Category Archives: Health

‘Lava haze’ and ‘vog’: toxic volcanic gases prompt health fears in Hawaii

Three dozen tourists were gathered at the Wailoa Sampan Basin Harbor in Hilo, Hawaii, hoping to get a glimpse of the lava that they’d seen on the news for weeks.

But because Hawaii Volcanoes national park – often a key stop in travelers’ itineraries – was closed after Kilauea erupted, their best hope on Monday afternoon was taking a boat to the point where the lava met the sea.

Some said they’d packed breathing masks, just in case the trade winds — which usually blow in clean sea air — changed direction and began blowing a lava haze, a noxious mix of gases and particles, their way.

Although many tourists to Hawaii island – the Big Island – choose to visit because of the active volcano, some have gotten more than they bargained for since the eruption. (Petra Wiesenbauer, who runs a popular Pahoa lodge near the park, had to hurry three guests out of the door while she and her neighbors fled the lava and toxic fumes.)

Up until lava crossed Highway 137 late Saturday night and entered the ocean, volcanic smog, called vog, which contains mostly sulfur dioxide and acid particles, along with ash, had been the biggest air quality concern.

But then the molten rock began pouring into the cool seawater and added clouds of lava haze or “laze”. Officials warned people to stay away since the plumes can travel up to 15 miles downwind, according to the Hawaii Volcano Observatory.

Toxic clouds rise up as lava from Kilauea volcano hits sea – video

The clouds form when hot lava boils seawater, creating tiny shards of volcanic glass and hydrochloric acid that then get carried in steam. The plumes can be deadly.

The USGS says on its website: “This hot, corrosive gas mixture caused two deaths immediately adjacent to the coastal entry point in 2000, when seawater washed across recent and active lava flows.” Hawaii civil defense cautioned people on Monday to “stay away from the ocean plume since it can change direction without warning”. In the case of laze and vog, store-bought respirators filter particles but not hydrochloric acid or sulfur dioxide.

Vog and laze can cause eye irritation, skin irritation and respiratory issues, according to officials. Those with conditions like asthma or cardiovascular disease are most sensitive, as are the elderly, children and pregnant women, according to an interagency group of volcano experts. Even before the recent Kilauea eruption, Hawaii already suffered air quality issues from volcanic gases. The island of Hawaii has the highest sulfur dioxide (SO2) emissions in the nation, according to EPA spokesman Dean Higuchi. And according to a 2016 report published in the scientific journal Environmental international, levels were “1,000 times greater” than the EPA’s definition of a major pollution source.

There has been a moderate increase in the number of people coming into Hilo medical center for treatment of vog-related symptoms since the eruption, according to Elena Kabatu, a hospital spokesperson. But she said that many more were likely experiencing the less serious effects of vog, such as dry eyes or a scratchy throat.

For those living in Pahoa, near the lava, conditions vary depending on whether the trade winds are blowing, residents said. Gilbert Aguinaldo, who has offered his vacant, central Pahoa lot to serve as a hub of locally organized community aid, said that volunteers were loaning out respirators and breathing masks to anyone who needs them.

Both vog and laze can cause eye irritation, skin irritation and respiratory issues.


Both vog and laze can cause eye irritation, skin irritation and respiratory issues. Photograph: Terray Sylvester/Reuters

“We are a little worried about the laze,” said Heather Lippert, 40, who was waiting to board the boat for the lava tour, “But I’m sure they’ll try to keep us safe.”

Vanessa Homyak, 36, said she and Lippert, who are from San Diego, had originally intended to stay at an Airbnb in Pahoa when they scheduled their vacation. But after the eruption began, the pair reconsidered. “We called the host and asked how things were,” she said. “They said, ‘If we were you, we would probably stay somewhere else.’”

They took the advice, staying instead on the other side of the island. But though they were out of the path of the lava, they discovered that they were directly in the path of the vog.

“We saw it when we flew into Kona, this big brown layer in the air,” Lippert said.

Erik Jacobs, who lives in Waikoloa, in the north-west part of the island and had just returned from a two-week vacation, said the vog was already irritating his eyes, making them feel dry and scratchy. He said his neighbors told him the vog was the “worst they’d ever seen” on the Big Island late last week.

Poor lose doctors as wealthy gain them, new figures reveal

Fewer GPs are choosing to work in poorer areas but more are joining surgeries that look after wealthier populations, new official figures reveal.

The exodus, uncovered by Labour MP Frank Field, is exacerbating the existing “under-doctoring” of deprived populations – the lack of family doctors in places where poorer people live.

Experts said the widening divide between rich and poor areas in GP numbers – which is one of England’s starkest health inequalities – would force the least well-off to wait longer for an appointment, even though they are generally sicker and die earlier than the rest of the population.

Frank Field MP


‘Most worrying is the number of GPs ceasing to serve people towards the bottom of the pile,’ said Frank Field MP Photograph: Anthony Devlin/PA

“A decade ago the country was beginning to make some serious inroads into the under-doctoring of the poorest areas. What these grim figures show is that in recent years that progress has not only stalled, but actually gone into reverse,” Field told the Observer.

“The most worrying trend here is the number of GPs ceasing to serve people towards the bottom of the pile, while at the same time people in the wealthiest areas have benefited from an even better service. Vulnerable people are having to suffer in silence without being able to see a GP.

“Here’s another example of everything going in the wrong direction if our goal is to equalise health opportunities and outcomes. It is a new appalling face of inequality in modern Britain.”

There were 8,207 GPs working in areas containing the most deprived quintile of the population in England in 2008. But by last year that number had fallen to 7,696 – a drop of 511 – according to the response to a written parliamentary question Field asked recently.

But over the same decade the number of family doctors working in the most prosperous fifth of the population increased from 4,058 to 4,192 – a rise of 134, public health minister Steve Brine told Field.


We desperately need more GPs right across the country… People in deprived areas often need more access to GP services

Dr Helen Stokes-Lampard

“These figures show a really disturbing trend, particularly given that low-income areas were already under-doctored before this latest fall took place”, said Norman Lamb, the Liberal Democrat MP and ex-coalition health minister. Ministers needed to create a “patient premium”, modelled on the pupil premium introduced in 2011, to ensure more money reaches surgeries in poorer areas, he added.

Last week it emerged that GP numbers in England had fallen by 542 in the past year, despite a high-profile government pledge in 2015 to increase the workforce by 5,000 by 2020. Patients were facing longer waits for appointments and greater difficulty getting to see their own GP.

“We desperately need more GPs right across the country,” said Dr Helen Stokes-Lampard, chair of the Royal College of GPs.

“But we know that some areas – often more deprived areas, but also rural and some coastal areas – are finding it more difficult than others to recruit.

“The paradox is that people living in deprived areas tend to have a greater number of long-term conditions and more complex needs, and actually they often need more access to general practice services.”

Jeremy Hunt, the health and social care secretary, has recently expanded the number of GPs in the Targeted Enhanced Recruitment Scheme from 200 to 250, under which trainee family doctors are paid £20,000 “golden hellos” in return for starting their career in areas of the country lacking in doctors.

Dr Richard Vautrey, chair of the British Medical Association’s GPs committee, said that the £20,000 payments were helpful, but “only short-term fixes.

“This requires sustained significant investment, enabling all practices to recruit sufficient GPs and other staff,” he added.

GPs in poorer areas are also ending up with bigger caseloads, but their counterparts in wealthy places are not, because there are more of them.

The number of patients per family doctor in the most deprived quintile rose from 1,213 people in 2010 to 1,397 people last year. But those in the richest quintile are treating on average 2,514 patients, three fewer than in 2010.

The Department of Health and Social Care refused to comment on the flight of GPs from poorer areas. It said: “GPs are a crucial part of the NHS and we are committed to meeting our objective of recruiting an extra 5,000 GPs by 2020.

“More than 3,000 GPs have entered training this year, 1,500 new medical school places are being made available by 2019 and NHS England plans to recruit an extra 2,000 overseas doctors in the next three years.”

Poorest and brightest girls more likely to be depressed – UK study

Brighter girls and girls from poorer families are more likely to be depressed by the time they enter adolescence, according to a study triggering fresh concern about soaring rates of teenage mental illness.

The government-funded research identified the two groups as being most at risk of displaying high symptoms of depression at the age of 14. In contrast, more intelligent boys and boys from the most deprived backgrounds appear not to suffer from the mental troubles that affect their female peers, the academics discovered.

The findings are based on detailed questionnaires filled in by 9,553 boys and girls aged 14 across the UK as part of the Millennium Cohort Study (MCS), which is tracking the progress of people born in 2000 into adulthood.

They add to growing evidence that teenage girls are particularly vulnerable to mental health difficulties. NHS figures show there were sharp increases between 2005/06 and 2015/16 in the number of girls under 18 admitted to hospital in England because they had self-harmed by cutting (up 285%), poisoning (42%) or hanging themselves (331%).

The researchers, led by Dr Praveetha Patalay, also found that being overweight, a history of being bullied and not getting on with peers were the three most common causes of depression in boys and girls aged 14. Their previous finding, that 24% of 14-year-old girls and 9% of boys that age were depressed, stirred widespread debate last year.

Dr Nihara Krause, a consultant clinical psychologist, said the findings about brighter and poorer girls were worrying, given the known links between depression and self-harm, and self-harm and risk of suicide.

“Some children who are depressed will self-harm. Some people say that physical pain is easier to tolerate than emotional pain,” she said. “What’s very concerning, in those who are depressed, is the link with suicide, because more and more studies show that self-harm is a predictor of suicide. Someone who self-harms is more likely to try to take their own life, especially if they are depressed. So these new findings are a concern from that point of view.”

Patalay said girls from families in the bottom two quintiles of household income were 7.5% more likely to be depressed at 14 than girls from the highest income families, but the same pattern was not found in boys.

Cleverer girls also had a significantly higher risk of having high depressive symptoms at 14, she said, and she was doing further research to calculate that risk more precisely among those with “higher childhood cognitive scores”.

Krause said: “Part of it could be that [brighter girls] have a ‘hyper brain’, a more active brain, which often means they have a much higher emotional reaction to things and they are constantly overthinking things.

“For example, if there’s a friendship situation that might be a concern to them, children of higher intelligence might think about all sorts of reasons why this situation has developed and get stressed about it.”

She pinpointed pressure on children to succeed at school – from their parents, schools and themselves – and competition for university places and jobs as a key cause of anxiety and depression in teenagers. In addition, some bright pupils are pushed too much, and those children can develop academically but be less adept at forming friendships, she suggested.

Children of either sex who have been bullied are 5.5% more likely to be depressed at 14, and boys or girls who do not get on well with their peers are 1.5% more likely to exhibit depressive symptoms.

The researchers also found that overweight boys and girls were 5% more likely to be depressed. This has prompted speculation as to whether the huge recent increase in childhood obesity is helping to drive what experts say is a growing mental health crisis in young people.

“We found a substantial link between being overweight and being depressed. Rates of overweight and mental ill-health are increasing in childhood, and they both have enormous consequences through our lives. Tackling these two health issues should be a public health priority,” Patalay said.

Emla Fitzsimons, a co-author of the findings and director of the MCS, said: “The study highlights a sharp increase in mental health problems among girls between ages 11 and 14. We certainly need to be looking at how the use of social media and cyberbullying may affect girls and boys differently.”

Dr Nick Waggett, chief executive of the Association of Child Psychotherapists, said it was unhelpful to highlight bright or poor girls as being at particular risk “when we already now there is a significant burden of mental illness in children and young people, including adolescent girls, and that there is a substantial shortfall in specialist services for them.”

Claire Murdoch, NHS England’s national mental health director, said: “After decades in the shadows, children’s mental health is finally in the spotlight, with more young people seeking help and years of unmet need being addressed. The NHS has responded, with 70,000 more young people set to get help, £1.4bn of extra funding and eating disorder and perinatal mental health services covering the whole country.

“But if the NHS is to meet fully the scale of the challenge then government, schools and councils need to work with us and our patients over the long-term.”

Cancer patient waited 541 days for NHS treatment, report says

The longest waits for cancer treatment in England have soared since 2010, with one patient waiting 541 days, analysis suggests.

Two-thirds of NHS trusts reported having at least one cancer patient waiting more than six months last year, while almost seven in 10 (69%) trusts said they had a worse longest wait than in 2010. This was reflected in the average longest wait rising to 213 days – 16 days longer than in the year the Conservatives entered government.

The official target requires at least 85% of cancer patients to have their first treatment within 62 days of referral by their GP, but this has not been met for 27 months in a row.

More than 100,000 people have waited more than two months for treatment to start since the target was first missed in January 2014.

The longest waiting times data was obtained by Labour through freedom of information requests to England’s 172 acute and community health trusts, to which 95 responded.

Jonathan Ashworth, the shadow health secretary, said: “The number of people needing cancer treatment has risen sharply in the past 10 years and the government has simply failed to increase availability of services at the rate required.

“The truth is that the brilliant efforts of NHS staff around the country to deliver the best for their patients are being hampered by tight NHS budgets. Years of underfunding and abject failure to invest in the frontline doctors and nurses we need, means Theresa May is letting down cancer patients.

“Now we know the astonishing truth that some patients are waiting a year or more just to get treatment. It’s simply not good enough.”

The number of patients waiting more than 62 days last year was double that in 2010 (26,693 compared with 13,354), including 10,000 who waited for more than three months, NHS statistics show.

Every trust bar two who replied to Labour’s survey said that at least one patient had waited more than 62 days for treatment.

The figures also showed a deterioration in longest waits for two other key cancer targets since 2010.

After receiving a diagnosis of cancer, patients should receive their first definitive treatment within a month (31 days) and after an urgent referral for suspected cancer they should see a consultant within two weeks.

In both cases, as with the 62 days target, two-thirds of trusts had lengthier longest waits last year than in 2010. The average longest wait to start definitive treatment rose to 90 days – three higher than in 2010 – with one patient waiting 254 days. The average longest wait for a consultant appointment increased to 66 days – eight time higher than seven years ago – with the worst example being a patient who waited 377 days.

In an ideal world, people would start treatment within a month of being diagnosed, according to Cancer Research UK.

Sara Bainbridge, a policy manager at the charity, said: “Part of the reason why hospitals are struggling to meet the target is because NHS diagnostic services are short-staffed. The government must make sure there are more staff to deliver the tests and treatment that people need on time. The long-term plan for the NHS, which is being developed now, is a good opportunity to be more ambitious about cancer survival and increase staff numbers.”

Andrew Kaye, the head of policy at Macmillan Cancer Support, said: “These findings show that despite the tireless work of doctors and nurses, it appears that some cancer patients are still enduring shockingly long waits to start treatment.

“Long delays can put people under incredible stress at an already difficult time and could also mean that someone’s health could take a turn for the worse.”

A spokesman for the Department of Health and Social Care said: “Cancer care has improved significantly in recent years, with around 7,000 people alive today who would not have been if mortality rates stayed the same as in 2010.

“Nobody should wait longer than necessary for treatment and, despite a 115% increase in referrals since 2010, the vast majority of people start treatment within 62 days – backed by our £600m investment to improve cancer services.”

I wanted to find out how my baby died. Instead I got dishonesty and hostility | James Titcombe

In November 2008 my nine-day-old son, Joshua, died in truly terrible circumstances, as a consequence of failures in his care at Furness general hospital, part of the University Hospitals of Morecambe Bay NHS foundation trust. Joshua’s death instantly turned my life upside down. But as I began to seek answers as to what exactly happened and why, nothing could have prepared me for the years of dishonesty, obfuscation and, at times, outright hostility that followed.

Critical records of Joshua’s care went missing, statements from staff were dishonest, investigations were superficial, the organisations that should have been taking action to ensure the maternity services at Morecambe Bay were safe instead acted to reassure each other that everything was OK.

In March 2015 an independent investigation, chaired by Dr Bill Kirkup, was published. The report found that there was a “lethal mix” of failures at the maternity unit where Joshua was born. The first opportunity the trust had to identify that things were starting to go badly wrong was the tragic death of a baby girl in 2004, yet this was effectively covered up. The family weren’t told the truth, and unsafe care at the unit continued. Between 2004 and 2013, 11 babies and one mother died avoidably.

Throughout this period, the Nursing and Midwifery Council (NMC), the regulator responsible for protecting the public by ensuring nurses and midwifes practise safely, appeared to take little action. In relation to Joshua’s care, the last hearings only took place in 2017, some eight years after Joshua’s death. Yesterday, a long awaited report from the Professional Standards Authority (PSA) finally provided some answers as to why. The report makes difficult and sad reading for me [full report here].

The PSA describes concerns about the evidence it was able to obtain from the NMC to assist its review. We are told that the standard of record-keeping was “very poor”, and that information relevant to the review wasn’t included in the NMC’s case files. The report recounts in heartbreaking detail the experience of many Morecambe Bay families who contacted the NMC. A clear pattern emerges of an organisation placing little onus on what these families were saying, and in some cases simply dismissing people’s concerns with little or no consideration.

In April 2012, Cumbria police met the NMC to given them a detailed list of cases at Furness general hospital about which they had significant worries. But the NMC took no action “for almost two years”. While this was ongoing, midwives under investigation continued to practise, and in some cases were involved in subsequent serious incidents involving avoidable harm and death.

It would be unrealistic to expect any large and complex organisation to get everything right all of the time, but any organisation with such an important public protection role must be open and transparent when things go wrong, so that the organisation can learn and improve and maintain public confidence and trust.

But the report highlights the continued failure of the NMC to be open, honest and transparent about its own actions, pointing to its misleading responses to families and the secretary of state, its failure to disclose external reports looking at learning from cases, and its failure to be open and transparent with information requests.

These are damning conclusions, and highlight an urgent need for change in the leadership and culture of the organisation.

But the response from the NMC this week can only be described as woefully inadequate. On Monday, Jackie Smith, the chief executive, announced her resignation but in doing so made no mention of the problems highlighted by the report, and instead spoke of her pride in all that the NMC had achieved. On Wednesday, the NMC did not put forward a single person to respond to media interview requests. There were, however, dozens of retweeted positive messages about the former chief executive on her own Twitter feed.

In addition, along with other families, I have received an impersonal and hollow letter from the NMC, along with some emails that the NMC should have disclosed to me following a personal data request from me (which they spent £240,000 responding to), but didn’t. One of the emails was between two NMC staff discussing visiting me in Cumbria in 2016 to take a statement about Joshua’s death. Upon seeing my surname the first person writes: “Is it wrong that my default position was to snigger at that name?”; “It’s not wrong it’s totally appropriate,” came the response.

These comments are puerile and silly, but also indicative of an organisational culture that has lost sight of its purpose, and the patients, mothers and babies it exists to protect.

The culture of an organisation stems from the action and behaviour of the people at the top. The response from the NMC so far, highlights an urgent and pressing need for change so it can properly do its job of protecting patients.

James Titcombe works for Patient Safety Learning

Suffer hay fever? Don’t blow your nose | Brief letters

It’s not just trees (We can’t chop down all these trees and not harm ourselves, 15 May). The railway ecosystem includes many other types of plant. On my trips from Winchester to Waterloo in the 1960s, I saw everlasting peas (Lathyrus latifolius) in full flower, cascading down the banks. There are still pockets of plant diversity on the route between Cambridge and King’s Cross, thanks to Margaret Fuller, wife of the crossing keeper at Shepreth, as recorded in The Illustrated Virago Book of Women Gardeners (ed Deborah Kellaway; 1995).
Margaret Waddy
Cambridge

David Cox offers some good advice (Seven ways to deal with hay fever, G2, 14 May) but misses out the real game-changer. Hay fever sufferers must not blow their noses. Everyone seems to know not to rub an irritated eye, but not that blowing has much the same effect on the nasal passages – congestion, irritation, and more discharge.
Dr Stuart Handysides
(Retired GP), Ware, Hertfordshire

Woody Guthrie’s words of long ago apply: Some rob you with a six-gun and some with a fountain pen (Carillion fall blamed on hubris and greed, 16 May). Why no prosecutions?
Huw Kyffin
Canterbury

Is it my imagination or is the royal romance, and lead-up to the wedding, beginning to sound a little like the plot of Notting Hill Part II (Markle’s father ‘may miss her wedding after surgery’, 16 May)?
Tony Hart
Formby, Merseyside

Who is giving Prince Harry away?
Marion McNaughton
Warburton, Cheshire

Join the debate – email guardian.letters@theguardian.com

Read more Guardian letters – click here to visit gu.com/letters

Suffer hay fever? Don’t blow your nose | Brief letters

It’s not just trees (We can’t chop down all these trees and not harm ourselves, 15 May). The railway ecosystem includes many other types of plant. On my trips from Winchester to Waterloo in the 1960s, I saw everlasting peas (Lathyrus latifolius) in full flower, cascading down the banks. There are still pockets of plant diversity on the route between Cambridge and King’s Cross, thanks to Margaret Fuller, wife of the crossing keeper at Shepreth, as recorded in The Illustrated Virago Book of Women Gardeners (ed Deborah Kellaway; 1995).
Margaret Waddy
Cambridge

David Cox offers some good advice (Seven ways to deal with hay fever, G2, 14 May) but misses out the real game-changer. Hay fever sufferers must not blow their noses. Everyone seems to know not to rub an irritated eye, but not that blowing has much the same effect on the nasal passages – congestion, irritation, and more discharge.
Dr Stuart Handysides
(Retired GP), Ware, Hertfordshire

Woody Guthrie’s words of long ago apply: Some rob you with a six-gun and some with a fountain pen (Carillion fall blamed on hubris and greed, 16 May). Why no prosecutions?
Huw Kyffin
Canterbury

Is it my imagination or is the royal romance, and lead-up to the wedding, beginning to sound a little like the plot of Notting Hill Part II (Markle’s father ‘may miss her wedding after surgery’, 16 May)?
Tony Hart
Formby, Merseyside

Who is giving Prince Harry away?
Marion McNaughton
Warburton, Cheshire

Join the debate – email guardian.letters@theguardian.com

Read more Guardian letters – click here to visit gu.com/letters

How sex toys are being redesigned to help survivors of sexual assault

For many survivors of sexual assault, a happy sex life feels out of reach. While much of the treatment on offer is focused on emotional and psychological healing, people are often left to work out for themselves what sex after trauma looks like for them.

But some people are working to change that, and are reconfiguring and reappropriating sex toys as tools for healing. Last year, the Dutch designer Nienke Helder created a range of objects to help survivors reprogramme how they deal with physical sensations. Drawing on her own experience, she wanted to redress what she saw as the “clinical” approach to recovery currently employed. “The tools are an opportunity to explore your personal sexual recovery,” she says. Her collection, titled Sexual Healing, includes a horsehair brush to explore touch and tickling, a mirror designed to help you better view your vulva, as well as a pelvic device that vibrates when your muscles are too tense, and a bean-shaped sensor that lights up if you’re breathing too fast, to remind you to slow down and relax. “By getting biofeedback through the tools, you can visualise what kind of processes are happening inside your body, which can help you understand in which situations your body reacts with a reflex.”

A Sexual Healing prototype by Neinke Helder.


A Sexual Healing prototype by Neinke Helder. Photograph: Nicole Marnati

Although Helder’s designs are still prototypes (she hopes to get them manufactured and sold soon), there are places where survivors can go to find existing tools. Sh! Women’s Erotic Emporium in east London is a female-focused sex shop with an extensive education and outreach programme. It consults with the NHS to recommend products for women who have been through trauma. “Unfortunately, many health professionals are still not comfortable talking about sex,” says Renée Denyer, the shop’s manager and in-house sex educator. She is also a facilitator for Cafe V, part of My Body Back Project, a support group for women who have experienced sexual violence. “For survivors of sexual assault and rape, their body is taken away from them. But when women are ready to start thinking about sex, after they’ve had therapy and counselling, there is nowhere to go, so we made that space.”

According to Denyer, using sex toys is a powerful way for survivors to reclaim their body. “Especially for those who experienced abuse from childhood, they very early on learned to tune out when any sort of sexual touch is happening,” she says. “Even later in life when they are with a chosen partner, they’ll dissociate because that’s what they’ve been conditioned to do. We work on trying to fix that.”

Many of the recommended products focus on non-fleshy, non-phallic and non-penetrative tools, whilst also encouraging the use of things such as flavoured lube so survivors are not triggered by the smell of genitalia. But it seems that the most important thing is to grant women permission to explore sex again in a healthy way, in a safe environment and without the time or physical pressure that can come with having sex with a partner.

Though there is still a long way to go to improve the recovery process, using a more sex-positive approach is bringing ​many survivors one step closer to a happy sex life​.

NHS spends almost £1.5bn a year on temporary nursing staff – report

The NHS is spending almost £1.5bn a year on temporary nursing staff to cope with shortages, research has found.

The NHS has a shortfall of 40,000 nurses in England, according to the Royal College of Nursing. A report from the Open University, Tackling the nursing shortage, argues that the £1.46bn being spent on temporary staffing to plug the gaps could pay for 66,000 qualified registered nurses.

NHS trusts paid for an additional 79m hours of registered nurses’ time at a premium rate in 2017, which is 61% above the hourly rate of a newly qualified registered nurse in full-time employment. If existing gaps were permanently filled, trusts could save as much as £560m a year, the report states.

“Relying on temporary nurses to plug gaps is just sticking a plaster over the problem, and costs considerably more than if vacancies were filled permanently,” said Jan Draper, professor of nursing at the Open University.

“The sector is facing challenging times. We know that poor retention and low recruitment results in inefficiencies and ultimately puts patient care at risk, so it’s vital that we look to a more strategic and sustainable approach.”

Janet Davies, general secretary of the Royal College of Nursing, said the report exposed the “utter false economy” in NHS staffing. “Short-sightedness in recent years has left tens of thousands of unfilled nurse jobs, to the severe detriment of patient care,” she said.

“Workforce planning has been ineffective and dictated by the state of finances, not the needs of patients. It is further proof that cost-cutting plans saved no money at all and – instead – increased agency costs, recruitment fees and the sickness absence bill through rising stress.”

Retention of nursing staff has become a significant problem for the NHS. Seven in 10 newly qualified nurses quit their NHS trust within a year of qualification, with some moving to other trusts away from where they trained.

The study found 34% of registered nurses were unhappy in their role, with 35% thinking of leaving their job if things did not improve. Meanwhile, the number of applications to study nursing at university have fallen by about a third since the introduction of student loans for nursing degrees, said the report.

The Brexit vote has also contributed to a growing recruitment crisis. Since the referendum there has been a 28% increase in the number of EU nurses leaving Britain, which could exacerbate the problem, said the report. Overseas applications for nursing roles has fallen by 87% in the past 12 months.

The study suggests that offering more flexible training, including distance learning, could help the problem, and urges a more consistent use of newly introduced degree apprenticeships.

Danger to patients revealed in reports by 18,000 NHS nurses

Cancer sufferers are being put at risk and care for patients undergoing surgery is “severely compromised” as a result of constant staff shortages on wards, according to devastating first-hand testimony from inside the NHS.

An astonishing dossier of concerns raised by nurses about the impact of staffing levels on patients reveals that nurses with the right skills are often in short supply, full staffing levels are becoming a “rare event”, and some emergency patients are being sent home as a result.

The testimony, compiled from 18,000 anonymous submissions from hospital nurses and shared with the Observer, states that some nurses are being asked to complete procedures beyond their expertise, while many vulnerable patients are not being given the emotional support they need. Some experienced nurses say they believe they are seeing the worst shortages in decades.

Compiled by the Royal College of Nursing, the dossier reveals the severe concerns over patient safety. One nurse writes: “A lack of trained chemotherapy nurses means we are treating patients every day in an unsafe manner, mistakes are being made and management have no answers to the staffing crisis.”

Another states: “Our [cancer] patients may have to have less psychological support as we do not have the time to sit with them and reassure them. It may also mean that timely chemotherapy delivery is difficult. Today’s shift, where we were fully staffed with the majority of our own team, was a very rare event.”

There were similar concerns in relation to patients heading for surgery. “The level of [nursing] staff running theatre lists daily is inadequate,” one nurse states. “We are operating with the worst levels in theatre that I have seen in 40-plus years in theatres. Patient care is severely compromised due to staffing levels.”

Another writes: “Many times I have felt unsafe and when escalated have been told ‘but nothing major happened’, meaning the ‘what ifs’ are never addressed until something happens. The skill-set of nurses is a major problem, with nurses having to scrub for cases out of their competency through sheer lack of numbers.”

Meanwhile, an A&E nurse reveals: “Due to staffing issues some emergency triage patients are sent home, if they are clinically stable, to return again the next day to be treated.”

There are also serious complaints about the level of provision of psychiatric nurses. “One community psychiatric nurse for half a county for a whole day is not a safe staffing level,” writes one nurse. “Staffing levels and high staff turnovers are a huge problem … that needs addressing before anyone else is harmed.”

A recent report by Macmillan Cancer Support found that there were widespread shortages of specialist cancer nurses. Hospitals in England were found to have vacancies for more than 400 specialist cancer nurses, chemotherapy nurses, palliative care nurses and also cancer support workers.

The disclosures come as the Royal College of Nursing calls for new English laws to make ministers accountable for ensuring safe staffing levels. In 2016 Wales became the first country in Europe to introduce safe staffing laws for nursing, while Nicola Sturgeon, the first minister, has promised legislation in Scotland.

In her speech to the college’s annual congress on Sunday its general secretary, Janet Davies, will say that nurse recruitment and morale have been plunged into crisis by “workforce planning driven by finance and not the needs of patients. The care we are able to provide is totally compromised by short staffing, and we cannot repeat this often enough: mortality levels increase when the level of registered nurses falls. We know our patient outcomes are better when there are more nurses to care for them.”

A Department of Health and Social Care spokeswoman said that overall staffing levels in the NHS were at a peak. “The NHS would collapse without our wonderful nurses – the fact that the NHS is ranked as the safest healthcare system in the world is a testament to them,” she said.

“From this year we will train 25% more nurses, we are committed to helping them work more flexibly to improve their work-life balance, and we have awarded a pay rise of between 6.5% and 29% in a deal backed by the Royal College of Nursing themselves.”