Antimicrobial resistance is a ‘ticking time bomb’

The Chief Medical Officer Professor Dame Sally Davies has announced that global action is needed if we are to overcome the ‘catastrophic threat’ of antimicrobial resistance.

The warning, made in her second annual report, highlighted the lack of new antibiotics discovered in the past two decades.

Despite new infectious diseases being discovered on an almost yearly basis, very few new antibiotics have been developed.

This means that we have limited resources to manage the increasing number of infectious diseases that are ever evolving to become resistant to current drugs.

‘We need to work with everyone to ensure the apocalyptic scenario of widespread antimicrobial resistance does not become a reality,’ said Professor Davies. ‘This is a threat arguably as important as climate change for the world.’

The importance of preserving current antibiotics was also emphasized. Professor Davies argued that in order to retain the effectiveness of existing antibiotics, responsible prescribing must be adhered to.

‘All physicians who prescribe antibiotics have a responsibility to their patients (and public health) to prescribe optimally,’ she said.

To help meet the challenges set out by Professor Davies, the Department of Health is planning to publish a UK Antimicrobial Resistance Strategy.

This five-year strategy will focus on championing the responsible use of antibiotics by ensuring NHS staff have the necessary knowledge, skills and training to prescribe antibiotics effectively.

Professor Davies stressed that governments and organizations across the world, including the World Health Organization and G8, need to realize the seriousness of the problem.

‘If we don’t act now, any one of us could go into hospital in 20 years for minor surgery and die because of an ordinary infection that can’t be treated by antibiotics.’

Taken from Practice Nursing, published 19 Mar 2013.

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NHS Diabetes calls for introduction of specialist foot care teams

A report published by NHS Diabetes has announced the NHS spent an estimated £639 million–£662 million on diabetic foot ulceration and amputation in 2010–11.

Each year around 6 000 people with diabetes have leg, foot or toe amputations in England, substantially reducing their quality of life.

However, many of these are avoidable. The NHS Diabetes report suggests rapid access to multidisciplinary foot care teams (MDTs) with strong links to community podiatry services could lead to faster healing, fewer amputations and improved survival.

The reduction in NHS expenditure on diabetic foot problems as a result of the introduction of such services would far outstrip the cost of having MDTs.

Lower-extremity amputation rates at James Cook University, Middlesbrough, fell by two-thirds after the introduction of an MDT.

In 2010-2011 it was estimated that the cost of an MDT was £33 000, whereas the annual saving to the NHS due to averted amputation was £249 000.

Currently, one-fifth of hospitals providing inpatient care for people with diabetes have no MDT.

Anne Morton, Director of NHS Diabetes said: ‘It is not acceptable that thousands of people with diabetes lose a limb each year because of poor quality care. It is even less easy to accept when we now have such a strong economic case for change.’

Taken from Practice Nursing, published 19 Mar 2013.

Why Brains Matter

The Neurological Alliance launched a survey entitled ‘Our Brains Matter’ as part of the 2013 Brain Awareness Week, 11-17 March.

Brain Awareness Week is a global campaign to increase public awareness of the progress and benefits of brain research.

The aim of the Our Brains Matter survey is to develop a clear picture of the experience of being diagnosed with a neurological condition in the UK. With the evidence gathered, the Neurological Alliance will push for improvements in the diagnosis of all neurological conditions.

The Neurological Alliance is the collective voice for 10 million children, young people and adults in England with a neurological condition. It is a membership organization consisting of more than 70 national brain and spine organizations.

The coalition of charities has warned that a ‘legacy of neglect’ is preventing an estimated 12 million people living with neurological conditions in the UK from gaining vital treatment.

According to the Neurological alliance this is due to a lack of specialist knowledge and haphazard services.

‘Around one in six people in the UK will experience a neurological condition in their lifetime,’ explains Arlene Wilkie, Chief Executive of the Neurological Alliance, ‘Yet little is being done to ensure that the NHS is fit for purpose when it comes to responding to these complex conditions.’

Taken from Practice Nursing, published 19 Mar 2013.

Australia introduces HPV vaccination for boys

Australian schoolboys have begun receiving vaccinations to protect them against cancers and disease caused by the human papillomavirus (HPV).

HPV is a common infection that is associated with cervical cancer and genital warts. It has also been linked with other cancers such as throat cancer, although not as strongly.

‘We’re confident that extending the program to males will reduce HPV-related cancers and diseases in the future,’ said Australian Health Minister Tanya Plibersek.

Following the introduction of the vaccine to girls in 2008 to help reduce the risk of cervical cancer, Australia has become the first country in the world to publicly fund HPV vaccinations in boys.

The action has resulted in organizations such as the Throat Cancer Foundation to urge the UK to follow suit. However, the Department of Health for England has held its ground, saying that due to the lack of scientific evidence, there was no plan to implement the vaccination of boys into the NHS programme.

According to the Throat Cancer Foundation, the vaccine costs as little as £45 per person, and treatment for throat cancer costs the NHS around £45,000 per patient, meaning there is considerable cause for discussion of the topic.

Taken from Practice Nursing, published 18 Feb 2013.

Community team improving the sexual health of vulnerable women

Two teams of community nurses in south London who give contraceptive help, sexual health advice and screening to vulnerable local women have been recognized for their contribution to sexual health in the community.

The Health Inclusion (Three Boroughs Team of Lambeth, Southwark and Lewisham) and Sexual Health Outreach team work in partnership in south London to give contraceptive advice and support to young women who are sex workers and at risk of unplanned pregnancies.

The teams provide health care services at hostels, hospitals and nurse-led clinics, and help those who find it difficult to access health services as a result of not having a permanent address.

Through training hostel staff and visiting hostels once a week, the Three Boroughs Team has provided significant advice and support for women in need. The provision of certain medications through patient group directions and information on available contraception options has helped reduce the number of unplanned pregnancies in young women.

The women staying at the hostels have given positive feedback on the scheme. ‘These women feel valued because specialists were sent in,’ said Amy Hall, a nurse practitioner at the Three Boroughs Team. ‘Many of these women don’t think of these ideas until it is too late and so it is great for them to have the option.’

Eileen Sills, chief nursing officer and CEO at Guy’s and St Thomas’ NHS Foundation Trust congratulated the team for their work helping vulnerable women. ‘The team make a real difference to the lives of the young women they see in the hostels, supporting them to make healthier lifestyle choices and to think about when to become pregnant. We’re very proud of their excellent work.’

Taken from Practice Nursing, published 18 Feb 2013.

Francis calls for cultural change

The public enquiry report chaired by Robert Francis QC concerning the standards of hospital care provided at the Mid Staffordshire NHS Foundation Trust has emphasized a need for cultural change within the NHS.

The 3-volume, 1782-page report highlighted the failure of the NHS system to detect poor quality care and to ensure that services meet the standards that the public expects. This failure to communicate concerns illustrates a betrayal of the trust that members of the public should be able to place in the NHS.

Francis called for a patient-centred culture, which has a commitment to serve and protect patients. His recommendations for achieving this include: a structure of fundamental standards, which identify the basic standards of care a patient can expect; an openness and statutory duty of doctors and nurses to be truthful with patients; compassionate, caring and committed nursing; and stronger healthcare leadership.

The report includes a number of recommendations for changing nursing training, regulation and professional support that, if implemented, will have an impact on nurses in all sectors of the NHS, including practice nurses. Francis identified that nurses are at the heart of patient-centred care, and stressed that training standards need to be strenghthened to ensure that qualified nurses are competent to deliver compassionate care to a consistent standard. These principles apply to nurses working in all sectors of the NHS.

‘Nurses throughout the NHS will feel devastated at the picture of poor and unsafe care that took place at Mid Staffordshire,’ said RCN president Andrea Spyropoulos. ‘What commentators often forget is that no one is more saddened or frustrated by stories of poor care than nursing staff themselves.’

The report has important implications for nursing leaders, particularly for the Royal College of Nursing (RCN). Francis found that nursing needs a stronger voice. According to the report, this can be achieved through strengthening nursing representation in the leadership of all provider organizations, enhancing the links with their professional regulators, and introducing a better appraisal system. It was also recommended that the RCN consider splitting its trade union and professional functions.

Taken from Practice Nursing, published 18 Feb 2013.

Greater role for practice nurses needed in London

A report published by the King’s Fund has outlined that care in London is not as consistently good as it could be. Analysis suggests that general practices need to do more to ensure that all Londoners experience high-quality care that is appropriate to their needs.

The report highlights the great variations that persist in both the availability and quality of care experienced by patients across London. While improvements and innovations can be seen in some general practices, they need to be spread more rapidly, with commissioners of primary care needing robust systems in place if they are to tackle unacceptable standards of care.

The report’s authors argue that GPs must be supported by a wider range of health professionals if they are to manage the growing range and complexity of health needs of patients. A greater role for practice nurses must be provided if future demands on primary care in London are to be met.

London GPs work with fewer practice staff than elsewhere in the UK. There are only a little over two practice staff per GP in London, compared with 2.47 nationally.

The quality of consultations with a GP and/or practice nurse was revealed in a 2011/12 patient survey to be lower in London than elsewhere in the UK. 87% of Londoners were satisfied with their consultations with a practice nurse compared to 91% in the rest of England. But’ as in the rest of England fewer patients were satisfied with their GP (84%) than with their practice nurse.

This new report affirms many of the findings of previous studies. The key issues and recommendations for changes to primary care raised in previous reports are still being issued today. Therefore, unless there is change in the way care is delivered in other settings, the transformation agenda for primary care and general practice cannot be achieved.

Taken from Practice Nursing, published 21 Jan 2013.