Category Archives: Beauty & Care

Digital autopsies should be standard for probable natural deaths, says study

Digital autopsies should be the first-line approach in postmortem investigations of probable natural death, and should be offered free of charge to families, researchers have said.

About 90,000 autopsies requested by coroners are carried out in England and Wales every year, with the majority of deaths found to be a result of natural causes.

A switch to body-scanning techniques could prove valuable, say researchers, since a traditional autopsy can be upsetting for the bereaved and a number of religions, including Islam and Judaism, teach that a body should be buried quickly and not violated after death.

“The main benefit is about avoiding the autopsy,” said Bruno Morgan, co-author of the research from the University of Leicester. “The autopsy is not just a simple operation, it is opening [the body] up fully, taking all the organs out and slicing them all into pieces.”

CT scans have long been used to aid postmortem investigations, while more recently studies have explored targeted coronary angiography – another CT scanner-based technique that involves inserting a catheter into an artery and is used to reveal whether blockages are present in the coronary arteries, and to investigate the heart itself.

The latter is a major step forward, since one limitation of digital autopsies has been the difficulty of standard CT scans in establishing causes of death such as coronary heart disease.

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The latest study offers a large-scale comparison of the accuracy of the combined CT techniques to traditional autopsy.

“This paper is the first one that has come out and says this is as accurate as autopsy is in this setting. It works and therefore it is a valid alternative,” said Morgan.

Writing in the Lancet, researchers led by a team at the University of Leicester describe how they studied 241 cases of adults who had died suddenly and unexpectedly of natural causes or had died a non-suspicious unnatural death.

Each was assessed by a postmortem CT scan, with targeted coronary angiography successfully carried out in 85% of the cases. Standard autopsies were then carried out for each case, with the pathologists not told about the findings from the body scans.

After excluding 31 cases, including 24 cases for which the cause of death was clearly traumatic, such as a gunshot wound, the team found that the body-scan approach gave a cause of death, based on “the balance of probabilities”, in 92% of cases.

In 11% of this group, results from either the scans or the autopsy were at odds with findings from a combination of the two. Further analysis revealed that these discrepancies were evenly split between errors in the body-scan approach and errors in the traditional autopsy.

The team say the gold standard for postmortem is the use of both traditional autopsy and body scans, but say the findings support a move to using digital autopsy as the first-line technique in cases of probable natural death. Should more evidence be required, they add, a traditional autopsy can subsequently be carried out.

The public are already allowed to request – usually at a cost of about £500, typically paid by the family – that digital autopsies are used for postmortem investigations where appropriate.

But Morgan says that option should be made available free of charge – a service currently only offered by a small number of councils.

“If you don’t want an invasive autopsy on yourself or on your family, you should be raising the debate and saying why can’t the council pay for this?” he said. “It strikes me that it is wrong that we should make people pay for something that is a statutory obligation,” he added.

Dr Mike Osborn, a fellow of the Royal College of Pathologists, said that postmortem investigations are vital in understanding why people die, as well as improving understanding of disease. But he acknowledged that autopsies can be distressing and clash with religious beliefs.

The development of digital autopsies, including those based on CT scans, he added, was exciting and important. While Osborn noted that some conditions still require a diagnosis from a traditional autopsy, he welcomed further research in the field to reduce the number of traditional autopsies required. “The accuracy of cross-sectional imaging postmortem has improved over the last 20 years and is likely to continue to do so,” he said. “The College fully supports further research in this area while reinforcing the need for thorough and robust governance in this emerging field.”

Digital autopsies should be standard for probable natural deaths, says study

Digital autopsies should be the first-line approach in postmortem investigations of probable natural death, and should be offered free of charge to families, researchers have said.

About 90,000 autopsies requested by coroners are carried out in England and Wales every year, with the majority of deaths found to be a result of natural causes.

A switch to body-scanning techniques could prove valuable, say researchers, since a traditional autopsy can be upsetting for the bereaved and a number of religions, including Islam and Judaism, teach that a body should be buried quickly and not violated after death.

“The main benefit is about avoiding the autopsy,” said Bruno Morgan, co-author of the research from the University of Leicester. “The autopsy is not just a simple operation, it is opening [the body] up fully, taking all the organs out and slicing them all into pieces.”

CT scans have long been used to aid postmortem investigations, while more recently studies have explored targeted coronary angiography – another CT scanner-based technique that involves inserting a catheter into an artery and is used to reveal whether blockages are present in the coronary arteries, and to investigate the heart itself.

The latter is a major step forward, since one limitation of digital autopsies has been the difficulty of standard CT scans in establishing causes of death such as coronary heart disease.

[embedded content]

The latest study offers a large-scale comparison of the accuracy of the combined CT techniques to traditional autopsy.

“This paper is the first one that has come out and says this is as accurate as autopsy is in this setting. It works and therefore it is a valid alternative,” said Morgan.

Writing in the Lancet, researchers led by a team at the University of Leicester describe how they studied 241 cases of adults who had died suddenly and unexpectedly of natural causes or had died a non-suspicious unnatural death.

Each was assessed by a postmortem CT scan, with targeted coronary angiography successfully carried out in 85% of the cases. Standard autopsies were then carried out for each case, with the pathologists not told about the findings from the body scans.

After excluding 31 cases, including 24 cases for which the cause of death was clearly traumatic, such as a gunshot wound, the team found that the body-scan approach gave a cause of death, based on “the balance of probabilities”, in 92% of cases.

In 11% of this group, results from either the scans or the autopsy were at odds with findings from a combination of the two. Further analysis revealed that these discrepancies were evenly split between errors in the body-scan approach and errors in the traditional autopsy.

The team say the gold standard for postmortem is the use of both traditional autopsy and body scans, but say the findings support a move to using digital autopsy as the first-line technique in cases of probable natural death. Should more evidence be required, they add, a traditional autopsy can subsequently be carried out.

The public are already allowed to request – usually at a cost of about £500, typically paid by the family – that digital autopsies are used for postmortem investigations where appropriate.

But Morgan says that option should be made available free of charge – a service currently only offered by a small number of councils.

“If you don’t want an invasive autopsy on yourself or on your family, you should be raising the debate and saying why can’t the council pay for this?” he said. “It strikes me that it is wrong that we should make people pay for something that is a statutory obligation,” he added.

Dr Mike Osborn, a fellow of the Royal College of Pathologists, said that postmortem investigations are vital in understanding why people die, as well as improving understanding of disease. But he acknowledged that autopsies can be distressing and clash with religious beliefs.

The development of digital autopsies, including those based on CT scans, he added, was exciting and important. While Osborn noted that some conditions still require a diagnosis from a traditional autopsy, he welcomed further research in the field to reduce the number of traditional autopsies required. “The accuracy of cross-sectional imaging postmortem has improved over the last 20 years and is likely to continue to do so,” he said. “The College fully supports further research in this area while reinforcing the need for thorough and robust governance in this emerging field.”

Cannabis drug cuts seizures in children with severe epilepsy in trial

A new drug derived from cannabis has been shown to reduce the convulsive seizures experienced by children with a severe form of epilepsy by nearly a half – and in a small number, stop them altogether.

Doctors involved in the trials say the drug could change the lives of thousands of children for whom there is little treatment, and might also help children and adults with more common forms of epilepsy.

Dravet syndrome, which affects one in 40,000 children in the UK, can cause life-threatening convulsions several times a day. The trial at Great Ormond Street children’s hospital in London and centres in the US and Europe was launched because some parents desperate to help their children told of improvements after giving them cannabis derivatives bought on the internet.

“There was a lot of interest on the internet three to four years ago,” said Prof Helen Cross, a consultant in paediatric neurology at Great Ormond Street. That led to the trial of a carefully formulated pharmaceutical form of cannabidiol with virtually no THC (tetrahydrocannabinol), which is responsible for psychoactive effects.

“This is cannabidiol. It is not the oils that are available over the internet and the results cannot be ascribed to that,” she said. “Families should not be feeling this is something they should be able to get [for themselves]. This is a pharmaceutical product.”

The trial involved 120 children, aged two to 18, with an average age of nine. They were randomly assigned to take either cannabidiol in liquid form twice a day or a placebo. Neither the families nor the doctors knew which children were getting the active drug.

On average, the seizures experienced by the children were reduced by nearly 40% and 43% of those taking cannabidiol saw their seizures cut by half. Three children – 5% – stopped having seizures altogether. There were side-effects, which included drowsiness, fatigue, diarrhoea and reduced appetite – but these are similar to those caused by other epilepsy drugs.

The drug is not a cure, however. Cross said seizures returned in those who had stopped the drug. Children would probably be on the medication for life.

There is a need for more and better epilepsy drugs. A third of people with epilepsy do not respond to those that exist. Doctors think cannabidiol may work in at least some of those cases too, although the reason it works in the case of Dravet syndrome is unclear. “I have to say we don’t know,” said Cross. But asked whether it could be effective in other children and adults, she said, “Probably, yes.”

In young women, there has been concern over the drug sodium valproate, which can cause birth defects. Women and girls who may get pregnant are faced with deciding whether to stop taking a drug that may successfully keep their epilepsy under control.

Cross said cannabidiol may also prove to be an option for them, although trials would need to be done.

The results of the trial are published in the New England Journal of Medicine. In a commentary in the journal, Samuel Berkovic, from the Epilepsy Research Centre of the University of Melbourne, called medicinal cannabis “a hot-button issue in the treatment of epilepsy”, after anecdotal reports in the media of “spectacular results, coupled with the allure of using a ‘natural’ compound and long-held beliefs surrounding its recreational use”.

The trial was the beginning of solid evidence for the use of cannabinoids in epilepsy, but more research was needed, he said.

GW Pharmaceuticals, which makes the drug, will apply for a licence to the authorities in the US and Europe. If it is approved, the National Institute for Health and Care Excellence will have to assess the drug for cost-effectiveness before it can be used in the NHS.

Nurse job interview tips: top nine questions and answers

Compassion and communication, respect and resilience, accountability and adaptability – a good nurse possesses a daunting set of qualities. If you’re newly qualified, how can you convince employers you have what it takes?

We asked those responsible for hiring band five nurses to tell us how they identify the right candidates. Here, they reveal some of the most common interview questions, as well as tips on how to answer them.

Why do you want this job?

The first question is usually broad. Candidates shouldn’t go into lots of detail but obviously shouldn’t give an answer that’s too short. If they’re newly qualified, they should think about what brought them into nursing in the first place. Why that specific branch of nursing … did they work there on a placement?
Wendy Preston, head of nursing practice, Royal College of Nursing

Why do you think you’re a good nurse and how can you evidence this?

They have got to show integrity and honesty, and also courage – we want to know they’re going to be a good advocate for their patients. They need to show they work according to the values of the six Cs – care, compassion, competence, communication, courage and commitment.We incorporate scenario question during the interview that will assess a nurse’s integrity. For example: “If you witnessed a nurse administering an incorrect drug, what would you do?” We ask for examples and to provide evidence from their career to date. Their answer will show their thinking processes and whether they know the right procedures to follow.We also understand the value of a happy team, so we want someone who can demonstrate they work well in a team and have a positive, can-do attitude. We want enthusiasm to shine through – you can see when someone’s energised by the work they do.
Ann Duncan, matron, Royal Marsden hospital, London

What does compassionate care mean to you and how do you deliver it?

I’m looking for someone who wants to care. I can teach you any skill, with help from my team, but caring and compassion is inherent. Answers often include kindness, empathy, treating the person as I would want myself or my family to be treated, listening to what it is the patient perceives as the problem and addressing that issue (often different from the clinical issues requiring nursing care).
Jo Thomas, director of nursing and quality, Queen Victoria hospital, Sussex

It is often good to ask a nurse if there has been a time they felt they were unable to give compassionate care and explore their answers. This can give us a good insight at interview. Examples staff have given include exhaustion, abnormally busy, low morale, poor skill mix/staffing levels, poor teamwork, challenging or abusive patients or relatives. Clearly we do not want this to be the norm for a nurse but understand there may be barriers to giving compassionate care all the time. We are looking for honesty and self-awareness. It is important to listen to what they say and how they say it.

Ann Duncan, matron, Royal Marsden hospital, London

How have you dealt with conflict in the past?

Interviewers are looking to see that the nurse can de-escalate a situation, that they know some basic conflict resolution strategies – such as taking people away from the area, sitting them down, finding out the root of the problem – and that they know when they need to escalate to a senior member of staff.
Wendy Preston, head of nursing practice, Royal College of Nursing

What makes a good shift?

We want to hear about the delivery of safe, effective care, and we want it to be documented and evidenced. We don’t want them to believe that high numbers of staff always equates to the best care. Some days, you will be short, but that doesn’t mean they are the worst shifts. It’s good when they say they know the importance of breaks and having catch-up time with staff.
Ann Duncan, matron, Royal Marsden hospital, London

There’s usually a question on resilience. We have to bear in mind that retention of staff is difficult and we want to encourage nurses to stay in the profession. Interviewers will want to know how they manage their time, cope with stress, stay hydrated. The best answer would be about work-life balance.
Wendy Preston, head of nursing practice, Royal College of Nursing

What are you most proud of in your nursing career to date?

Even though some of them have been student nurses they will have moments they are proud of, and we ask them to give an example of when they went above and beyond for a patient. We want to hear a personal story and we want them to be illustrating that they are kind, caring and compassionate, and that they are prepared to do everything they possibly can to ensure safe and effective care.

The stories can vary from nurse to nurse, but we will be able to hear and see if a nurse has genuine pride in their work, and we’ll gain an understanding of what is important to them.
Ann Duncan, matron, Royal Marsden hospital, London

Tell us about a mistake you have been involved with

Often they will talk about someone else’s mistake, not theirs. It’s good if they talk about their mistake, what they’ve learned from it, what they’d do differently, how they have changed their practice, how they have worked with others to change their practice. Interviewers will be looking for how they use evidence in their practice and how they learn from things.
Wendy Preston, head of nursing practice, Royal College of Nursing

What would others say about you in three words?

This is an end-of-interview question. I’m looking for someone who is self-aware, but also whether the three-word description matches the answers and examples they have given to the other questions. Some answers I’ve had in the past include loyal, compassionate and fair; genuine, caring and professional; equitable, passionate and reliable.

The point of the question is to assess how effective the individual is in seeking feedback and reflection, and whether they can articulate this in single words. Being able to answer can demonstrate that you have the insight and maturity to seek the opinions of others. A follow-up question, depending on the seniority of the role, might be: have you changed your practice as a result of feedback from others?
Jo Thomas, director of nursing and quality, Queen Victoria hospital, Sussex

Do you have any questions for us?

Often people are flummoxed and say no, but it’s good to be prepared with a couple of questions. A good question to ask, if it hasn’t come up, is about what kind of preceptorship programme, or learning and development, can they offer. If you have got any holidays booked, this is the time to say it.
Wendy Preston, head of nursing practice, Royal College of Nursing

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NHS faces staggering increase in cost of elderly care, academics warn

The NHS and social care system in the UK is facing a staggering increase in the cost of looking after elderly people within the next few years, according to major new research which shows a 25% increase in those who will need care between 2015 and 2025.

Within eight years, there will be 2.8 million people over 65 needing nursing and social care, unable to cope alone, says the research – largely because of the toll of dementia in a growing elderly population. The research, published by the respected Lancet Public Health medical journal, says cases of disability related to dementia will rise by 40% among people aged 65 to 84, with other forms of disability increasing by about 31%.

The new figures follow a furore over the Conservative manifesto and Theresa May’s U-turn on social care this week. In a bid to keep the costs of care down, the manifesto said those needing care at home would have to pay until they had £100,000 in savings left, including the cost of their home.

After accusations that the Conservatives were imposing a “dementia tax”, May promised a cap on the amount any person would pay for care – although without specifying what the cap would be.

The new analysis will make grim reading for whichever party gains power. “The societal, economic and public health implications of our forecast are substantial,” say the researchers, led by academics from the University of Liverpool and University College London.

“Public and private expenditure on long-term care will need to increase considerably by 2025, in view of the predicted 25% rise in the number of people who will have age-related disability. This situation has serious implications for a cash-strapped and overburdened National Health Service and an under-resourced social care system,” they added.

The figures take account for the first time of the changing disease burden as well as the increasing elderly population and longer life expectancy. Cardiovascular disease, which can cause heart attacks and strokes, has gone down, but dementia is rising as people live longer. This makes the research an advance on previous studies, says Professor Stuart Gilmour of the department of global health policy at the University of Tokyo in a commentary published alongside the paper.

“The results show starkly the growing burden of disability that the UK National Health Service and social care system will face over the next decade,” he writes.

“[It] faces a rapid increase in the number of elderly people with disabilities … at a time when it is uniquely unprepared for even the existing burden of disability in the UK population. This important research should be taken as a warning and a strong call for action on health service planning and funding, workforce training and retention, and preparation for the ageing of British society.”

The government urgently needs to consider the options, says the paper. Firstly, more care homes are needed, it says. Secondly, there must be more support for informal and home care – they suggest tax allowances or cash benefits. “Affected individuals and their families pay an estimated 40% of the national cost of long-term care from income and savings,” they write.

But prevention is also vital. Poor diet, smoking, drinking heavily, high blood pressure, diabetes and little physical activity are risk factors for both heart disease and dementia, they say. Immediate investment in improving people’s lifestyles would pay dividends, they say. “We seriously need to protect the future of older citizens through prevention,” said lead author Dr Maria Guzman-Castillo of the University of Liverpool.

She said political parties had not so far been looking at the true scale of the crisis to come. “We think they are not looking at this. There is a gap between the academic community and the government,” she said.

Professor Helen Stokes-Lampard, chair of the Royal College of GPs, said more investment in the NHS and social care was desperately needed. “It’s a great testament to medical research, and the NHS, that we are living longer – but we need to ensure that our patients are living longer with a good quality of life. For this to happen we need a properly funded, properly staffed health and social care sector with general practice, hospitals and social care all working together – and all communicating well with each other, in the best interests of delivering safe care to all our patients.”

Margaret Willcox, president of the Association of Directors of Adult Social Services (ADASS), said: “As most people expect to need some form of care in their lifetime, there is an urgent need for the whole country to consider how best to ensure people with care needs are funded and how their care is delivered.

“The need to future-proof adult social care should be a national priority for the new government. Unless a long-term sustainable solution is established to tackle significant sector pressures, a rising number of elderly and disabled people living longer and with increasingly complex needs, along with their families, will struggle to receive the personal, dignified care they depend on and deserve.”

Conservatives buy ‘dementia tax’ Google ad as criticism of policy grows

The Conservatives have paid for a Google advert that appears at the top of the page when users search for “dementia tax” in response to growing attacks on Theresa May’s social care policy.

People using the search engine on Monday to find out about the term, coined to describe the prime minister’s manifesto commitment to shake up the funding of old age care, found the top result was a paid-for link from Conservatives.com that read: “The so-called ‘dementia tax’ – get the real facts.”

It links to a five-point Q&A, which explains that “only by getting a good Brexit deal will we be able to continue to fund our public services, like social care”. The tactic shows the Conservatives are willing to adopt the pejorative term for their policy, in the digital realm at least, in order to fight back against criticism.

It comes after the Financial Times used the phrase on its front page on Monday in a report that claimed senior Tories were not briefed on its inclusion in last week’s manifesto. May has said she would make elderly people pay for care in their own home unless they have less than £100,000 in assets.

Theresa May is confronted by a voter over social care

The battle for influence over the information voters receive online was illustrated further when Labour appeared to counter the Conservative move by also buying an advertised link at the top of Google searches for the term.

The paid for Labour link read: “The Conservative manifesto – what You need to know.”

Access to the top of Google’s rankings is available to be bought, with the price set through digital auctions. Digital campaigning experts said the total cost was likely to be hundreds of pounds although the exact amount depends on the number of people that click through. According to Google data, interest in the term “dementia tax” rose steadily throughout Monday morning.

May is coming under pressure to drop or water down her controversial shakeup of social care amid warnings that it is unfair and could deter older people from seeking care.

Conservative candidates are reporting that the proposal is going down badly on the doorstep, potentially accounting for a drop in the party’s lead in the polls. Two Tory candidates seeking re-election, including Sarah Wollaston, who chaired the Commons health committee, have gone on the record to criticise the proposal.

Senior Tories including Boris Johnson and Damian Green were sent out to defend the policy on Sunday as “grownup and responsible”, but reports have emerged that the shakeup was inserted in the manifesto at the last minute without the approval of some cabinet ministers.

With the policy polling badly, opposition parties lined up to condemn May’s decision. Labour said it was in effect a “dementia tax”, hitting those unlucky enough to become ill in old age.

Ian Brady’s psychiatric nurses speak of ‘daily miracle’ of treating him

Psychiatric nurses who cared for Ian Brady at the high security hospital where he was imprisoned have spoken of the “daily miracle” it took to put his crimes aside and ensure he was treated like every other patient.

Brady, who died this week, had been confined to Ashworth hospital since 1985 after a diagnosis of psychopathy. He had previously spent 19 years in mainstream prisons for the Moors murders.

Nurses who treated him say that his refusal to take treatment seriously made him an exceptionally difficult patient. One nurse, who spoke on condition of anonymity, worked with Brady for eight years. Within days of starting his job in the rehabilitation programme at Ashworth in July 1990, he received a letter from Brady saying that he had no interest at all in being rehabilitated and asking for constant supplies of pens and paper.


We had to give Ian Brady meals. This seemed like a strange thing to do for someone who had done what he had done

“I gave them to him but it created a rod for my back,” he said. “He used them to write continuous elaborate letters of complaint on his treatment.”

According to Tony Thompson, who worked as a national nursing adviser in mental health and later as director of practice development in Ashworth, Brady revelled in deriding any attempt at rehabilitation. But Thompson said the public view of Brady left the nurses in a difficult position.

“One of the hardest things for staff was acknowledging that no one wanted him to get better,” he said. “There was huge public pressure to keep him contained and guarded. As care providers, where that did that leave us? What was our role to him?”

That public revulsion of Brady was reflected in reports that his wish to be cremated in Glasgow and have his ashes scattered in the city would not be granted because the city council had asked that none of the four crematoria in the city agree to dispose of his remains.

Earlier in the week, when it was suggested that Brady had wished to be cremated on Saddleworth Moor – where he and Myra Hindley committed the series of murders that made them notorious – coroner Christopher Sumner had postponed releasing his body until he was assured that this would not happen. Funeral directors in Sefton told the Guardian that they would be reluctant to take the body.

Before his death, the media often referred to the Ashworth nurses as “guards”, and Brady, as someone who closely followed the newspaper coverage of himself, was influenced by this.

“He would often say, ‘you’re not really nurses! You’re just just guards here to control me.’ In many ways that was part of our job, but it was not our only job.”

Part of Thompson’s role was leading a group of staff who had to cope with the unpredictability of Brady’s behaviour and the dilemma of understanding heinous crimes in terms of “illness” to be treated.

“We were divided in many ways as there was a public expectation that we could not let him escape,” he said. “Everyone saw him as a criminal but we also saw him as a patient, and while we had to watch his every move from sleeping to going to the bathroom they were also offering skilled care.”

Thompson said professional objectivity was essential to the staff doing their jobs properly. “It was maintenance of boundaries that helped staff handle their ambivalence,” he said. “The most important thing was making sure he was treated like everyone else.”

Another of the psychiatric nurses who cared for Brady, Tom Mason, later wrote a book, The Influences of Evil, examining the notion of evil and its influence over aberrant behaviour. In an interview before his death in 2011, he reflected on the strangely mundane nature of some of the work.

“We had to give Ian Brady meals,” he said. “This seemed like a strange thing to do for someone who had done what he had done, but that was part of our job. I remember seeing Brady for the first time and he had a look in his eye I will never forget. It was a glint that made you shiver.”

According to the anonymous nurse this parity was difficult to maintain as Brady often manipulated situations so that he was the centre of attention. “He was like the protagonist in his own film and we were the walk-on parts,” he said. “The media didn’t help. Every Sunday there was some sort of piece about him which he would read and then cause havoc in the wards.”

He recalls one incident in 1994 when Brady tried to sue the Express newspaper for publishing false claims that he had assaulted one of their writers.

“He couldn’t leave Ashworth so I had to make arrangements for his trial to take place in the hospital. He was furious about this. He wanted his day in court. He wanted to be taken through Liverpool in a van with flashing lights.”

While there were many other patients at Ashworth who had committed the most serious crimes, Brady’s notoriety fed into his belief that he was exceptional.

“The nurses were the ones who saw him all day every day, and it was very hard for them to be consistent,” the nurse said. “But they stayed bold and resolute. Despite his complaints and games the caring machine rolled on. It was a daily miracle really.”

Tom Mason said that even as they maintained professional behaviour, the nurses would debate whether they saw him as a patient or a criminal – or both. “We knew what he had done and we heard what people said about him,” he said. “But when you’re seeing someone every day and serving them breakfast each morning, you just have to keep going and not let whatever it is that makes someone like Brady do the awful things he did affect you or anyone else.”

Marlboro maker accused of using branded tins to sidestep plain packaging rules

The maker of Marlboro cigarettes has been accused of trying to sidestep new UK laws on plain packaging by rolling out durable tins that look just like ordinary cigarette packets.

Philip Morris, one of the world’s largest tobacco companies, came under fire from MPs and anti-smoking campaigners on the eve of the biggest change in tobacco regulation since the smoking ban.

From Saturday, retailers will no longer be able to sell branded cigarette packets, as a 12-month grace period to allow tobacco firms to phase out old cartons comes to an end.

Instead, retailers will only stock plain packets featuring graphic pictures designed to deter smokers. They will also no longer be allowed to stock packets of 10 cigarettes or smaller sizes of rolling tobacco, as part of a package of measures designed to limit the appeal of smoking.

In the run-up to the change, Philip Morris has distributed tin containers, the same size as a 10-pack of cigarettes, to convenience stores around the country. The tins, which were available at chains including Sainsbury’s, Londis and Budgens, are printed with Marlboro branding, and feature deterrent pictures and the message “Smoking kills”.

One expert said focusing on smaller packs could impact specific groups. “Research shows that packs of 10 appeal to young people and the price conscious,” said Karen Reeves-Evans, of the Tobacco Control Research Group at the University of Bath.

“By offering packs of 10 in reusable tins, Philip Morris International is knowingly increasing the lifespan of packs of 10 and promoting its brand, if smokers decant their cigarettes into these small branded tins. The fact that these tins appeared almost immediately prior to the branding and size restrictions coming into force is suspicious.”

Alex Cunningham, the Labour MP for Stockton North and a vocal campaigner for plain packaging, said the move appeared to be a ploy to prolong the visibility of Marlboro’s brand in the UK.

“It’s against the whole spirit of what’s intended with the plain packaging legislation,” he said. “The tobacco companies will stop at nothing in order to retain their branding and sell a product that everyone knows has such tremendous health risks. It’s an immature trick and I hope people will soon put them into their bins and they’ll find their way to the recycling centre.”

The chief executive of Action on Smoking and Health, Deborah Arnott, said the metal tins appeared to contradict the company’s recent declaration that it was aiming for a “smoke-free future”. She said: “What’s important is not what they say but what they do.”

Under the EU directive, all tobacco packaging will be uniformly green with large images showing the harmful effects of smoking


Warning labels on boxes of cigarettes in a newsagent in London. Photograph: Bloomberg via Getty

Philip Morris said it manufactured the tins before 20 May last year, the cutoff point after which tobacco firms were no longer allowed to produce branded packs. But the legislation gave firms a 12-month grace period to continue distribution, allowing the firm to keep selling them.

It said only a “relatively small number” were distributed, although it would not say how many, adding that the stocks would be depleted by the weekend deadline.

The tins cost the same as an ordinary pack of 10 cigarettes but, unlike cardboard packets, could help keep Marlboro’s branding visible for years because they are so durable. A thread on Reddit, the messageboard website, suggests the tins havehelped increase the popularity of Marlboro, with users saying they were making an effort to find them.

The Guardian understands that some retailers were offered the product but refused to stock it. Philip Morris rival JTI Gallaher has also issued aluminium tins for its Benson & Hedges, Mayfair and Camel brands in the run-up to the plain packaging laws coming into force in the Republic of Ireland.

The move was described as “extremely cynical” by Ireland’s former health minister James Reilly, according to the Sunday Times. A spokesperson for British American Tobacco, which owns brands including Rothmans and Dunhill, said the company had not issued a similar product.

The tobacco industry has previously come under fire for allegedly deploying tactics designed to limit the effect of plain packaging legislation, such as using price stickers to differentiate themselves from other brands.

Companies were also accused of ramping up production of branded packaging in the days leading up to 20 May last year, in order to stockpile packets for sale during the 12-month grace period in which their sale was still permitted.

Big tobacco firms have failed in successive attempts to overturn countries’ laws on plain packaging. Philip Morris lost a landmark case against the government of Uruguay, while an attempt to overturn Australia’s plain packaging law via a World Trade Organisation dispute also failed.

Marlboro maker accused of using branded tins to sidestep plain packaging rules

The maker of Marlboro cigarettes has been accused of trying to sidestep new UK laws on plain packaging by rolling out durable tins that look just like ordinary cigarette packets.

Philip Morris, one of the world’s largest tobacco companies, came under fire from MPs and anti-smoking campaigners on the eve of the biggest change in tobacco regulation since the smoking ban.

From Saturday, retailers will no longer be able to sell branded cigarette packets, as a 12-month grace period to allow tobacco firms to phase out old cartons comes to an end.

Instead, retailers will only stock plain packets featuring graphic pictures designed to deter smokers. They will also no longer be allowed to stock packets of 10 cigarettes or smaller sizes of rolling tobacco, as part of a package of measures designed to limit the appeal of smoking.

In the run-up to the change, Philip Morris has distributed tin containers, the same size as a 10-pack of cigarettes, to convenience stores around the country. The tins, which were available at chains including Sainsbury’s, Londis and Budgens, are printed with Marlboro branding, and feature deterrent pictures and the message “Smoking kills”.

One expert said focusing on smaller packs could impact specific groups. “Research shows that packs of 10 appeal to young people and the price conscious,” said Karen Reeves-Evans, of the Tobacco Control Research Group at the University of Bath.

“By offering packs of 10 in reusable tins, Philip Morris International is knowingly increasing the lifespan of packs of 10 and promoting its brand, if smokers decant their cigarettes into these small branded tins. The fact that these tins appeared almost immediately prior to the branding and size restrictions coming into force is suspicious.”

Alex Cunningham, the Labour MP for Stockton North and a vocal campaigner for plain packaging, said the move appeared to be a ploy to prolong the visibility of Marlboro’s brand in the UK.

“It’s against the whole spirit of what’s intended with the plain packaging legislation,” he said. “The tobacco companies will stop at nothing in order to retain their branding and sell a product that everyone knows has such tremendous health risks. It’s an immature trick and I hope people will soon put them into their bins and they’ll find their way to the recycling centre.”

The chief executive of Action on Smoking and Health, Deborah Arnott, said the metal tins appeared to contradict the company’s recent declaration that it was aiming for a “smoke-free future”. She said: “What’s important is not what they say but what they do.”

Under the EU directive, all tobacco packaging will be uniformly green with large images showing the harmful effects of smoking


Warning labels on boxes of cigarettes in a newsagent in London. Photograph: Bloomberg via Getty

Philip Morris said it manufactured the tins before 20 May last year, the cutoff point after which tobacco firms were no longer allowed to produce branded packs. But the legislation gave firms a 12-month grace period to continue distribution, allowing the firm to keep selling them.

It said only a “relatively small number” were distributed, although it would not say how many, adding that the stocks would be depleted by the weekend deadline.

The tins cost the same as an ordinary pack of 10 cigarettes but, unlike cardboard packets, could help keep Marlboro’s branding visible for years because they are so durable. A thread on Reddit, the messageboard website, suggests the tins havehelped increase the popularity of Marlboro, with users saying they were making an effort to find them.

The Guardian understands that some retailers were offered the product but refused to stock it. Philip Morris rival JTI Gallaher has also issued aluminium tins for its Benson & Hedges, Mayfair and Camel brands in the run-up to the plain packaging laws coming into force in the Republic of Ireland.

The move was described as “extremely cynical” by Ireland’s former health minister James Reilly, according to the Sunday Times. A spokesperson for British American Tobacco, which owns brands including Rothmans and Dunhill, said the company had not issued a similar product.

The tobacco industry has previously come under fire for allegedly deploying tactics designed to limit the effect of plain packaging legislation, such as using price stickers to differentiate themselves from other brands.

Companies were also accused of ramping up production of branded packaging in the days leading up to 20 May last year, in order to stockpile packets for sale during the 12-month grace period in which their sale was still permitted.

Big tobacco firms have failed in successive attempts to overturn countries’ laws on plain packaging. Philip Morris lost a landmark case against the government of Uruguay, while an attempt to overturn Australia’s plain packaging law via a World Trade Organisation dispute also failed.

General election 2017: ITV hosts first leaders’ debate – politics live

18:01

ITV debate – Verdict

Updated

17:25

ITV debate – Severin Carrell’s analysis

The ITV leaders debate has exposed the patchwork, oddly shaped nature of the UK’s political system. The only two party leaders with a realistic chance of becoming prime minister, Theresa May and Jeremy Corbyn, have declined to appear – further highlighting the weakness of this format, in which the speakers spent much of the debate virtue-signalling, untested.

We had leaders of two nationalist parties whose candidates only stand in small parts of the UK, in Nicola Sturgeon of the Scottish National party, and Leanne Wood from the Welsh nationalists Plaid Cymru. Yet neither are candidates in the election. Tim Farron of the Liberal Democrats, Caroline Lucas of the English Greens and Paul Nuttall of Ukip are standing, yet none has a realistic chance of being in the next government. The Greens will likely end with one MP, in Lucas. Ukip are likely to end with none at all.

Only Nuttall, the one outsider among the five, was directly challenged over his policies. Nicola Sturgeon, Scotland’s first minister, is the only one of the five who has served in government. Yet her 10 years in power in Edinburgh was not under direct scrutiny in this debate, facing an audience in Salford that can never vote for her. Likewise Wood.

Sturgeon made assertions on Scotland’s economy for which there is no evidence, implying that the SNP’s policy of lifting 100,000 small businesses out of paying business rates has helped the economy. The Scottish government has never tested the benefits of that policy for the Scottish economy, which is on the cusp of official recession.

The SNP (@theSNP)

FM: “Growing the economy means doing more to support business, in Scotland we’re taking 100000 businesses out of business rates.” #ITVDebate

May 18, 2017

Clearly aware of this, Sturgeon had the insight to qualify her own answers – confirming how odd this debate really was. Keenly aware that her government’s patchy record on education is a fierce topic of debate in Scotland, she said: “Nothing is more important to me than education, where there are some challenges we are working really hard to address.”

Unprovoked, she said the same about housing: “We’ve got challenges; we’ve not done everything right.” It is quite unclear what meaningful impact this programme will have on the final outcome of the election on 8 June.

Updated

17:17

ITV debate – Verdict from the Twitter commentariat