Nationwide investigation into the spread of antibiotic resistant E. coli.

Public Health England has begun a United Kingdom-wide investigation into the spread of antibiotic-resistant E. coli. The study will look at E. coli that produce enzymes known as Extended Spectrum Beta Lactamose (ESBL), which are able to break down common antibiotics like penicillin, and will look at how resistance spreads in patients, healthy people, sewage, slurry and farm animals

Experts say that, about 10 years ago, ESBL-positive E. coli level began to increase. These resistant strains can cause blood poisoning and urinary tract infections. Nowadays some 10% of the 30,000 E. coli infections reported annually are believed to be resistant. The risk in hospitals is growing.

According to Professor Neil Woodford, Head of Antimicrobial Resistance at Public HealthEngland, resistant E. coli from non-human sources pose health threats that are not yet fully understood. He says that, “ The study is very important because its results will help to shape future intervention strategies to reduce the spread of these antibiotic-resistant strains of bacteria and to reduce the numbers of infections that they cause.”

One of the problems is that, although other classes of antibiotics can be used to treat infections, doctors do not know what strain is affecting the patient. This means that it is possible to give inappropriate drugs that may be ineffective and could lead to fatal consequences.

Dr DavidWareham, a consultant microbiologist at Queen Mary, University of London, illustrates the point. He says that growing the bacterium takes several days with a further day required for a resistance test. This means that doctors can be forced to use broad-spectrum antibiotics, exacerbating the problem and driving resistance.

According to Peter Hawkey, Professor of Public Health and Clinical Bacteriology at the University of Birmingham, overseas travel is a major risk factor in the spread of resistant strains of E. coli. In India, for example, ESBLs comprise 60% of all E. coli infections – against 10% currently in the United Kingdom - and 85% of visitors are likely to pick up resistant organisms, even though symptoms may not present. A figure of 60% in Britain would lead to increased use of last-resort antibiotics.

Government backs new IVF technique

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The government is planning to draft new regulations allowing three-person IVF that could see the procedure being made available to couples in the United Kingdom within two years. According to experts, the technique could eliminate the debilitating and sometimes fatal mitochondrial diseases that are passed from the mother to the child and could help up to 10 couples a year.

Mitochondria convert energy so that it can be used by cells and are passed, via the egg, from the mother to the baby. Defective mitochondria can leave cells starved of energy resulting in blindness, weak muscles, heart failure and even death in extreme cases. About one in 6,500 babies are affected by defective mitochondria.

Research indicates that mitochondria from a donor egg can prevent mitochondrial diseases. However, the technique would mean that babies end up with DNA from three people - both parents and a third donor - as mitochondria have their own DNA, and would inherit genetic information from three. They would have over 20,000 genes from their parents and 37 from the donor.

Newcastle University is pioneering one of the three-person IVF techniques. Professor DougTurnbull, a researcher at Newcastle, believes that the introducing the procedure is great news for those families affected by mitochondrial disease. It will give them more reproductive choice and the chance to have children who are free from the disease.

Following public consultation earlier this year, the Human Fertilisation and Embryology Authority found that there was ‘general support’ for the new technique and there was no evidence to suggest that it was not safe. According to ProfessorSally Davies, Chief Medical Officer for England, "Scientists have developed ground-breaking new procedures which could stop these disease being passed on, bringing hope to many families seeking to prevent their future children inheriting them. It's only right that we look to introduce this life-saving treatment as soon as we can." She acknowledges that there are sensitive issues involved but is personally comfortable with the proposal.

There have been objections to the proposed procedure from the outset, as it will have ramifications for generic inheritance. Dr. David King, Director of HumanGenetics Alert, says that it is unsafe and unnecessary and the majority of respondents in the consultation, in fact, rejected the proposal. He claims that the consultation was inadequate and biased and that it would be a disaster to base a decision that could eventually lead to a ‘eugenic designer baby market’ based on its findings.

Despite these concerns, draft regulations on the use of the treatment are to be produced this year, ready for a final version to be debated and voted upon in Parliament next year. As yet, the details have to be decided. It is likely that the procedure will be available only to those with the most severe cases and that those children born as a result of the procedure will not have the right to know the identity of the donor and will be subject to lifelong monitoring.

Introducing these regulations now, says Academy of Medical Sciences President Sir JohnTooke, means that there will be no unnecessary delay in offering the treatment to affected families once there is adequate proof that it is safe and effective. It will also keep the United Kingdom to the fore of cutting-edge research in the field.

Rogue medical practitioners working in Britain

Overseas doctors who have misconduct and sometimes even criminal records are working in the NHS in Britain. Since 2006, the GMC has uncovered 138 cases of medical practitioners who, despite being branded a danger in their own countries, have been treating patients in Britain.

Among the most prominent cases are the following:

•          Dr Hellfried Sartori, an Austrian, who was jailed twice in the USA for practising without a licence and was blamed for accelerating the deaths of four cancer sufferers in Australia after employing “alternative therapy”, which included injecting a with a mixture containing paint stripper. He was banned in Britain in 2008 after a number of complaints, but by then he had been registered here for 13 years.
•            Dr Marcos Ariel Hourmann from Argentina came to Britain in 2005. He arrived after being charged with killing a patient in Spain and worked in a number of Accident and Emergency wards around the country. He was convicted in Spain in 2009 and struck off by the GMC the following year, but not before acting as a police forensic examiner in Wales.
•            Maurice Saadien-Raad, a South African, worked for four years in British hospitals despite the fact he was twice suspended in his homeland and was dismissed from a clinic in Australia when his competence was brought into question. He was suspended in 2007 after giving out the wrong drugs and being accused of deception and sexual harassment.
•       According to experts, the cases that have been uncovered could represent the tip of the iceberg as many rogue health practitioners could have flown in under the radar. The problem is that, although foreign practitioners are required to produce a certificate from their most recent country of work, which should include details of any disciplinary action, there is no worldwide standard. This means that overseas regulators may fail to include relevant information or may not go back far enough. This can result in crucial information being left out.

NiallDickson, GMC Chief Executive, notes that when the GMC takes action against a doctor, it informs other regulatory bodies around the world. He believes that all regulators should do the same but, at present, this is not the case.

JuliaManning, Chief Executive of the think tank 2020 Health, has summed up the problem. She says, “ When we have doctors working in this country who have been found guilty of misconduct abroad, or even struck off, the risks are clear.”

NHS must act to reduce health inequalities

According to a report presented by the Institute of Health Equity at the London headquarters of the British Medical Association (BMA), action must be taken to reduce the health divide between the rich and poor.

The report, which has the support of the BMA, stresses that insufficient attention is paid to the social and economic conditions that contribute to poor health. It highlights the problem by pointing out that in England the life expectancy of the best off is seven years longer than that of the poorest; this gap rises to 17 years in London and 28 years in Glasgow.

ProfessorSir Michael Marmot, whose 2010 review “Fair society, healthy lives” highlighted health inequalities and who helped prepare the report, says that although Britain has the world’s most equitable health service, social inequalities are leading to inequalities in health. In his 2010 review he assessed that health inequality costs Britain some £31-33bn annually in lost production and taxes, £20-32bn in welfare payments and £5.5bn in additional costs to the NHS.

Professor Marmot believes that while health professionals are aware of the problem, there is a sense that others should deal with it and that there is little they can do. Many organisations and individuals, however, have received the report favourably and agree that action is both necessary and possible.

BMA representative Dr Vivienne Nathanson says that many doctors are already looking at the social conditions that contribute to their patients’ ill health, but there is a need to spread the word about this integrated approach to treatment.

For his part, Health Secretary Jeremy Hunt supports the report and has called on health professionals to deal not only with medical issues but also the underlying social and economic causes of ill health. The NHS, he points out, has a legal duty to reduce health inequality.

In April, responsibility for the prevention of ill health passed to local authorities. The report, however, is aimed at the health service. Among its key recommendations are:

•          Access to potential medical careers for people from all backgrounds should be improved.
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•          Health service providers should act as advocates for patients and for changes in policies.
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•          Social history should be recorded alongside medical history and medical practitioners should provide referrals to other relevant agencies for those in need
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•          Medical training and professional development should include the social determinants of ill health.

New technology gives fresh hope to liver transplant patients

Organ transplants have saved thousands of lives over the years but the length of time that an organ can be kept alive outside the body has placed constraints on the number of transplants that can be performed. Livers, for example, are currently cooled to 4°C to preserve them. However, they continue to deteriorate and must be used within about 12 hours, severely limiting the window of opportunity for surgeons to operate. In fact, currently only about 650 liver transplants are carried out annually in the UK and demand far outstrips supply. This could be about to change.

In a world first, a team of scientists at Oxford University has developed a machine that can warm the liver to body temperature while maintaining a circulation of blood, oxygen and nutrients. This allows it to function as it would inside the body, meaning that it is not only preserved but can also repair itself, give doctors the opportunity to examine it for defects and, crucially, allow doctors more time before they have to operate.

Researchers believe that the machine will keep livers alive for at least 24 hours and tests indicate that 72 hours or more is not beyond the realms of possibility. Also, the machine is portable (about the size of a supermarket trolley) and could be modified to help preserve other organs and to test the toxicity of new medicines.

To date, in a pilot trial at King’s College Hospital in London, two patients have been given livers kept alive by the new machine. In neither case have there been any complications. The first, 62-year-old Torbay man Ian Christie, was diagnosed with cirrhosis of the liver last May and told that, without a transplant, he could die within 18 months. He is delighted with the results.

Oxford’s Professor Constantin Coussios, who helped develop the device, is amazed at the success of the trials, while Professor Nigel Heaton, Director of Surgery at King’s, has described the new development as a potential “bona fide game changer.” He says that the extra time it affords gives patients extra options. Echoing these sentiments, Wayel Jassem, the surgeon who performed the transplants, says that the new technology represents a major breakthrough that could herald exciting changes in liver transplant practice.

NHS could charge a call out fee for doctors

According to a report issued by the NHS Confederation, the body that represents all NHS trusts, frank discussions are needed on ways to shore up NHS finances. Among the suggestions outlined in the report as means of raising funds are proposals that patients should be charged for calling out a doctor to their home (a pilot scheme has been trialled in Germany) and should pay for meals. Patients should also have to pay to watch television, an idea that some NHS trusts are already considering.

Although the Confederation said that there are no plans in place to initiate a system of charges, opponents have expressed outrage. The proposed call out charge, set at £8.50, has raised concerns about patent safety. In fact, one survey has found that if a charge was imposed 24% of patients would delay in making a call to the doctor, while some 18% would not call at all. Katherine Murphy, Chief Executive of the Patients Association, claims that such charges would amount to a tax on patients and are contrary to the NHS’s principle of “free at the point of use.” She adds that patients should not have to pay for reform of the NHS through new charges.

Chief Executive Mike Farrar, however, says that open and honest discussions are needed about why the NHS must change. He says, “We cannot risk the wheels coming off and patient care suffering.”

The report warns that the NHS may need radical proposals as it faces spiralling costs caused by an ageing population and rising levels of obesity. The NHS currently spends 1.5% of its annual £100bn budget on propping up Private Finance Initiative but this figure is expected to double in the next ten years. In 2012, for the first time an NHS trust went into administration and officials estimate that another 20 are facing a severe crisis.

Cardiac patients can access their surgeon’s performance record

At its annual meeting held in Brighton in March, the Societyfor Cardiothoracic Surgery (SCS) announced that patients about to undergo heart surgery will have access to a range of information, including details of their surgeon’s past performance and other health statistics. This information will be available via a website, Blue Book Online, which is designed to raise the transparency of the medical profession.

Due to scandals at the Bristol Royal Infirmary where 35 babies died and others suffered permanent damage due to failures in cardiac surgery and high death rates at Mid-Staffordshire Hospital, cardiac surgeons have had to become more open about their performances. SCS President James Roxburgh believes that wider availability of data and transparency might be the only way to prevent further instances of serious failures of clinical governance.

According to Professor Ben Bridgewater, a cardiac surgeon at University Hospital of South Manchester, the number of patients using the Internet to access clinical information about their care has increased exponentially. He believes that the Internet is the ideal way for up-to-date data to be made available and that greater transparency will encourage the medical profession to act more in the best interests of patients.

Until now, data relating to mortality rates following cardiac surgery and the performance of some 80% of surgeons has been published on the website of the Care Quality Commission. 

Breastfeeding could save the NHS millions

UNICEF UK has claimed that the NHS would save around £40 million a year if more women breastfed their babies.  The organization claims that breast milk boosts the immune system of babies and offers protection from more than 50 infant and adult illnesses, including respiratory illnesses, gastroenteritis and ear infections to a degree unattainable by other foodstuffs.

Unfortunately, however, although the recommended period for breastfeeding is at least six months and more than 80% of British women begin breastfeeding after giving birth, less than half continue beyond six weeks. This is one of the lowest durations for breastfeeding in the world. According to UNICEF UK, if women extended the six-week period to four months the outcome would be that nearly 10,000 fewer young children would need hospital treatment and there would be more than 50,000 fewer visits to GPs.

According to UNICEF UK Deputy Director Anita Tiessen, the vast majority of these women would prefer to have continued but give up in the face of lack of support. Ms Tiessen would like to see breastfeeding acknowledged as a major public health issue with investment and legislation introduced to improve the experience for mothers. She notes that any financial investment would reap a rapid return. 

For her part Sue Ashmore, Programme Director of the UNICEF UK Baby Friendly Initiative, would like to see breastfeeding become something that is seen around us every day. 

Professor Mike Kelly, Director of the Centre for Public Health Excellence at the National Institute for Health and Clinical Excellence, agrees that supporting breastfeeding is a simple idea that could help reduce health inequalities and save money, two of the most urgent problems facing the NHS.

NHS Lothian to take steps to reduce waiting times

To reduce its backlog in operation waiting times, NHS Lothian plans to recruit around 250 new theatre staff.

This plan was outlined in the local health board’s annual review and follows revelations earlier this year that waiting times had been manipulated by listing patients as “unavailable”. It is part of a £10 million strategy to reduce the patient backlog, which it was estimated could be up to 500 by the New Year if contingency plans were not made.

The board anticipates that some patients may have to be sent to other health boards in Scotland or, in a few cases, to Europe for surgical procedures if it is to meet new 12 week targets dictated by legislation taking effect on 1^st October. This is despite the fact that the new surgeons and extra nursing and health staff will mean that theatres can operate in the evening and at weekends.

According to NHS Lothian Chief Executive Tim Davison, who was appointed in July after two months as the interim Acting Chief Executive, the board is making progress in reducing waiting times for treatment but will not become complacent. The new staff will facilitate increased capacity and allow more people to be treated locally in a timely fashion.

Cabinet Secretary for Health and Well-being Alex Neill chaired the annual review meeting. He commented that NHS Lothian was undertaking the biggest operation to reduce waiting times ever mounted by a Scottish NHS Board. He believed that Tim Davison was the right man for the task.