Health Policy InsightNational News
'Genetic link' to breast cancer
NHS spending on consultancy: how does your area compare? Full spreadsheet
Constultants (the analyst kind, not the doctors) cost the NHS millions. Find out which health authority spends what
• Get the data
The NHS spent almost £314m on consultancy services in the last year of the previous government, according to a detailed breakdown obtained by the Guardian. Health secretary Andrew Lansley said that across the country, spend on consultancy services was virtually the same as spending on skin cancer and lung cancer services combined or equivalent to almost 10,000 nurses.
In London the spending on consultancies amounted to a levy of £15 a patient. By comparison Yorkshire and the Humber health bodies managed by spending less than 20% that amount per patient. Two years ago in the North West spending amounted to £26m but now that is over £40m.
Lansley has already spelt out plans to clamp down on excessive management spend - spelling out in June that health trusts would have to reduce their management costs by more than 45% over the next four years.
He said: "I am staggered by the scale of the expenditure on management consultants in the NHS. Even at a time when it became clear that the nation's borrowing was out of control, Labour allowed wasteful spending to blossom. In contrast, I have asked Primary Care Trusts and Strategic Health Authorities have to reduce their management costs by 46% over the next four years. This will root out unnecessary bureaucracy and any expensive duplication of functions. Every penny saved will be reinvested in improving patient care, meeting demand and driving up quality"
However the Management Consultancies association said that the figures should be taken in context. "This level of spending still only represents around 0.3% of the NHS's budget of over £100bn," said Alan Leaman, chief cxecutive of the association. "To dismiss this work – and there are many more examples – as 'wasteful' is folly.
Lansley claimed in your report that he is "staggered by the scale of
the expenditure on management consultants in the NHS". He shouldn't
be. First, it is cost effective. Second, given the right brief, consultancies bring an invaluable external perspective, focus and discipline, with knowledge and
understanding that cannot be generated in-house".
• DATA: download the full spreadsheet
• Search the world's government with our gateway
Can you do something with this data?Flickr Please post your visualisations and mash-ups on our Flickr group or mail us at datastore@guardian.co.uk
• Get the A-Z of data
• More at the Datastore directory
• Follow us on Twitter
Randeep Ramesh
guardian.co.uk © Guardian News & Media Limited 2010 | Use of this content is subject to our Terms & Conditions | More Feeds
ME 'virus link' found in children
Unfit men working long hours face greater heart risk, study shows
Poor physical fitness and working more than 45 hours a week is potentially lethal combination for men aged 40-59
Unfit, middle-aged men who work more than 45 hours a week are more than twice as likely to die of heart disease as those who devote less time to their jobs, new research medical research warns today.
It identifies the combination of poor physical fitness and working for unusually long hours as a potentially lethal combination for men aged between 40 and 59. However, men who manage to remain physically active into middle age are not at risk, emphasising the health benefits of regular exercise.
The findings in the study, in the medical journal Heart, reinforce the health risks being run by men in that age group who are part of Britain's long hours culture. Working excessive hours is thought to damage cardiovascular health by causing someone's heart rate and blood pressure to go up and stay raised for long periods. This happens whether the work itself is physically demanding or not.
The heart health and physical fitness levels of some 5,000 Danish men aged 40-59 working for 14 companies was examined for 30 years by a team from the National Research Centre for Denmark's Working Environment.
Participants did cycling tests to indicate how fit they are and disclosed how many hours they worked a week. More than two-thirds worked between 41 and 45 hours, but almost one in five clocked up more than 45 hours.
Among unfit men, those who were in the latter category were more than twice as likely to die of heart trouble than those who worked for less than 40 hours.
Heart health campaigners said that the study underlined the need for middle-aged men to maintain a good level of fitness by taking part in regular physical exercise, despite the pressures on their time.
Dr Jane Landon, deputy director of the National Heart Forum, a coalition of 65 health organisations which aims to reduce the damage done by poor heart health, said: "Men in this age group don't need to be doing extreme sports but they do need to be keeping physically fit by, for example, walking or cycling or even doing gardening or DIY, which all contribute to a good level of fitness."
Men's risk of developing heart trouble increases as they head into middle age, and is heightened if they put on weight, or have a poor diet or are unfit. The research's conclusion that fit men of the same age and working patterns as those who are unfit proved the protective effects of regular exercise, she said.
Cathy Ross, senior cardiac nurse at the British Heart Foundation, said that men should try to be physically active for at least 30 minutes at a time five times a week. "We already know that working long hours can increase blood pressure, a known risk factor for cardiovascular disease."Being physically active helps to control your blood pressure and previous studies have shown that being physically fit can help you cope with the demands of long hours, physically demanding jobs and shift work," she said.
"This study adds to these findings by demonstrating that men who are physically active as part of their everyday life do not increase their risk of coronary heart disease, irrespective of the number of hours they work."
Denis Campbellguardian.co.uk © Guardian News & Media Limited 2010 | Use of this content is subject to our Terms & Conditions | More Feeds
ME 'could be caused by a virus'
Letters: Challenges to NHS proposals
The cash offer to NHS managers to give up their jobs "is on the table until the end of October" (£137,500 cash offer for NHS bosses to quit, 2 September). Does parliament not have to approve the radical proposals in the white paper? Unison is challenging the legality of these proposals in court (Report, 24 August) because the consultation exercise which ends on 5 October is about how the proposals are implemented, not whether they will happen. The business director of the healthcare company Tribal welcomed the white paper with these words: "This white paper could amount to the denationalisation of healthcare services in England and is the most important redirection of the NHS in more than a generation, going further than any secretary of state has gone before." We call upon all readers to sign the e-petition on the NHS Support Federations's website, visit www.keepournhspublic.com to join us, and let their MPs know if they disagree with these proposals, which may lead to the NHS becoming a logo with fragmented services despite Andrew Lansley's assurances that it will not lead to the privatisation of the NHS.
Wendy Savage
Co-chair, Keep Our NHS Public
• I was sorry to read of the government's intention to scrap NHS Direct and replace it with a cheaper alternative (Report, 28 August). Instead of being advised by trained nurses, we shall have to rely on staff given a brief course in the entire field of medicine. What might the next such innovation be – perhaps a three-week course in brain surgery?
Brian Hayes
London
guardian.co.uk © Guardian News & Media Limited 2010 | Use of this content is subject to our Terms & Conditions | More Feeds
Non-stick pan 'cholesterol link'
UK radiotherapy 'lagging behind'
Cancer treatment
Young gay men fuelling HIV epidemic, study warns
Researchers say that rising rates of syphilis along HIV among young gay men suggests risky sexual behaviour was to blame
The HIV epidemic in Europe, including the UK, is being fuelled by the risky behaviour of young gay men, according to research published today.
Public messages and campaigns about the dangers of unsafe sex do not appear to be getting through to men who have sex with men, the researchers say – particularly the young ones.
By investigating the genetic profile of the virus in more than 500 newly screened patients over nine years, scientists in Belgium have identified clusters of people with type B virus – not the one that is most prevalent in Africa.
Those infected are almost all white, male, gay and young, they say. These men also tend to have other sexual diseases, such as syphillis, which suggests that they are involved in unsafe sexual behaviour and are not using condoms.
The research was carried out by scientists at Ghent University in Belgium, and there is every indication that their findings hold true for the UK. Nick Partridge, the chief executive of the Terrence Higgins Trust, said that gay men were the group most at risk of HIV infection in the UK.
The Health Protection Agency (HPA), which monitors HIV numbers in the UK, warns every year of the rising rate of infections among men who have sex with men (MSM). In its last full report, for 2009, it said that the rate of infection among gay men remained high, even though there had been a slight overall drop.
HIV infection can go unnoticed for years, but the HPA report said one in five of those diagnosed had become infected within the previous six months – suggesting recent risky behaviour was to blame.
A 2008 report specifically on HIV among men who have sex with men said there were around 32,000 living with HIV in the UK. Just under half of all new diagnoses were among men who had sex with men, and 82% of the infections were probably acquired within the UK.
The Belgian researchers, Kristen Chalmet and colleagues from the Aids Reference Laboratory at Ghent University, found one "striking and alarming" cluster of cases. Over the nine years of the study, 57 men acquired genetically very similar viruses, they say. Eight of them did so in the last year. "Members of this cluster are significantly younger than the rest of the population and have more chlamydia and syphilis infections," they write today, in the open access journal BioMed Central Infectious Diseases.
Even excluding that group from the study, there was still a relationship between HIV infection and contracting syphilis, which suggested risky sexual behaviour.
The study found two main types of HIV, but their analysis found that those infected with the two sub-types were "significantly different populations". The vast majority of cases of infection within Belgium were sub-type B cases, and those infected were most often men who have sex with men. The non-B cases were more likely to be in heterosexuals and to have been acquired abroad.
"We clearly demonstrate that, despite the existence of prevention programmes, easily available testing facilities and a supposedly broad public awareness of the infection and its possible routes of transmission, MSM still account for the majority of local onward transmissions," they write.
"Continuous efforts to sustain prevention programmes targeting MSM are definitely needed."
Nick Partridge echoed the call for targeted campaigns. "Gay men are still the most at risk of HIV infection in the UK. We also know that more than a quarter of people with HIV in the UK are currently undiagnosed, and they're far more likely to pass the virus on than those who know they have it." "Targeted HIV prevention programmes are key to reducing the numbers of new infections each year. But we'd also argue for innovative testing services to better diagnose men who've been at most risk."
Professor Pat Cane, head of the HPA's antiviral unit, said work done in the UK with the Medical Research Council, "has shown that there are two predominant sources of HIV circulating in the UK at the moment – one in men who have sex with men (HIV1, sub-type B) and the other associated with sub-Saharan Africa (non B, HIV1)."
Sarah Boseleyguardian.co.uk © Guardian News & Media Limited 2010 | Use of this content is subject to our Terms & Conditions | More Feeds
Many fathers get depressed after having children
One in five men suffer from depression by the time their child is 12, according to a Medical Research Council study
One in five men become depressed after becoming fathers as they juggle lack of sleep, extra responsibilities and a changed relationship with their partners, new research shows.
By the time their first child is 12, 21% of fathers have had at least one episode of depression, according to an in-depth study funded by the Medical Research Council (MRC).
The findings provide strong evidence that postnatal depression affects significant numbers of men as well as women, and last night prompted calls for fathers-to-be to have their mental state assessed by the NHS in the same way as expectant mothers during their pregnancy. There are worries that problems with a parent's wellbeing can damage their children's behaviour and development.
Research scientists led by Professor Irwin Nazareth, director of the MRC's general practice research framework, studied 86,957 families who received medical care between 1993 and 2007. They identified depression among parents by analysing diagnoses of the condition and antidepressant prescriptions.
Some 3% of fathers had had depression in the first year of their child's life, rising to 10% by the time their offspring was four, 16% by the age of eight and 21% by 12, it was found.
The study also underlined how postnatal depression among mothers is much more common. Of those studied, 13% had been depressed within a year of giving birth, 24% by the time their child reached four, 33% by eight and 39% by the age of 12.
The researchers say the stresses of having a child trigger the depression – such as too little sleep, changed responsibilities and extra pressures being placed on the parents' relationship.
Professor Steve Field, leader of the UK's 44,000 family doctors, said: "This is the best piece of research I've seen on this important but under-appreciated area of medical care. As a GP, I have often seen fathers stressed and depressed, particularly in the first year or two after becoming a parent."
Men who are adapting to the new duty of parenthood while continuing in their job are under stress, and many do not go to see their GP to talk about any fears and worries they may have, added Field, the chairman of the Royal College of GPs.
"This should raise awareness of the stresses and potential problems ahead for dads and dads-to-be and also encourage GPs to screen men, if appropriate. This study should help improve the quality of dads' lives and ensure that talking therapies or other treatments, if needed, are used early."
Rob Williams, chief executive of the Fatherhood Institute, said: "For too long there's been the assumption that it's depression and other mental health problems in mothers that has an impact on children. But in reality, the impact of a father's poor mental health on his children is also powerful.
"The study is likely to have underestimated the numbers of fathers who experience depression, because we know fathers are less likely than mothers to seek help with depression."
Both GPs and health visitors should screen fathers as well as mothers for depression, especially when the woman is depressed, as their partners are more likely to feel the same, Williams added.
"We are missing a golden opportunity to forewarn new parents of the challenges they might face once their baby arrives. Parents need to be told about the risks of depression for both mothers and fathers and they should also be told about the signs which they should be looking out for in their partner."
Denis Campbellguardian.co.uk © Guardian News & Media Limited 2010 | Use of this content is subject to our Terms & Conditions | More Feeds
Substance abuse, not mental illness, causes violent crime
Study finds people with drink or drug addictions have similar rates of violent crimes whether or not they have a mental illness
Illnesses such as schizophrenia and bipolar disorder are not the reason why violent crimes are committed by mental health patients, a study showed today.
An exhaustive study which tracked more than 8,000 patients diagnosed with schizophrenia and another 3,700 identified as having bipolar disorder over three decades in Sweden found that the abuse of illegal drugs and alcohol caused mentally ill people to perpetrate crimes of murder, manslaughter and sexual violence.
Dr Seena Fazel, a clinical senior lecturer in forensic psychiatry and consultant forensic psychiatrist at the University of Oxford, said: "The relationship between violent crime and serious mental illness can be explained by alcohol and substance abuse. If you take away the substance abuse, the contribution of the illness itself is minimal."
The academic said that all over Europe patients had been reinstitutionalised because of "this view that people with mental illness are a high risk … there's a lot of stigma". He said a solution would be to tackle drug and alcohol abuse across the whole population.
Dr Fazel added: "It's probably more dangerous walking outside a pub on a late night than walking outside a hospital where patients have been released."
He said rates of violent crime among people who were mentally ill and abused substances were no different from those among other people who abused substances.
People with mental illnesses who abuse substances have violent crime rates which are six to seven times higher than the general population – as do people with no mental health issues who have similar drink or drugs problems.
Dr Fazel said data also showed that those who were mentally ill but did not abuse substances were only at "minimally increased risk" of committing violent crime.
Around 0.9% to 1% of the general population suffers from bipolar disorder while 0.4% to 0.5% have schizophrenia.
Research has shown that around 20% of people with bipolar disorder abuse alcohol and drugs compared with about 2% of the general population. Dr Fazel said that one reason for this might be that substance abuse was "genetically programmed" into patients.
"We are looking at two reasons why this figure is higher. One is whether patients attempt to self-medicate with substance abuse. The other is that there is a possibility of genetic predisposition towards substance abuse given that schizophrenia and bipolar disorder both have an element of genetic predisposition."
Randeep Rameshguardian.co.uk © Guardian News & Media Limited 2010 | Use of this content is subject to our Terms & Conditions | More Feeds
Bipolar 'not linked to violence'
Benefit health tests unjust, say charities
Warning that people with serious illnesses are being judged fit for work when they are not
A coalition of charities claims that a controversial health test being pushed by ministers to decide who will get long-term sickness benefits is not working. There is mounting evidence, say the charities, that people with serious illnesses are being judged fit for work when they are not.
More than 30 organisations including the Papworth Trust, Mind and the MS Society – representing some of Britain's most vulnerable people – have written to the head of the government review of the test saying that they are being "overwhelmed by evidence showing the assessments are inaccurate and unjust". The charities point out that of the 166,000 people so far found fit for work, a third went on to appeal.
The government intends to reassess all incapacity benefit claimants to see if they are capable of working, stressing that the welfare bills are unaffordable. Last month it emerged there were 889,000 people who had spent all of the last 10 years on sickness benefits, at an average annual cost of £4.2bn.
Charities say people who are not in visible distress are often wrongly being found fit for work. There are complaints that the assessors are not trained to deal with learning disabilities, mental health issues and long-term health problems.
In one case highlighted by the Papworth Trust, a 52-year-old woman attempted suicide after she was told that because she could "walk, talk and dress nicely" she would not qualify for state assistance. In a high-pressure job in social care she had snapped under pressure a few months earlier.
"My doctor and psychiatrist both wrote saying I was unfit to work but the young woman in the assessment said that you can speak, hear, see and are not incontinent so you can work. She was very sorry. But it was crushing. I had lost my job, my house, my car," said the woman, who requested anonymity.
Soon after being turned down for benefits, which amounted to £65 a week, she was rushed to hospital with a drugs overdose. "It was the final straw for me. I thought, what else can I do?"
Government sources admitted there have been "issues" with the assessment, saying ministers had made changes "to better recognise people suffering from cancer and mental health conditions". There will also be an independent review by health expert Malcolm Harrington.
Despite this, the charities have concerns over the speed at which the government is moving, saying it may mean the process is not as fair as it should be. "Assessing 1.6 million existing incapacity benefit claimants equates to 41,000 per month. [It] is an ambitious target," they say.
The charities are also worried by changes introduced in the emergency budget tying housing benefit to jobseeker's allowance. "It is concerning that an assessment which we do not believe has demonstrated its ability to place people correctly on to employment and support allowance may become the basis of eligibility for a far wider range of benefits."
Randeep Rameshguardian.co.uk © Guardian News & Media Limited 2010 | Use of this content is subject to our Terms & Conditions | More Feeds
How insect brains could be used to fight MRSA
Junior medics 'leaving training'
From the archive, 6 September 1900: The plague in Glasgow and Govan
Originally published in the Manchester Guardian on 6 September 1900
The outbreak of plague in Glasgow and Govan is one of the most remarkable events of recent years. The prevailing feeling of the average Englishman has been that however much this disease might ravage other parts of the globe, it had nothing more than a historical or philanthropic interest to his own country, except in so far as it interfered with commerce. The extent of this feeling is shown by the fact that when, in 1889, the Infectious Diseases Notification Act was passed, plague was not included in the list. It has, however, reached us, and we shall be fortunate indeed if the present small epidemic proves to be the full extent of its attack.
Plague has been absent from England since the year 1665, when the last epidemic was buried under the ashes of London.
This outbreak began apparently in India, or Western China, in 1893-94, and it became epidemic in Hong Kong in 1894. The ravages of the disease in that island, where it still remains, have been and are terrible. It spread from Hong Kong to Bombay, Calcutta, and Alexandria, arriving in Europe at Oporto last year; and it has now reached England. It has been remarkable for the slow but most persistent way in which it has steadily pushed forward in spite of every precaution taken to prevent it. Quarantine has failed to stop it, and it is at present to be found in Sydney and on the east coast of South America; and our own more reasonable system of inspection seems for the moment also to have failed to stop its extension.
More hopeful position in Glasgow
Our Glasgow correspondent telegraphs:—It may now safely be asserted that the authorities in Glasgow have successfully grappled with the bubonic plague, which has troubled the city for the last fortnight. No further cases have been admitted to the hospital since Monday, and of the 16 cases which were said to have been suffering from the plague two patients have now been declared to be free from that disease. The number under observation in the reception-houses has been increased to 111, but this very fact points to the carefulness with which the work of the medical and sanitary authorities is carried out. The second case which was suspected to have arisen in Govan has now turned out to be a case of another disease, and the minds of the people there have been greatly relieved. In that district, however, every care is being exercised, and the authorities yesterday resolved to secure and furnish a reception-house to which any suspected case might be taken.
guardian.co.uk © Guardian News & Media Limited 2010 | Use of this content is subject to our Terms & Conditions | More Feeds
Fairer spending could save 4m children by 2020, says report
Save the Children says millennium development goal on infant mortality at risk as poorest miss out on resources
Millions of children die before their fifth birthday because developing countries skew public health spending to the rich rather than the poor, a leading charity says today. This misdirecting of money jeopardises the chances of meeting a crucial target of the UN's millennium development goals, says Save the Children.
The charity says that 4 million child deaths could be averted over a 10-year period if the 42 developing countries which account for 90% of all under-five mortality took an "egalitarian approach". The warning comes before a UN summit in New York later this month which will review progress towards meeting the eight goals.
One of the biggest concerns is that not enough is being done to cut the number of child deaths across the globe. Although UN nations agreed to reduce child mortality by two-thirds from its 1990 level by 2015, progress has been steady and slow – and exacerbated by the rising inequalities within poor nations.
Save the Children says this target will not be met at current rates and efforts are in danger of going "off-track" – only 3.5 million more children survive past their fifth birthday today than 20 years ago. The scale of the task is such that at least 1 million more children every year will need to live past five to achieve the UN's 2015 target.
"Nearly three-quarters of the countries with the highest child mortality burden will not reach the goal on current trends," says the report, A Fair Chance in Life.
The charity says cutting child mortality rates does not depend on how rich a country is or how fast its economy is growing. Patrick Watt, the charity's director of development policy, said health depends on fairness not wealth. He pointed out that people in Gabon were as rich as counterparts in Argentina, but had a child mortality rate almost four times higher.
"Growth is not the only answer either," says Watt. "India has had growth of 8% a year, but its current rate of reduction in under-five mortality is just 40% of what's needed to achieve by 2015 … This nails the myth that only growth is needed to end poverty – you need to focus on equity."
The problem, says Watt, is that there is a growing gap between who benefits from public spending: a poor child in Peru is five times less likely to live past five than a rich child; in India three times less likely and in Nigeria two and a half.
The gap in many parts of the globe is widening rather than narrowing, warns the charity. Save the Children says that in developing nations it is the children of the wealthiest fifth of the population who have disproportionately benefited from the focus on infant mortality to the extent that "in some cases the poorest fifth of the population [are] no better or even worse off".
It highlights what has happened in Burkina Faso, where a reduction in child mortality rates masks an actual increase in child mortality among the poorest 20% of the population. Sub-Saharan Africa, where close to one child in seven still dies before their fifth birthday, faces the greatest challenge. Although the mortality rate in the region has fallen, high fertility levels mean the absolute number of child deaths has increased since 1990, from 4.2 to 4.6 million.
Even in this part of the world, fairer access to public health resources would have saved lives. In Kenya, where there was an increase of nearly 150,000 under-fives' deaths between 1993 and 2003, an "egalitarian approach", says the charity, would have actually prevented 214,000 deaths.
Corruption too has played a part – oil-rich Chad has been plagued by bribery, which has undermined faith in government at a time when child mortality has actually increased.
The charity says that the key to saving more lives is to focus on nutrition, sanitation and women's rights – noting that one to three years of maternal schooling would reduce child mortality by about 15%. There is also a need to provide universal health services to mothers – the report highlights innovative programmes in Indonesia and Bolivia. It calls on donors to provide the cash to enable the charity to implement such schemes.
However, some experts said Save the Children should be pressing governments to make equality targets the issue. Kevin Watkins, from Oxford University's global governance programme, said: "If a poor child is fives times more likely to die than a rich one, then that's a human rights issue. We need developing countries … to focus on spending on the poor, not just saying that more donor money is the answer. A country like Vietnam has a great record in cutting child deaths because it taxes and spends progressively."
Randeep Rameshguardian.co.uk © Guardian News & Media Limited 2010 | Use of this content is subject to our Terms & Conditions | More Feeds
Gum and heart link 'breakthrough'
Research into age-related illness
