Public demand government action as England and Wales risk falling behind in fight against drink driving

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Three quarters (74%) of UK drivers want a lower drink drive limit, according to a survey published today by road safety charity Brake and Direct Line. (http://www.brake.org.uk/news/1328-dldrinkdrive-dec14)

In the wake of Scotland lowering its drink drive limit earlier this month, the appetite clearly exists for the rest of the UK to follow suit, and ideally go further by introducing a zero-tolerance limit.

In the UK-wide survey of 1,000 drivers:

* three in ten (31%) said the UK should get in line with Scotland and most of the EU by lowering the limit to 50 milligrams of alcohol per 100 millilitres of blood (50mg/100ml) – a limit also set to come into force in Northern Ireland next year;

* more than two in five (43%) said the UK should go further by introducing a limit of 20mg/100ml – effectively zero-tolerance – as in a number of EU countries, including road safety leaders Sweden;

* only a quarter (26%) said the limit should remain at the current level of 80mg/100ml – a limit shared only by Malta in the EU.

Brake is calling on Westminster politicians of all parties to make a zero-tolerance 20mg/100ml drink drive limit a key manifesto commitment for next year’s general election, in line with the evidence that even 20-50mg/100ml alcohol in your blood makes you at least three times more likely to be killed in a crash [1]. This could help stop the estimated 65 deaths a year caused by drivers who drink but are under the legal limit [2].

Brake is also rPicture 4enewing calls in the run-up to Christmas for the public to show zero tolerance on drink driving, pledge to never drive on any amount of alcohol – not a drop – and plan ahead to make sure they and loved ones can get home safely from festivities.

Brake and Direct Line’s survey also found almost unanimous support for tougher measures to tackle repeat drink drive offenders, who currently face the same penalty no matter how many times they are caught:

* almost all (95%) drivers agreed repeat offenders should face higher penalties;

* nine in ten (89%) said repeat offenders should have ‘alcohol interlocks’ fitted to their vehicles to stop them starting the engine without passing a breath test.

Brake is calling for longer sentences – up to two years – and alcohol interlocks combined with rehabilitation for repeat offenders to help cut reoffending. Currently, one in eight drink drivers and three in 10 ‘high risk offenders’ do it again [3].

Julie Townsend, deputy chief executive, Brake, said: “It is often said that the UK has some of the safest roads in the world, but there is no room for complacency, not least on drink driving, which remains one of the biggest killers. The UK has now slipped off the top of the European road safety rankings, and without critical progress, including the introduction of a zero-tolerance drink drive limit, we will be left further behind.

“The current drink drive limit in England and Wales sends a confusing message and asks drivers to do the impossible – guess when they are under the limit, and guess when they are safe to drive. In reality, even very small amounts of alcohol impair driving, so the only safe choice is not to drink at all before driving. The law needs to make that crystal clear. We’re also appealing to the public in in the run up to Christmas to show zero tolerance on drink driving, and pledge to never get behind the wheel after any amount of alcohol.”

Rob Miles, director of motor at Direct Line, commented: “Many people don’t really know what the legal limit actually means in terms of how much you can drink. Our advice is not even to take the risk – if you’re driving, it’s not that great a hardship just to stick to soft drinks for the evening. If you’ve had a large glass of wine and are wondering if you’re over the limit, you’re better off not driving at all.”

Read about Brake’s ‘not a drop, not a drag campaign’ (http://www.brake.org.uk/notadrop)
Tweet us: @Brakecharity (https://twitter.com/Brakecharity), hashtag#NotADrop.

End notes
[1] Review of effectiveness of laws limiting blood alcohol concentration levels to reduce alcohol-related road injuries and deaths, National Institute for Health and Clinical Excellence, 2010
[2] Reducing the BAC limit to 50mg – what can we expect to gain?, Professor Richard E Allsop, Centre for Transport Studies, University College London (PACTS, 2005)
[3] Drink driving (repeat offenders) bill, Rehman Chishti MP, 2013 http://www.pacts.org.uk/2013/07/drink-driving-repeat-offenders/

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Hospital inspections: lessons to be learnt

The programme of independent hospital inspections carried out by the Care Quality Commission (CQC) was made tougher in September 2013. During the first year to the end of August 2014 under the new arrangements 38 NHS acute trusts (each comprising one or more hospitals) were inspected. The most recent inspection to be fully reported is that of the Imperial College Healthcare NHS Trust. This inspection occurred in September 2014 and details were published on 16th December 2014. Hospitals inspected within the Imperial Trust included  St. Mary’s Hospital, Charing Cross Hospital, Hammersmith Hospital and Queen Charlotte & Chelsea Hospital.

There is now sufficient data to reach some conclusions about the state of NHS hospitals and ways to make the best use of the inspectors’ findings. The general quality of CQC findings is high and they command a high degree of respect from doctors and managers. My main reservation is over the way in which the overall message is communicated rather than with the actual recommendations. Hospitals or activities within hospitals can be rated outstanding, good, requires improvement or inadequate. These ratings are very similar to and probably modelled on those applied by OFSTED. However, education has important differences from hospital treatment. A school that left out an important subject like mathematics or English ahead of GCSE’s would certainly be inadequate. However, a hospital that chooses not to treat certain conditions or that does so inadequately may be extremely proficient at treating other illnesses. Hospitals often specialise in specific diseases.

The use of terms like “requires improvement” and “inadequate” may give a misleading impression to the Public who may not interpret them in the appropriate context. For example, in the recent Imperial College Trust report the inspected outpatients’ departments were all deemed “inadequate” as was the A&E department at St. Mary’s. These results are not as concerning as the language suggests.  The Imperial Trust as a whole had an average rating of “requires improvement” as did three of the four hospitals inspected. The fourth, Queen Charlotte and Chelsea, was rated “good”. These findings are typical of those for other trusts. For example, of the 38 acute trusts against which ratings were published up to August 2014, nine were rated good, 24 required improvement and five inadequate. By far the commonest category is “requires improvement”. This fact illustrates the high standards sought and does not stop UK hospitals from being amongst the best in the world.

Apart from the risk of findings being taken out of context there are other limitations to inspections. For example; the Imperial Trust inspection was in September but the findings have only just been published. During the intervening three months important changes have occurred. The current CEO has been in post since April 2014 and requires time to implement new policies. The A&E unit at St. Mary’s has been improved considerably and reinspected the CQC, who now confirm that it is compliant. However, CQC was unwilling to publish summaries of follow-up visits at the same time as the original inspection reports. On the home page of its website CQC states:

“Our job is to check whether hospitals, care homes, GPs, dentists and services in your home are meeting national standards. We do this by inspecting services and publishing our findings, helping people to make choices about the care they receive.”

In order for patients to make the best decisions CQC should consider issuing data from follow-up inspections more quickly and taking steps to avoid misinterpretation. The good done by CQC will be compromised if patients decline hospital treatment owing to inappropriate scares leading to a lack of confidence in the NHS. Unlike hospital staff my comments are not restricted by a need to foster good relationships with the CQC.

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Top 5 Worst Celebrity Diets to Avoid in 2015

In anticipation of our gaining a few pounds over the
nextScreen Shot 2014-12-09 at 12.47.44 few weeks, we are delighted that the BDA has done the ground work and highlighted the diets to avoid come the New Year urge to undo the damage. Here are the ones to avoid:

1. Urine Therapy

Celebrity Link:  Bear Grylls has reportedly drank his own urine (for his TV show).

What’s it all about?  Urine Therapy, or urotherapy, includes the drinking of one’s own urine for cosmetic or medical/wellbeing purposes.  Some claim that the urea component of urine can have an anti-cancer effect.

BDA Verdict:  Literally, don’t take the proverbial!  Emergencies, only as Urine Therapy has no scientific evidence that it adds anything beneficial to the body and its safety has not been established.  As for any anti-cancer claims made in favour of Urine Therapy, this is simply not backed up by scientific studies.

2. Paleo Diet

Celebrity Link:  Miley Cyrus and Matthew McConaughey have reportedly followed this ‘diet’.

What’s it all about?  The Paleo diet (also known as the Paleolithic Diet, the Caveman diet and the Stone Age Diet) is a diet where only foods presumed to be available to Neanderthals in the prehistoric era are consumed and all other foods, such as dairy products, grains, sugar, legumes, ‘processed’ oils, salt, and others like alcohol or coffee are excluded.

BDA Verdict:  Jurassic fad!  A diet with fewer processed foods, less sugar and salt is actually a good idea, but unless for medical reason, there is absolutely no need to cut any food group out of your diet.  In fact, by cutting out dairy completely from the diet, without very careful substitution, you could be in danger of compromising your bone health because of a lack of calcium.  An unbalanced, time consuming, socially isolating diet, which this could easily be, is a sure-fire way to develop nutrient deficiencies, which can compromise health and your relationship with food.

3. Sugar Free Diet

Celebrity Link:  Tom Hanks and Alec Baldwin have reportedly followed this ‘diet’.

What’s it all about?  The Sugar Free Diet is when you exclude all types of sugar (and often all carbohydrates too) from your diet.

BDA Verdict:  Not a total sweetener for success!  We encourage cutting down on free sugars, adding sugar or products already containing added sugar, in addition to being label aware, because as a nation, we consume too much sugar on the whole.  Some versions of the Sugar Free Diet call for you to cut out all sugar from your diet which is not only almost impossible, but would mean cutting out foods like vegetables, fruit, dairy products, nuts – not exactly a healthy, balanced diet.  Also beware, substitutes some of these plans recommend like agave, palm sugar or honey, are actually just sugar in another form and a huge contradiction.

4. VB6 Diet

Celebrity Link:  Beyoncé and Dita Van Teeese have reportedly followed this ‘diet’.

What’s it all about?  The VB6 Diet (vegan before 6pm) of Chegan Diet (cheating vegan) is a diet that calls on you to follow a vegan eating plan most of the time/before 6pm, then after 6pm, nothing is off limits.

BDA Verdict:  VB careful!  By virtue, this should set you on course to eating during the day, at least, less processed food, more plant based foods like beans, pulses, wholegrains and nuts (watch your portion sizes) and much more fruit and vegetables which is a good thing overall as we should be aiming for at least 5 portion of fruit and veg a day and more fibre.  Having said that, following a vegan diet doesn’t automatically translate into a healthy diet.  The danger here is, post-6pm becomes a window of opportunity to hoover up a myriad of foods high in calories, saturated fat and packed with added salt and sugar, undoing your earlier healthier choices.  The reality is, eating different food groups at different times of the day doesn’t matter, in terms of your health, its nutritional balance that’s important.

5. The Clay Cleanse Diet 

Celebrity Link:  Zoe Kravitz has reportedly followed this ‘diet’.

What’s it all about?  A spoon of clay a day will remove toxins from the body and remove negative isotopes, helping you detox and stay in shape

BDA Verdict:  Clay away from this diet!  The Food Standards Agency issued a warning about clay after high levels of lead and arsenic were discovered in products saying: ‘We remind consumers, especially pregnant women, about the dangers of ingesting clay, clay-based detox drinks and supplements’. The whole idea of detox is nonsense. The body is a well-developed system that has its own built-in mechanisms to detoxify and remove waste and toxins. Nuff said!

BDA spokesperson and consultant dietitian, Sian Porter added:

“Every year in the BDA press office, we get call after call about all sorts of diets, from the weird and faddy right through to the downright dangerous, such as the Breatharian Diet that calls on people to live on fresh air and sunlight alone!  2014 has been no exception.

“It seems that as a nation we are constantly on the search for that magic bullet approach to losing weight, wanting a quick fix to give us the bodies we so often see on TV, in glossy magazines and adorning billboards up and down the UK.

“Quite often the fad diets we come across come at a price.  Firstly, there can often be a cost to your health if you follow these diets over a period of time and secondly, there are often accompanying books, products, paid-for memberships or online services that can quickly add up.  The truth is, if something sounds too good to be true, it probably is.

en_a06fig01“When wanting to lose some weight, don’t think about ‘going on a diet’ or just what changes you need to make over a month or two to lose the weight, think about what changes you need to make forever to lose that weight and, as importantly, keep it off.  An eating pattern for life should be the one you can stick to and include enjoyment, a rich variety of foods in appropriate portion sizes and moderation.  Go for the marathon approach rather than the sprint finish.

“2015 is almost upon us, with many people making New Year resolutions to lose.  Make the difference this time by losing it in a safe, robust and sustainable way.

“Merry Christmas and a Healthy New Year from the British Dietetic Association.”

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Rising ambulance call-outs: time to rethink the role of the paramedic

BBC Radio Sussex this morning picked up on the news from Friday that ambulance call-outs in the South East have almost doubled in the past seven years and that the ‘system is at breaking point’ according to the GMB union.

It reported, “In 2007, the service received more than 600,000 calls. During the last financial year it reached nearly one million. Figures show there were 259 calls from one property in Rochester last year and 118 from another property in Hove.

Demand is increasing across the country for all NHS services. The average member of the public sees a GP six times a year; double the number of visits from a decade ago[1]. However supply has also increased: minor injury units and walk-in centres were introduced ten years ago with the intention of diverting less serious cases away from the major hospital trauma units, as shown here by the King’s Fund.

Hundreds of calls from the same address are signs of both neglect and abuse: neglect by that person’s GP to provide the required care and reassurance, and abuse of the emergency number by the individual. 999 is not a counselling service, and their seems to be no understanding by frequent users that they may be blocking serious calls about life-threatening accidents.

The use of all services rising for many reasons: partly because supply has increased, partly because of the rise in proportion of older people and those with complex needs, and also those living alone who want immediate care or reassurance. Alcohol continues to be a driver, and the lack of understanding of the cost pressures of the NHS mean that the public do not treat it as a finite resource.

The ambulance service is seen as alternative to out of hours or NHS111 and A&E. The fact that SECAMBS stated on the radio this morning that there is NO increase in proportion of people actually being taken to hospital is an important fact, as it that 10% of callers are ‘heard and treated’ over the phone.

It sounds like it’s time we rethought the role of the paramedic and ambulance service.

[1] Health and Social Care Information Centre, Trends in consultation rates in general practice.

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Where will the money come from to connect the NHS?

Guest Blog by 2020health Consultant Director, John Cruickshank

Published in November 2014, ‘Personalised Health and Care 2020’ sets out a framework for action around the exploitation and adoption of digital healthcare.   The document has been prepared by the National Information Board, which now represents all the major national stakeholders in the English health and care system.
Over the course of my 30+ years in the sector, some half dozen of these national strategies for IT in the NHS have been published.  The better ones have been forward thinking on vision, short on platitudes, clear on expectations and what will be ‘done once’ nationally to enable progress, with evident funding policies and a structure that enables  – and measures – delivery.  How does this paper face up to these challenges?
The good news is that this document is above average and has much to commend it, not least the explicit focus on improving the care and experience of patients and citizens. It is well worth reading and in places inspiring.  Its three key themes of collaboration, transparency and participation all make good sense and are threaded through the document.
The document was originally due out much earlier in 2014, so was it worth the wait?  Rather like the ‘Pantomime Horse’, it suffers from design by committee (perhaps why it took so long to appear) with some recommendations rather convoluted and opaque.  But unlike our dear Horse, it is stronger and more appealing in its middle sections than its front and back.
Strangely for a major government report, the Executive Summary is so short as to give almost no clues to the depth of consideration and recommendations in the meat of the report.  And in then painting a picture in chapters 2-4 of the need and current status, it is sketchy.  It contrasts the uptake of digital in health with other industries in a way which is nothing new.  The paper apparently airbrushes out ten years’ of huge investment and some progress enabled by the National Programme for IT in the NHS (NPfIT).
And at the back end (chapter 12), while commendable in terms of commitments to specific dates, the action plan is long on promise about future roadmaps and the like, but short on clear deliverables, roles and responsibilities.   For example, it is widely known that one of the reasons for inaction has been the lack of clarity of roles between the Department of Health, NHS England and the Health & Social Care Information Centre (HSCIC) around digital, and where funding and accountability lies.  This paper hints at some progress but does not inspire one with much confidence.  And with many of the due dates lying after the next Election, one also wonders whether they are remotely deliverable given the likelihood of political change.
The meat of the report (chapters 5-11) has good analysis and many welcome recommendations.  The more eye catching ones include:
•    NHS Choices as a single point of access to common digital transactions, integrated with 111.
•    National accreditation and kitemarking of apps (one hopes this does not stifle innovation).
•    Piloting digital care accounts for patients with a personal budget.
•    National ‘experiment’ of a mobile care record under the control of patients.
•    Use of the Digital Maturity Index to track effective use of IT in the acute sector and beyond.
•    Dame Fiona Caldicott as National Data Guardian of health and care.
•     A new National Tariff that supports and rewards new models of care, enabled by technology.
•    Leadership support to exec and non-exec directors in the development of digital strategies.
So what are its limitations and gaps?  I would highlight the following:
•    How is the document expected to be used?  Would a Trust CEO or indeed an ICT Director know what to do next?
•    Throughout 2013, the promise was the NHS would be ‘paperless by 2018’.  Although laudable, this was a false promise in that the aim should be more streamlined care not the removal of paper. And it was not remotely deliverable. The ‘paperless’ term has been quietly dropped in this paper, with a new commitment ‘all patient and care records being digital by 2020’.  Why ‘all’ and how is this deliverable?
•    The commitment to greater standardisation is welcome but this is a familiar theme – ten years ago, the mantra of NPfIT was ‘ruthless standardisation’. What’s different this time?
•    What is the national technology architecture within which national infrastructure and systems will operate?  Who is responsible for developing it?
•    How will the hints on funding policy (e.g. around future Tech Funds) be developed to give longer term clarity about national investment policies? Nothing was mentioned in the Autumn Statement about funding this essential infrastructure.
•    In my opinion, some element of systems coordination around the common development of digital and health records are essential to corral health communities to deliver joined up care to their local population.  How will this report enable this to be achieved, particularly with NHS England rationalising its local informatics support?
Finally, many NHS organisations around the country (and particularly those in the north, midlands and east) face a cliff edge in July 2016 when their NPfIT patient record contracts will expire and national funding for their systems cease.  The paper is entirely silent on this. Can local commissioners and providers afford the new arrangements, do they have robust plans in place, and how will patients be assured that their care will not be put at risk?

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Emergency Hospital Admissions…..does the admission route matter ?

Guest blog by Dr Iseult Roche

A&E direct hospital admissions have increased since 2002 and new research (published in the Journal of the Royal Society of Medicine) also shows emergency admissions via GP’s  have fallen in the same period of 2002-11. However, why this increase has happened is “unclear”.

This possibly gives another potential reason why there is an increased burden on A&E A&E imagedepartments; not only from an increased number of admissions, but also in the type of work staff and departments are expected to carry out and manage. A&E departments are supposed to deal with acute presentations only, but this is far from the case.

The research author, Thomas Cowling writes “A&E staff now have increased responsibility as gatekeepers for inpatient care and as care coordinators, which is not reflected in how A&E departments’ activity is measured or reimbursed.”

This is certainly true and places  A&E departments at risk in varying ways – from targets and finances, to staffing levels and duties, and most importantly optimum patient care.

Mr Cowling noted: “New models of urgent care services that employ GPs in or alongside A&E departments as gatekeepers to specialist urgent care ought to be evaluated before they are scaled up to avoid further ad hoc developments. This also applies to the current government’s pilot scheme of extended opening hours in general practice.”

Although the number of direct Speciality Admissions via GP referral had fallen during that time, it would be incorrect to consider one as being entirely responsible for the other.

There are many hypothetical reasons for these patterns and Doctors have suggested these:
– Firstly, during this time frame the total overall number of Emergency admissions have increased.
– Secondly, the general population are more health aware and self-refer if they have acute worries.Genetic testing
– Thirdly,  urgent tests cannot be obtained as speedily via a GP compared to A&E ; even basic blood tests take time and for some direct speciality referrals, such results are necessary (or at least useful) for a speedy and successful acceptance. In some cases GP’s may send a patient to A&E with a letter, rather than spend a lengthy period of time in discussion with a busy on-call registrar.

Other reasons suggested have included the advice given by 111 service (or its’ predecessor),  the negative attitude portrayed of GP’s in the media – so patients believe they will not get an urgent appointment and go to A&E rather than consult their GP – and also Speciality accepting protocols which may require admission via A&E rather than directly to the admitting team on-call.

old womanFor patients in care or nursing homes, there is a burden of responsibility placed on the staff and they may well resort all too quickly to sending patients to A&E rather than wait for a GP call-out (even if a GP consultation would be sufficient).

The potential reasons for the correlation are legion, but certainly it would be incorrect if the results were to be taken at a simplistic or face value.

Also, in reality, if a patient is acutely unwell and is actually admitted via A&E rather than GP, surely how they were admitted is less important, when compared to the fact they actually did need admitting. Although there are many patients who may present to A&E unnecessarily and a GP appointment would have prevented this (however that is a slightly different matter).

GP’s do an incredibly demanding job, balancing holistic long-term care with acute needs. Moral seems to be at a low point among GP’s and trainees. This is a time for health workers to stick together for the benefit of all, especially our patients.

Certainly the results pose questions about the current strategy in place to reduce pressure on Emergency departments and hospitals generally.

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Obesogenic nation – when will we have a strategy with teeth?

Today’s report on weight-loss surgery is another warning to government on the social, economic and personal costs of obesity. It shows that about 5% of those having surgery are aged 25 years or under and 40% of them were ‘super-obese’, in other words they had a BMI of 50 or more. This is a shocking statistic that reflects the failure of everyone around that individual to provide support through their childhood into their early adult years.

And whilst on average people have lost 60% of their excess weight a year after surgery, obesitythumbnailunless the root causes of over-eating are tackled, some will lose little weight whilst others around them will become obese. It is perfectly possible to have surgery and continue to eat high calorie foods and drink excess alcohol resulting in little weight loss, if the very reasons for over-eating have not been properly addressed. Whilst a psychological assessment is always made before surgery, many people need significant amounts of ongoing counselling support which currently is not provided.

Our recent report Careless eating costs lives highlights the obesogenic environment in which we now live and that action at all levels – from the personal to government – is urgently needed.

Added to this, rising levels of malnutrition indicate that we are not eating as we should.

The Health and Social Care Information Centre (HSCIC) in August, show the number of people admitted to English and Welsh hospitals rose dramatically – from 5,469 to 6,520 – in the past year alone. There was 19-percent increase in the number of UK citizens hospitalized for malnutrition over the past twelve months[1]. Over the last five years there was a 71 per cent increase in hospital admissions where malnutrition was a primary or secondary diagnosis, from 3,900 admissions in 2009-10 to 6,690 admissions in 2013-14.

Above all we have to get serious about prevention of obesity in the first place. A national strategy on nutrition, a mandatory Responsibility Deal, local government plans, concerted action in schools and less snacking by you and me are all required. We don’t have enough surgeons for all those eligible for weight-loss surgery anyway, and as the good doctor has always said, prevention is better than cure – for the individual, society and the economy.

[1] http://www.hscic.gov.uk/catalogue/PUB14568

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