10.1136/bmj.j747)

Asthma affects sex life

A survey by Asthma UK found that 68% of 544 people with asthma thought that their condition affected their sex life, and 73% had been embarrassed about using an inhaler on a romantic night out. Just under 15% thought that their asthma had contributed to a relationship ending, and 46% said that they would be more sexually confident if they did not have asthma. Many respondents had used their reliever inhaler during or after sex, and some had decided to have less sex or stop having it altogether. Several had been admitted to hospital because an orgasm had triggered an asthma attack, and some reported problems performing oral sex because of breathing difficulties.

Surgery

Bed shortage leaves surgeons under-occupied

UK surgeons have been left “kicking their heels” because thousands of operations have been cancelled as a result of a bed shortage this winter, said Clare Marx, president of the Royal College of Surgeons, and Chris Hopson, chief executive of NHS Providers, in a letter to the Times. “This is frustrating for staff, who just want to care for patients—rising numbers of whom suffer the anxiety of having their planned operations cancelled on the day,” they wrote, demanding that NHS England review what can be done to reduce the pressure on beds seen this winter.

Cosmetic surgery

Procedures fall 40% in 2016

In 2016 only 30 750 people had cosmetic surgery in the UK, compared with 51 140 in 2015—a 40% drop—figures from the British Association of Aesthetic Plastic Surgeons showed. It said that more people had chosen cheaper, non-surgical procedures, such as chemical peels. The biggest fall was in the number of brow lifts (down 71%), while breast augmentation remained the most popular surgery despite falling by 20%.

Refugees

Child health champion condemns inaction on refugees

Neena Modi, president of the Royal College of Paediatrics and Child Health, urged the UK government to reverse its halt to receiving unaccompanied refugee children through the Dubs amendment to the Immigration Act 2016. “By shutting them out, this country is failing vulnerable children, acting shamefully, and sending a clear message to its citizens, and the rest of the world, that it does not care for the most helpless in society,” she said. “Only 350 lone children have been accepted into the country, a far cry from what is needed.”

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