Category Archives: Asthma

Use carrot and stick to tackle obesity crisis | Letters

The UK is the “most obese nation in western Europe” (Report, 11 November), and there is widespread agreement that a range of measures is required to address this problem. One such measure, the government’s proposed sugar tax on soft drinks, should therefore be commended, especially since it introduces the concept of using price policies to promote healthier eating. However, the policy is likely to be more effective if the stick of the sugar tax is balanced by a carrot of subsidies on fruit and vegetables, increased consumption of which protects against numerous disorders – notably heart disease, stroke and bowel cancer – and is likely to limit the rise in obesity. As the WHO pointed out in its 2015 report Using Price Policies to Promote Healthier Diets, “Taxes on sugar-sweetened beverages and targeted subsidies on fruit and vegetables emerge as the policy options with the greatest potential to induce positive changes in [food] consumption”. However, as the WHO says, extra government intervention will likely be required to bring the price of fruit and veg down to a level everyone can afford and provide the maximum benefit to all. This will require more research on price policy strategies of how to spend the tax on sugar-containing drinks – something which was not the remit of the government’s adviser, Public Health England.
Henry Leese
Windermere, Cumbria

Your report says correctly that the government’s childhood obesity strategy was heavily criticised “for its reliance on voluntary action by the food and drink industry and lack of restrictions on the marketing and advertising of junk food”. It was also criticised for making no reference to breastfeeding, or to the current inadequate restrictions on marketing and advertising of breastmilk substitutes that contravene the WHO code. Obesity begins in infancy, and it is no accident that the breastfeeding rate in Britain is among the lowest in Europe.
J Peter Greaves
London

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NHS cash squeeze forces hospitals to postpone non-urgent operations

The NHS is under fire for forcing patients who need surgery to wait at least three months before they can have an operation in order to save money.

NHS clinical commissioning groups (CCGs) in Lincolnshire have provoked sustained criticism after deciding to introduce minimum waiting times for non-urgent surgery including cataract operations and joint replacements.

They have adopted the policy as a result of the NHS-wide cash squeeze and also because they insist that some patients’ condition clears up while they wait.

A Liberal Democrat MP, Norman Lamb, a former health minister, said the move was “a shameful indictment of the under-funding of the NHS” that would prove unfair and divisive. “It undermines the core principles of the NHS: that everyone should get compassionate treatment, as early as possible, when they need it. Those who can afford it will go private to skip the wait, while others will be left waiting in pain and discomfort. This is simply impossible to justify.”

Trafford CCG in greater Manchester has confirmed that it is also considering bringing in a similar policy, according to the Health Service Journal (HSJ), which first reported on the plans.

NHS England oversees all 209 CCGs which between them spend over £60bn of the NHS’s £125bn annual budget. It appeared to back minimum waits, despite the controversy they have aroused.

A spokesman for NHS England said that with health budgets so squeezed that NHS bodies face “difficult choices” about what they spend their money on. However, there are doubts about whether it is legal for any CCG to bring in minimum waits for care, given that patients are supposed to be guaranteed in the NHS constitution that they will be treated as soon as possible.

Lincolnshire West CCG told HSJ that it had “a responsibility to ensure public money is spent effectively and efficiently”. It added that “there is evidence that some conditions do get better over time and that, in some cases, surgery may be unnecessary” though did not specify to which conditions it was referring.

The commonest non-urgent operations hospitals perform include removal of cataracts, replacement of a worn-out hip or knee and the repair of a hernia.

The Royal College of Surgeons (RCS) said making patients wait at least 13 weeks for treatment was “arbitrary” and “ethically wrong” because patients would suffer.

Sue Hill, the college’s vice-president, said: “We strongly urge all these CCGs to reconsider this decision. Patients in Trafford currently wait an average of 7.2 weeks for any type of treatment. If this policy were to go ahead average waiting times in Trafford would double and it is difficult to see how these targets coud be achieved.”

While the RCS appreciates the severe financial pressures facing CCGs, “introducing an arbitrary minimum waiting time for surgery is unlikely to save money in the long-term and is ethically wrong. Delaying surgery can mean a patient’s condition worsens, and can make surgery more difficult and less successful,” added Hill.

Cambridgeshire and Peterborough CCG was the first to bring in minimum waits for non-urgent surgery, also for 12 weeks. But it recently abandoned the policy two months after it was brought in.

Minimum long waits for treatment were banned when the coalition was in office through a ruling in 2011 by the now defunct Cooperation and Competition Panel. However, it appears that that applied only to primary care trusts, which CCGs replaced, and not to CCGs, which hold the NHS budget across England.

Jon Ashworth, the shadow health secretary, urged the government to prevent NHS bodies from using the tactic. “I’m demanding Jeremy Hunt intervenes, enforces the NHS constitution and bans these minimum waiting times. Secondly, in the budget Theresa May must provide the NHS with the money it needs to end this postcode lottery of care that has developed under the Tories.”

An NHS England spokesperson said: “CCGs face difficult choices about what can be afforded within the funds parliament has made available, recognising the priority being accorded to emergency care, mental health, cancer and GP services. Last month 1.3 million patients started consultant-led elective treatment and the vast majority of patients wait less than 18 weeks.”

Lincolnshire NHS enforces three-month wait for surgery

The NHS is under fire for forcing patients who need surgery to wait at least three months before they can have an operation in order to save money.

NHS clinical commissioning groups (CCGs) in Lincolnshire have provoked sustained criticism after deciding to introduce minimum waiting times for non-urgent surgery including cataract operations and joint replacements.

They have adopted the policy as a result of the NHS-wide cash squeeze and also because they insist that some patients’ condition clears up while they wait.

A Liberal Democrat MP, Norman Lamb, a former health minister, said the move was “a shameful indictment of the under-funding of the NHS” that would prove unfair and divisive. “It undermines the core principles of the NHS: that everyone should get compassionate treatment, as early as possible, when they need it. Those who can afford it will go private to skip the wait, while others will be left waiting in pain and discomfort. This is simply impossible to justify.”

Trafford CCG in greater Manchester has confirmed that it is also considering bringing in a similar policy, according to the Health Service Journal (HSJ), which first reported on the plans.

NHS England oversees all 209 CCGs which between them spend over £60bn of the NHS’s £125bn annual budget. It appeared to back minimum waits, despite the controversy they have aroused.

A spokesman for NHS England said that with health budgets so squeezed that NHS bodies face “difficult choices” about what they spend their money on. However, there are doubts about whether it is legal for any CCG to bring in minimum waits for care, given that patients are supposed to be guaranteed in the NHS constitution that they will be treated as soon as possible.

Lincolnshire West CCG told HSJ that it had “a responsibility to ensure public money is spent effectively and efficiently”. It added that “there is evidence that some conditions do get better over time and that, in some cases, surgery may be unnecessary” though did not specify to which conditions it was referring.

The commonest non-urgent operations hospitals perform include removal of cataracts, replacement of a worn-out hip or knee and the repair of a hernia.

The Royal College of Surgeons (RCS) said making patients wait at least 13 weeks for treatment was “arbitrary” and “ethically wrong” because patients would suffer.

Sue Hill, the college’s vice-president, said: “We strongly urge all these CCGs to reconsider this decision. Patients in Trafford currently wait an average of 7.2 weeks for any type of treatment. If this policy were to go ahead average waiting times in Trafford would double and it is difficult to see how these targets coud be achieved.”

While the RCS appreciates the severe financial pressures facing CCGs, “introducing an arbitrary minimum waiting time for surgery is unlikely to save money in the long-term and is ethically wrong. Delaying surgery can mean a patient’s condition worsens, and can make surgery more difficult and less successful,” added Hill.

Cambridgeshire and Peterborough CCG was the first to bring in minimum waits for non-urgent surgery, also for 12 weeks. But it recently abandoned the policy two months after it was brought in.

Minimum long waits for treatment were banned when the coalition was in office through a ruling in 2011 by the now defunct Cooperation and Competition Panel. However, it appears that that applied only to primary care trusts, which CCGs replaced, and not to CCGs, which hold the NHS budget across England.

Jon Ashworth, the shadow health secretary, urged the government to prevent NHS bodies from using the tactic. “I’m demanding Jeremy Hunt intervenes, enforces the NHS constitution and bans these minimum waiting times. Secondly, in the budget Theresa May must provide the NHS with the money it needs to end this postcode lottery of care that has developed under the Tories.”

An NHS England spokesperson said: “CCGs face difficult choices about what can be afforded within the funds parliament has made available, recognising the priority being accorded to emergency care, mental health, cancer and GP services. Last month 1.3 million patients started consultant-led elective treatment and the vast majority of patients wait less than 18 weeks.”

Anger after report finds birth defects not caused by hormone pregnancy tests

A hormone pregnancy test used in the 1960s and 1970s was not responsible for serious birth defects, according to an official review, which has been severely criticised by campaigners.

An expert working group set up by the Commission on Human Medicines (CHM) concluded there was no “causal association” between a drug called Primodos and severe disabilities in babies.

However, MPs and families who have campaigned against hormone pregnancy tests (HPTs) for more than 40 years, said the report was a whitewash.

Yasmin Qureshi, the MP for Bolton South East, said there should be a judicial review or a separate inquiry to examine allegations of a cover-up by medical regulators at the time.

The Labour MP said: “I am completely disgusted by the report. They clearly have not looked at the evidence that was presented to them. If they had looked at the evidence presented to them they could never have arrived at the conclusion they have now. This report is a complete whitewash. It is not worth the paper it has been printed on.”

Mims Davies, the Conservative MP for Eastleigh, said she was disappointed by the report and would be meeting with the prime minister to raise her concerns.

Davies said: “I was thoroughly dissatisfied by the complete lack of transparency in the creation and preparation of this report, with the only representative of campaigners against these historic injustices on the panel being gagged by a confidentiality agreement and prevented from speaking about the report’s preparation.”

The expert group recommended that families who took an HPT and experienced an “adverse pregnancy outcome” should be offered genetic testing to establish whether there was a different underlying cause.

Campaigners believe that as well as causing disabilities, the drugs could also cause miscarriage or stillbirth.

Marie Lyon, chair of the Association for Children Damaged by Hormone Pregnancy Tests, said: “It’s truly shocking and I am appalled by the report. We all feel betrayed, and I feel like I have no faith in government health agencies now. I am distraught for our members, who still haven’t had the answers they need.”

Charlotte Fensome, whose brother Steven has severe epilepsy, said she was horrified by the report.

“I’m obviously hugely disappointed by this report. My parents are 81 and 76, and they are struggling every day with my brother. Every victim of Primodos is a personal tragedy, and I am shocked at how this investigation has been carried out.

“My mother was given Primodos when she was eight weeks pregnant, and my brother was born with severe brain damage. It affects the whole family every single day. This is just a battle, and there is a long war ahead.”

The expert group assessed a number of studies looking at a possible link between women given an HPT to diagnose pregnancy and congenital anomalies in babies, but concluded there was no connection.

The expert group found that “although there was never any reliable evidence that HPTs were unsafe, concern about this issue, coupled with the development of better pregnancy tests” led to the use of HPTs being restricted in the 1970s.

A 1967 report found there might be a link between HPTs and spina bifida, and – following the thalidomide scandal which had recently led to that drug being withdrawn – concerns about HPTs rose dramatically.

Primodos, which was also used to treat menstruation problems, was then withdrawn completely in 1978. “Whether these precautionary actions were sufficiently timely became a subject of controversy,” noted the report.

Modern pregnancy tests measure hormone levels in a woman’s urine. The older HPTs contained synthetic versions of two hormones found naturally in the body. Two pills were taken on consecutive days, with a withdrawal bleed a few days later in those who were not pregnant.

Primodos contained synthetic versions of progesterone and estrogen.

Prof Stuart Ralston, the chair of the CHM, said: “This was a comprehensive and wide-ranging scientific review of all the available evidence on the possible association between HPTs and birth defects by internationally leading experts across a broad range of specialisms.”

Dr Ailsa Gebbie, the chair of the expert working group, said: “Our recommendations will strengthen further the systems in place for detecting, evaluating and communicating risk with use of medicines in pregnancy and help safeguard future generations.”

A spokeswoman for Bayer AG, which acquired Primodos manufacturer Schering in 2006, said: “Bayer notes that a review by an independent expert working group on hormone pregnancy tests of the Commission on Human Medicines has found, consistent with Bayer’s view, based on all available data, that the scientific evidence does not support a causal association between the use of hormone pregnancy tests, such as Primodos, and birth defects or miscarriage.”

Anger after report finds birth defects not caused by hormone pregnancy tests

A hormone pregnancy test used in the 1960s and 1970s was not responsible for serious birth defects, according to an official review, which has been severely criticised by campaigners.

An expert working group set up by the Commission on Human Medicines (CHM) concluded there was no “causal association” between a drug called Primodos and severe disabilities in babies.

However, MPs and families who have campaigned against hormone pregnancy tests (HPTs) for more than 40 years, said the report was a whitewash.

Yasmin Qureshi, the MP for Bolton South East, said there should be a judicial review or a separate inquiry to examine allegations of a cover-up by medical regulators at the time.

The Labour MP said: “I am completely disgusted by the report. They clearly have not looked at the evidence that was presented to them. If they had looked at the evidence presented to them they could never have arrived at the conclusion they have now. This report is a complete whitewash. It is not worth the paper it has been printed on.”

Mims Davies, the Conservative MP for Eastleigh, said she was disappointed by the report and would be meeting with the prime minister to raise her concerns.

Davies said: “I was thoroughly dissatisfied by the complete lack of transparency in the creation and preparation of this report, with the only representative of campaigners against these historic injustices on the panel being gagged by a confidentiality agreement and prevented from speaking about the report’s preparation.”

The expert group recommended that families who took an HPT and experienced an “adverse pregnancy outcome” should be offered genetic testing to establish whether there was a different underlying cause.

Campaigners believe that as well as causing disabilities, the drugs could also cause miscarriage or stillbirth.

Marie Lyon, chair of the Association for Children Damaged by Hormone Pregnancy Tests, said: “It’s truly shocking and I am appalled by the report. We all feel betrayed, and I feel like I have no faith in government health agencies now. I am distraught for our members, who still haven’t had the answers they need.”

Charlotte Fensome, whose brother Steven has severe epilepsy, said she was horrified by the report.

“I’m obviously hugely disappointed by this report. My parents are 81 and 76, and they are struggling every day with my brother. Every victim of Primodos is a personal tragedy, and I am shocked at how this investigation has been carried out.

“My mother was given Primodos when she was eight weeks pregnant, and my brother was born with severe brain damage. It affects the whole family every single day. This is just a battle, and there is a long war ahead.”

The expert group assessed a number of studies looking at a possible link between women given an HPT to diagnose pregnancy and congenital anomalies in babies, but concluded there was no connection.

The expert group found that “although there was never any reliable evidence that HPTs were unsafe, concern about this issue, coupled with the development of better pregnancy tests” led to the use of HPTs being restricted in the 1970s.

A 1967 report found there might be a link between HPTs and spina bifida, and – following the thalidomide scandal which had recently led to that drug being withdrawn – concerns about HPTs rose dramatically.

Primodos, which was also used to treat menstruation problems, was then withdrawn completely in 1978. “Whether these precautionary actions were sufficiently timely became a subject of controversy,” noted the report.

Modern pregnancy tests measure hormone levels in a woman’s urine. The older HPTs contained synthetic versions of two hormones found naturally in the body. Two pills were taken on consecutive days, with a withdrawal bleed a few days later in those who were not pregnant.

Primodos contained synthetic versions of progesterone and estrogen.

Prof Stuart Ralston, the chair of the CHM, said: “This was a comprehensive and wide-ranging scientific review of all the available evidence on the possible association between HPTs and birth defects by internationally leading experts across a broad range of specialisms.”

Dr Ailsa Gebbie, the chair of the expert working group, said: “Our recommendations will strengthen further the systems in place for detecting, evaluating and communicating risk with use of medicines in pregnancy and help safeguard future generations.”

A spokeswoman for Bayer AG, which acquired Primodos manufacturer Schering in 2006, said: “Bayer notes that a review by an independent expert working group on hormone pregnancy tests of the Commission on Human Medicines has found, consistent with Bayer’s view, based on all available data, that the scientific evidence does not support a causal association between the use of hormone pregnancy tests, such as Primodos, and birth defects or miscarriage.”

UK banker being kept alive against wishes of family and doctors

An investment banker who sustained severe brain damage after a cardiac arrest is being kept alive against the wishes of his family and doctors because the official solicitor has intervened to prevent his death.

The unusual case, which is likely to be referred to the supreme court for an emergency hearing, tests whether relatives and medical staff must seek judicial permission before life-support treatment is withdrawn.

On Monday, Mrs Justice O’Farrell ruled in the high court that the court of protection does not need to be consulted in cases, such as that of “Mr Y”, where clinicians and the patient’s family agree that it is not in the best interests of the patient to be kept alive in a coma.

However the judge anticipated that the official solicitor would appeal against her decision. It is normal practice in such cases for treatment to continue until the legal disputes are resolved.

Mr Y, 52, is said to be unaware of either himself or his environment. Before his cardiac arrest in June, he was very active despite working long hours in a stressful profession. He ran and skiied, regularly went to the gym and was said to have loved music and rock concerts. He had not left a living will or any instructions on what should happen to him in the case of sudden illness.

His wife, their two children, and his brother and sister, the court was told, all accepted that Mr Y would not want to live in a vegetative or minimally conscious state with profound disabilities.

“He would hate to be helpless and dependent on other people for his daily needs,” the judgment said. “He would not want to live in a care home.”

The judge concluded there was no legal obligation “that all cases concerning the withdrawal of CANH [clinically assisted nutrition and hydration] from a person who lacks capacity must be sanctioned by the court”.

O’Farrell cited a landmark judgment in another case, saying it had clearly established that principle. Where doctors had obeyed the Mental Capacity Act and good medical practice, where there was no dispute with the family or others close to the patient, and there were no other doubts or concerns, there was no need to bring the matter before the court, she said.

The earlier ruling, by Mr Justice Jackson, marked a significant change in how end of life cases are handled and sought to do away with unnecessary litigation for families at times of emotional strain.

It was thought that the official solicitor, who provides legal representation in cases for those unable to participate, would appeal against Jackson’s decision in September but this did not happen.

The legal dispute was now expected to be fought over Mr Y’s case, which was initiated by Vikram Sachdeva QC on behalf of the unnamed NHS trust that is treating him. The 39 Essex Chambers barrister applied to the high court for a declaration that it is not mandatory to seek judicial permission to end life-supporting treatment in such cases.

It is thought that the official solicitor is applying to the supreme court for an emergency hearing, skipping the court of appeal because of the importance of the case. It likely to trigger interventions by right to life campaigners.

If treatment was withdrawn by the NHS hospital treating Y, O’Farrell said, he would probably die within two to three weeks.

As long ago as 1993, n the case of Anthony Bland, a Hillsborough survivor who was left in a persistent vegetative state, the courts established that it was legal to stop providing treatment – including food and water – if it was deemed to be in the patient’s best interests.

Citing the Bland case, O’Farrell observed in Y’s case that “the right to life is not absolute. As a matter of principle the withdrawal of CANH from a person who lacks capacity, resulting in death, may be lawful where it is not in his best interests to continue such treatment.”

According to recent estimates there are 4,000 to 16,000 patients in a vegetative state in the UK, with many more in what is described as a minimally conscious state.

The Ministry of Justice, which handles inquiries on behalf of the official solicitor, did not immediately comment on the case.

‘We are a force to be reckoned with’: voices of newly qualified nurses

‘I finish most shifts feeling guilty and remember things I didn’t have time to do’

Nursing isn’t what I expected it to be, there’s never enough time for patient contact which really saddens me. Nurses are now mainly office-based and have to delegate the patient contact to healthcare workers. I often class a good shift as one where I have managed to sit down and talk to someone who needed me. I finish most shifts feeling guilty and wake up in the middle of the night and remember things I didn’t have time to do. The stress of the job is unbelievable.

The pay conditions really anger me. Working in mental health can be a risky job where staff are assaulted and have to face quite a lot of abuse. I do not think it is fair that I only get paid around £10 an hour, which is a lot less than my friends who do low-level administration work in offices where they get paid to answer the phone. The government is relying on the good nature of nurses to continue doing their job because they care.
Kate Clayton, 15 months post-qualified, mental health nurse, Staffordshire

‘Nurses are a force to be reckoned with – I think that has become more prominent in recent years’

Before I began nursing I didn’t really see nurses as specialists or professors. It was only during my nursing studies and hospital placements that I began to realise the breadth of opportunities within nursing and the new found confidence nurses have. Nowadays we all work as a multidisciplinary team (MDT) and nurses work more closely with doctors and allied healthcare professionals. We, as nurses, are encouraged to speak up, ask questions and play a bigger part in the MDT and in our patients’ care plans. We also now have so many different opportunities for nurses like specialist roles, research and education. I think in the future we will see a lot more nurses going on to do the likes of PhDs and more specialist training. We are a force to be reckoned with and I think that has definitely become more prominent in recent years.
Bebhinn O’Dowd, 12 months post-qualified, critical care research nurse (specialising in major trauma), London

‘We are constantly working more hours than we should because it’s so short-staffed’

There is so much responsibility in modern nursing. You literally have people’s lives in your hands. It’s a big burden for a 22-year-old. Some older nurses have told me that in the past we would have been slowly fed into the system instead of being thrown in and immediately pushed to the limits. We are constantly working more hours than we ever should because it’s so short-staffed.


It seems more of an uphill battle to get what is deserved and to get the kind of respect nurses used to get

Liv Webster

Pay is of course something my friends and I rant about and some people who I studied nursing with have already changed their career path – we’re not even 18 months qualified. A lot are being pushed into private sectors and agency work so the NHS is losing valuable members of the team who can’t deal with the pay when they have families to support. Having said that I absolutely love my job and wouldn’t do anything else.
Ella Clarke-Billings, 14 months post qualified, surgical nurse, London

‘I didn’t realise the monumental amount of paperwork that nursing incorporated’

I went straight into the private sector due to more opportunity. I would have preferred to work for the NHS at the time but in my specialism I found it very hard to get into. I wanted to be a liaison nurse, which is a role to support people with a learning disability while they are in hospital, but people don’t seem to leave those jobs once they’re in them as they are so good to have. There is definitely more room for climbing the ladder in the NHS but that’s not what interests me. For me, getting the right healthcare for my service users and supporting them to have the best quality life they can is what’s most important. It’s why I wanted to become a nurse – to be the voice for those that couldn’t be heard and that’s what I can do in the company I work for.

I didn’t realise the monumental amount of paperwork that nursing incorporated. I definitely thought it would be more hands-on than it is. It seems more of an uphill battle to get what is deserved and to get the kind of respect nurses used to get, especially in my specialty which other health professionals seem to deem as useless. People don’t view learning disability nurses as proper nurses as we deal a lot with the social side and not just the medical side of care. I have even had family members joke that I’m not a proper nurse; when you aren’t given that level of respect it can really deflate you.
Liv Webster, 15 months post-qualified, learning disabilities nurse, Lichfield

‘Coming into nursing is different but it’s important to see it as a vocation rather than a job’

Nursing has certainly changed since I started in the early 1970s. The introduction of technology has had a big impact. I’ve seen the introduction of electronic health records, email and e-learning, and this kind of innovation has helped improve the practice of learning for the benefit of patients and carers. Many nurses had to adapt to the change and for some it was a difficult time as they did not have the computer skills required. For new nurses this will never be a problem as the way they study is academic and they have been brought up with technology.

But ultimately a good new nurse will have the same core skills and qualities, such as empathy and compassion, as when I trained. Coming into nursing now is different but it is even more important now that those entering see it as a vocation rather than a job. It is a hard career albeit rewarding.
Helen Smith, 41 years post qualified, mental health matron and ward manager, West Midlands

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One in five European NHS doctors plans to quit UK, survey reveals

Almost one in five of the NHS’s European doctors have made plans to quit Britain, according to research that has raised fresh fears of a Brexit-induced medical brain drain.

And almost half of the health service’s 12,000 medics from the European Economic Area (EEA) are considering moving abroad, the British Medical Association survey of 1,720 of them found.

The findings come amid growing evidence that Brexit may exacerbate problems of understaffing in the NHS by making both retention and recruitment of EU staff more difficult. In September NHS figures showed that more than 10,000 staff from EU countries had quit since the Brexit vote. And the number of EU nurses coming to Britain has dropped by 89% in the last year, Nursing and Midwifery Council figures released this month showed.

In total, 45% of respondents to the BMA survey said they were thinking about leaving Britain following the result of the EU referendum in June 2016 – three percentage points more than when the BMA ran a similar poll in February – while a further 29% were unsure whether they would go.

Among those who were considering going elsewhere 39% – or 18% of the whole sample – have already made plans to leave. The 12,000 doctors from the EEA (the EU plus Iceland, Liechtenstein and Norway) represent 7.7% of the NHS’s medical workforce.

Some of those leaving have been offered jobs abroad, while others are applying for posts overseas. Some have begun the process of seeking citizenship elsewhere, while others are having their qualifications validated so they can work in another country, the BMA said.

Q&A

What was wrong with the claim that the UK sends the EU £350m a week?

The claim that Britain “sends the EU £350m a week” is wrong because:

  • The rebate negotiated by Margaret Thatcher is removed before anything is paid ​​to Brussels. In 2014, this meant Britain actually “sent” £276m a week to Brussels; in 2016, the figure was £252m.
  • Slightly less than half that sum – the money that Britain does send to the EU – either comes back to the UK to be spent mainly on agriculture, regional aid, research and community projects, or gets counted towards ​the country’s international aid target.

Regardless of how much the UK “saves” by leaving the EU, the claim that a future government would be able to spend it on the NHS is highly misleading because:

  • It assumes the government would choose to spend on the NHS the money it currently gets back from the EU (£115m a week in 2014), thus cutting f​unding for​ agriculture, regional development and research by that amount.
  • It assumes​ the UK economy will not be adversely affected by Brexit, which many economists doubt.

“That so many EU doctors are actively planning to leave the UK is a cause for real concern. Many have dedicated years of service to the NHS and medical research in the UK, and without them our health service would not be able to cope,” said Dr Andrew Dearden, the BMA’s treasurer.

The Labour MP Darren Jones, a supporter of the pro-EU Open Britain campaign, said: “The British people were told last year that Brexit would boost the NHS by £350m a week. Now the evidence is piling up that it will break it instead.

“We all depend on the brilliant work done by doctors, nurses and other staff who come from the EU. There is no chance that we could replace their expertise if they continue to leave the UK.”

But the Department of Health said that figures released last week by the General Medical Council, showing a slight year-on-year rise in 2016-17 in the number of EEA doctors joining its medical register, showed the BMA’s findings were inaccurate.

“This survey does not stand up to scrutiny. In fact, there are actually more EU doctors working in the NHS since the EU referendum, more EU graduates joining the UK medical register and 3,193 more EU nationals working in the NHS overall,” a spokesperson said.

Mental health? It’s in the mind and the body, too | Rachel Kelly

Something is stirring in the world of mental health and for once the news is positive. This month, British scientists began testing a radically new approach to treating schizophrenia based on emerging evidence that it could be a disease of the immune system. Meanwhile, scientists are investigating the possibility that low levels of chronic inflammation may be linked to depression.

Oliver Howes, a professor of molecular psychiatry at the MRC London Institute of Medical Sciences and a consultant psychiatrist at the Maudsley hospital in south London, is leading the schizophrenia research. “In the past, we’ve always thought of the mind and the body being separate, but it’s just not like that,” he says. “The mind and body interact constantly and the immune system is no different. It’s about changing the way we think about mental illnesses.”

Hear, hear to that. For a while, I’ve believed that we need to stop splitting mental and physical health. The mind doesn’t exist outside the body. A body without a mind is a corpse. In a way, this is a return to an old way of thinking: a “healthy mind in a healthy body” was the main component of the ancient Greek Hippocratic philosophy. But since Descartes split mind and body, arguing that the two were distinct, we’ve been living with the consequences.

The NHS distinguishes between mind and body – and can use the division as an excuse not to fund mental health services. And I used to embrace the split, too, until I was afflicted by two severe depressive episodes. I was astonished by how physically unwell I became. I couldn’t sleep. My heart sped up. I felt nauseous. Every bit of me hurt. I was suicidal, because I felt so rotten.

Try this for a moment. Take a deep breath. Let your shoulders drop. Close your eyes. Breathe. Enjoy that moment of physical relaxation. And notice something interesting. When we become physically relaxed, we become mentally relaxed. It’s impossible to be physically relaxed and mentally tense. Equally, if you feel stressed and tense, your body follows.

In repressive cultures where expressions of the thought are not allowed, the mind can manifest itself in symptoms of pain. Those who have suffered intolerable trauma, such as childhood sexual abuse, often have a wide range of physical symptoms. Equally, any doctor will tell you that the physical body breaks down when the mind can’t take any more trauma. Thyroid disorders, psoriasis and arthritis are all autoimmune illnesses that can develop at times of emotional stress.

Once we accept the union of mental and physical health, a few things become clear. First, we should ditch the term “mental health”. From now on, we should talk about someone’s health – all in. We would lose much of the stigma that still surrounds saying we are “mentally” unwell. We’re not. We’re just unwell.

And it follows we should embrace a new way of treating those with mental illnesses once we accept that mental illness can be embodied in this way. The split between mind and body has poorly served us, both in terms of diagnosis and in treatment. First diagnosis. We need to look more to underlying causes for why we often feel so glum, many of them physical.

We don’t exercise enough. We eat junk food. Many of us suffer from chronic high levels of inflammation, with inflammed guts leading to stressed bodies – and low mood. We lead hectic lives. We live in cities. We are divorced from nature, and each other. We are glued to our phones. We are not compassionate to ourselves, or to others.Second, treatment. What promotes good cardiovascular, endocrine and musculoskeletal health also promotes good mental health and vice versa. When I look back at my own battle with the black dog, I wonder if I might have recovered more quickly, or been less ill in the first place, if I had understood more about the connection between my mental and physical health. It seems I’m not alone – and hooray for that.

Rapid use of blood drug could save thousands of lives, study finds

Immediate treatment with a cheap and widely available clot-stabilising drug could save the lives of thousands of people each year, including women with severe bleeding after childbirth, a study has found.

A meta-analysis of more than 40,000 patients found that the likelihood of death due to blood loss was reduced by more than 70% if tranexamic acid was administered straight after injury or birth.

But the effectiveness of the drug – available over the counter in the UK to women suffering from heavy periods – diminished over time. The chances of survival fell by 10% for each 15-minute delay, with no benefit seen when administered after three hours.

Postpartum haemorrhage (excessive bleeding after childbirth) is the leading cause of maternal death worldwide, killing about 100,000 women a year, mostly in low- and middle-income countries. More than 2 million people worldwide die from traumatic extracranial bleeding, often as a result of road traffic injuries and violence.

Prof Ian Roberts from the London School of Hygiene and Tropical Medicine, who initiated the study, said: “Responding quickly can be the difference between life and death and that means patients must be treated urgently at the scene of injury or as soon as the diagnosis of haemorrhage is made. We have to make sure tranexamic acid is available before patients reach hospital and whenever a woman gives birth.”

Antifibrinolytic drugs work by stopping blood clots from breaking down and reducing bleeding. They have been used for many years to reduce heavy menstrual bleeding and are often given during surgery to reduce the need for blood transfusions.

For the meta-analysis, published in the Lancet on Tuesday, the authors identified a total of 13 tranexamic acid trials conducted between 1946 and 2017 – but only two assessed the impact of treatment time on its effectiveness.

Their analysis showed that almost two-thirds of bleeding deaths occurred within 12 hours of onset (884 of 1,408 bleeding deaths). Deaths due to postpartum haemorrhage peaked two to three hours after childbirth.

Survival from severe bleeding increased by a fifth with the use of tranexamic acid compared with placebo, irrespective of the site of bleeding. Only 1.5% of women given tranexamic acid died of bleeding versus 1.9% of women given placebo plus standard care, and 4.9% of trauma patients given tranexamic acid died of bleeding compared with 5.7% given placebo and standard care.

The researchers took age and systolic blood pressure into account. They found no evidence of complications or increased risk of clotting (ie heart attack, stroke, pulmonary embolism, and deep vein thrombosis) compared with placebo, and fewer cases of heart attacks were noted with tranexamic acid, which is also used as a skin whitener in Japan and the far east.

The study builds on previous research which showed that tranexamic acid cut deaths due to postpartum haemorrhage and bleeding after serious injury by about a third if given within three hours of the onset of bleeding.

Roberts said: “Tranexamic acid is safe, cheap, easily administered, and does not need to be refrigerated. Most haemorrhage deaths occur within hours of bleeding onset. Prompt treatment has the potential to save thousands of additional lives worldwide every year.

“Given the importance of early treatment, time from bleeding onset to early treatment should be audited and communicated to healthcare professionals. Establishing national or regional quality improvement initiatives, with best practice benchmarking of time to treatment, might improve survival.”

He said more research was needed to understand the mechanism of the treatment.