March 02, 2015

LSBU expert argues for investment in specialist nurses

The NHS must consider investment in nurses with specialist training in advanced practice to ultimately reduce costs and increase efficiency, according to an expert in healthcare at London South Bank University (LSBU).

Interviewed in a dedicated supplement for the Health Service Journal (HSJ) Alison Leary – professor of healthcare modelling at LSBU who has researched the work done by specialist nurses in advanced practice – argues that misconceptions have arisen around the use of the expert group that are hampering their perceived value and impact.

Specialist nurses in advanced practice are trained to post-graduate level with advanced clinical education, knowledge, skills, and scope of practice in nursing. The specialists provide expert management of specific conditions, co morbidities and treatment pathways, often as part of a multidisciplinary team with a focus on improving patient care and developing services.

Professor Leary said: “There is a perception that these nurses are expensive, but actually they are a very good return on investment and there are a lot of studies that show that.”

Together with colleagues, I have looked at the work of 12,000 specialist nurses in advanced practice, around 50million hours of work, and they are a cost effective, high-quality option in terms of delivering care.

With just small investments in education and administrative support, we could grow and develop this workforce. It is a solution, not a cost and problem.”

The HSJ supplement Time for some advanced thinking?: The benefits of specialist nurses was published on 27 February and pulls together the opinions of patients, researchers, academics healthcare managers and those working in charitiesand patient support groups – as well as nurses themselves – to discuss the differences specialist nurses make.

Professor Leary added: “The changes to the health service in the last ten years mean that these people are pivotal to running services in long term conditions and managing very complex caseloads.

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March 02, 2015

Black men less willing to be investigated for prostate cancer

The incidence of prostate cancer among men of Afro-Caribbean origin is higher than in white men, they are more likely to be diagnosed as emergencies and their mortality rates are higher. Until now it has been unclear why these disappointing outcomes exist.

To investigate the possible effects of patients’ preferences and choices, a team led by the University of Exeter Medical School carried out a study in more than 500 men attending general practices in Bristol. The research was supported by the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC).

The men were presented with realistic hypothetical scenarios – each included a description of a prostate cancer symptom and the estimated risk of prostate cancer. Working with colleagues at the Universities of Bristol and UCL, the researchers found that preference for investigation was lower in black men irrespective of the risk presented in the scenario. This difference was strongest in relation to the scenarios associated with the lowest risk level, with just 44 per cent of black males opting for investigation compared with 91 per cent of white males. In both groups, the most common reason for declining investigation was low risk, but significantly more black men stated that they simply did not want to know if they had cancer.

The study, published on March 2 in the British Journal of General Practice (BJGP), was led by Tanimola Martins, at the University of Exeter Medical School. He said: “We know that black men are significantly more likely to develop prostate cancer, and are more likely to die from it. For the first time, this study has found evidence that black men are less willing than white men to be tested for the disease. GPs should be aware of the reduced appetite for testing in black males, which may be linked to fear and a perception that treatment may lead to severe complications. Doctors could consider proactively discussing the subject. Education targeted at the black community and the health professionals who treat them may also help to address this.”

Professor Willie Hamilton, of the University of Exeter Medical School, outlined the next steps. He said: “We know that black people have worse outcomes with other cancers, particularly breast cancer. To address this, we need to understand the reasons behind that, and this could be a significant step on that journey.”

Dr Jonathan Banks, one of the study’s co-authors from the University of Bristol’s Centre for Academic Primary Care, said: “The findings help us understand some of the reasons why black males have a lower preference for investigation in prostate cancer. We hope these findings may lead to new ways to help educate the black community and the health professionals who treat them about symptoms and the importance of early investigation.”


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February 27, 2015


Today [Thursday 26th February] the Government has published an independent Review of Choice in End of Life Care, responding to the publication, Adrienne Betteley, End of Life Care Programme Lead at Macmillan Cancer Support, says:

“Today’s welcome review has taken vital steps in advancing the hugely important issue of giving people real choice and support at the end of life.

“For far too long, the heartbreaking reality of end of life care has meant that thousands of people with cancer have been forced to die in hospital, at great expense to the NHS, when they would rather die in the comfort of their own home surrounded by their loved ones.

“Macmillan Cancer Support welcomes the recommendations to improve the quality and experience of care for people at the end of life through free social care support and improved access to 24/7 end of life care.

“If the Government is serious about giving people a genuine choice and support at the end of life, they must act now to make these recommendations a reality. With an upcoming general election, it is also vital that all political parties show this same commitment to improving choice at end of life by including free social care for people at the end of life in their manifestos.”


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February 27, 2015


AROUND 500,000* children will die from smoking when they are adults unless more is done to cut smoking rates according to new Cancer Research UK figures released today (Friday).

Based on current smoking rates Cancer Research UK estimates that of today’s 12 million under 16 year olds, 2.7 million will become smokers as young adults. This could lead to around half a million smoking related deaths unless rates fall.

This shocking statistic has prompted the charity to renew its call for MPs to back the introduction of plain, standardised tobacco packaging when they vote on the issue in the coming weeks.

Smoking rates have fallen to around a fifth of the population but the decline has slowed in recent years. Cancer Research UK wants to sharpen the decline to help reduce the number of young people who start smoking and go on to become addicted to tobacco.

With overwhelming support from both the public and health communities – as well as backing across the political spectrum – Public Health Minister, Jane Ellison announced in January that the Government would vote on standardised tobacco packaging before the general election in May.

These new packs would then be introduced across the UK in 2016.

Sarah Woolnough, Cancer Research UK’s executive director of policy, said: “Our latest calculations reveal the appallingly high number of lives that will be lost unless we move faster to reduce the lethal impact of tobacco.

“We must challenge the idea that tobacco is a normal product if we’re to stop tobacco killing so many people. For too long tobacco has been allowed to cause illness and death. If we’re serious about health, we must do more to reduce smoking rates. Three years ago we began campaigning for cigarettes to be sold only in plain, standardised packaging which evidence shows reduces the appeal of tobacco to children. We are delighted the Government is committed to achieving this, and the time has come to vote to save the lives of future generations.”

There is strong evidence from Australia that standard packaging of tobacco is hitting sales of this deadly product. Between 2010 and 2013 – the period where standard packs were introduced – Australia saw a 15 per cent reduction in smoking prevalence. Data also confirmed that fewer young people are taking up the habit.

Official statistics from Australia also reveal that the level of illegal, counterfeit tobacco has not climbed since the new packs have been introduced.


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February 24, 2015

NHS Staff Survey 2014 gives cause for concern on whistleblowing – Picker Institute Europe respond to results

Results from the 2014 NHS Staff Survey, published today, portray a service striving to provide good patient care – but struggling to deliver with tight resources.

The survey shows that the NHS is continuing to improve its focus on patient care: 67% of staff said that this was their organisation’s top priority in 2014, compared to 66% last year and only 62% in 2012. But despite this positive focus, less than two thirds of staff would be happy with the standard of care provided by their organisation if a friend or relative needed treatment there (down from 65% in 2013, but still an improvement from the 63% recorded in 2012). This measure is strongly related to patient experiences of care, so the fall is concerning.

As well as looking at the quality of care, the survey asks about staff experiences of the NHS as a place of work. Results for some key questions on job satisfaction have declined. Only 56% of staff would recommend their organisation as a place to work (down from 58% in 2013), and only two in five (41%) feel that their organisation values their work. It is clear that staff are feeling the pressure of tight resources: less than a third think there are enough staff for them to do their jobs properly (29%, down from 30% in 2013). And, tellingly, the proportion satisfied with their level of pay has fallen by 5% points – from 38% in 2013 to 33% in 2014. This is the first drop in satisfaction with pay, which has otherwise remained steady, since 2011.

It is encouraging that the proportion of staff reporting feeling pressure to attend work whilst feeling unwell has fallen markedly, from 68% in 2013 to 65% this year. Despite this drop, though, it remains a concern that almost two in three staff members report attending work in the past three months despite not feeling well enough to perform their duties. And for the second year running there has been a small but significant increase in the proportion of staff feeling unwell due to work related stress in the last twelve months (39%).

Commenting on the results, Dr Andrew McCulloch, the Picker Institute’s Chief Executive, said: “The NHS Staff Survey is the most comprehensive source of evidence on the experiences and views of the 1.2 million people working for the NHS in England. This year’s survey is the largest ever and the results are enlightening. Staff and employers alike are committed to providing good patient care. But there are clear issues about the standards that the service is able to deliver: staff appear all too conscious of the financial pressures, and for the first time in recent years there was real evidence of concerns about pay beginning to bite.”

Dr McCulloch continued: “Evidence shows that there is a relationship between staff experience in the NHS and the quality of care patients’ experience. For the service to deliver world class care to its users, it first needs to ensure its staff are well looked after. We call on the leaders of all NHS organisations to review their own staff survey results in detail and work with staff to identify and enact action plans to improve people’s experiences.”


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