Smokers and obese Londoners could be refused surgery in bid to save NHS cash

Health reporter(wp/es):

Smokers and obese Londoners could be refused surgery and IVF treatments axed in a radical bid to save NHS cash.

Richmond and Croydon are considering whether to end funding of fertility treatments or limit it to “exceptional cases”, such as people left infertile by cancer treatments.

Richmond clinical commissioning group (CCG) is also proposing to ban smokers and people with a Body Mass Index (BMI) over 40 - those classed as “severely obese” - from non-emergency surgery.

Operations would only proceed if they lost at least 10 per cent of their body weight in nine months or achieved a BMI under 30, meaning they were just “overweight”.

Smokers would have to make “genuine supported steps” to quit or achieve a particular goal before their operation would be allowed to proceed.

Health campaigners today warned the “appalling” draft restrictions on fertility treatment broke NHS recommendations for three cycles of IVF, while the Royal College Of Surgeons said restricting access to surgery was “totally unacceptable”.

Richmond, which needs to save £11 million this year, plans to reduce initial eligibility for IVF to women up to 40.

A consultation proposes “significantly increasing the threshold” to the point where “IVF and specialised fertility treatment is no longer commissioned”.

Croydon CCG, which needs to save £30 million, last week began consulting on a proposal to stop “routine IVF”. 

It currently offers one free cycle. Private fertility treatment typically costs about £3,000 per cycle.

About 250 women a year would be affected. The changes would save a total of about £1.2 million.

Susan Seenan, chief executive of the charity Fertility Network, said: “It’s completely wrong of them to be cutting such a vital service for people who have a medical issue that stops them conceiving.”

Restrictions on surgery for obese patients and smokers in part of Yorkshire have already been approved by NHS England. Those who fail to lose weight or quit face delays of between six to 12 months.

A Royal College of Surgeons spokeswoman said: “Obese patients should be encouraged to lose weight before surgery for their overall health. 

“However making it a condition of receiving that treatment is totally unacceptable and we urge the CCG against such a policy. We are not aware of any clinical evidence to suggest patients are more likely to lose weight if the NHS denies or delays treatment.

“Richmond CCG has been upfront in admitting their proposals are also aimed at reducing financial pressures. However, patients may be left suffering in unbearable pain and in some cases delays could lead to their symptoms worsening so it is difficult to see how this will save significant money. 

“We encourage the CCG to reconsider how it can save money without targeting specific groups of patients and affecting their access to healthcare.”

Richmond CCG has already agreed to reduce access to knee surgery, bunion surgery and treatment for gallstones, and reduce the number of operations to remove tonsils and varicose veins.

It also wants to reduce the amount of prescriptions for baby milk, vitamin D tablets, gluten-free food and “self-care” medication such as paracetamol and antihistamines.

Dr Graham Lewis, chairman of Richmond CCG, said: “Increasing demands on NHS services means that we cannot provide everything we want for people living in the borough of Richmond. 

“We have to prioritise and make difficult decisions, which include a proposal to reduce the number of IVF cycles offered from one to an exception only basis, to secure the future of local health services for everyone.”

In relation to the proposed restrictions on surgery, Dr Lewis said: “There is a lot of evidence to demonstrate that not all patients gain improvement in their symptom levels or mobility from undergoing operations such as hip or knee replacements and other treatments, such as physiotherapy, may be more effective. 

“In addition, being overweight and smoking are factors which contribute to poorer outcomes, so it makes sense to reduce these risks before surgery.”

A Croydon CCG spokeswoman added: “The proposals were brought about in light of the financial pressures the local NHS is facing. NHS Croydon CCG needs to make savings of almost £30 million next financial year, which is around six per cent of the commissioning budget for local health services of £482.3 million.”

Richmond’s consultation will run until 3 February, with Croydon’s running to 1 March.

40 flights cancelled as cabin crew begin 48-hour strike

Staff reporter(wp/es):

Around 40 British Airways flights have been cancelled as hundreds of the airline's cabin crew walked out in a row over pay. 

British Airways said around 40 Heathrow flights had to be cancelled in response to the 48-hour strike which began on Tuesday.

The airline stressed however that all passengers would be able to reach their destination as passengers on cancelled flights had been rebooked on other services. 

This means some passengers will have to travel on flights departing at different times to their original booking but BA said its customers were informed of their new travel arrangments on Friday so they could plan their trips.

The airline said all flights to and from Gatwick and London City airports will operate as normal.  

The 48-hour strike, which started at midnight on Tuesday, is being conducted by so-called “mixed-fleet” cabin crew who represent around 15 per cent of stewards at the airline.

“Mixed-fleet” crew based at Heathrow have argued they are unfairly paid less than other cabin crew.

The Heathrow-based crew threatened to go on strike over Christmas but the action was suspended following last-minute talks with BA. 

Unite said since 2010 all British Airways new cabin crew employees joined mixed fleet, with basic pay starting at £12,192, plus £3 an hour "flying pay" totalling an average pay of £16,000, including allowances, each year.

"These poverty pay levels for cabin crew are below the living wage and are among the lowest in the industry, putting the UK's national carrier to shame," the union said a statement.

BA responded: "The pay data shows that the range of earnings paid out to full-time mixed fleet crew between September 2015 and August 2016 was £21,151- £27,356. 

"Our proposal for our mixed fleet cabin crew reflects pay awards given by other companies in the UK and will ensure their reward levels remain in line with cabin crew at our airline competitors. 

“It is also consistent with pay deals agreed with Unite for other British Airways colleagues.”

Unite national officer Oliver Richardson said: "Going on strike is never an easy decision, so we are pleased with the numbers of 'mixed fleet' cabin crew who have taken the courageous step to take a stand against poverty pay at British Airways. 

"This is a low paid workforce struggling to make ends meet on wages which are among the lowest in the airline industry." 

BA said: "As part of our contingency plan, we will be merging a very small number of flights to and from Heathrow.

"This will mean some customers will travel slightly earlier or later in the day than their original booking.”

Unite said over 800 "mixed fleet" crew had joined the union since the start of the dispute, taking its membership to over 2,900.

Dramatic fall in London HIV rates 'may be due to internet drugs'

Health reporter(wp/es):

A dramatic fall in new HIV infections among gay men in London may be the result of the increased use of internet drugs, it has been claimed.

Four sexual health clinics in the capital saw a decrease in new HIV infections of about 40 per cent last year compared to 2015.

According to New Scientist, some doctors believe the decline may be due to people buying medicines known as pre-exposure prophylaxis (PrEP) online.

The drugs, which cut the chance of catching the virus, have been approved in the UK as a medication for cutting the chances of getting HIV but are not yet available on the NHS.

Activists in the UK have set up a website, I Want PrEP Now, through which it can be bought from online pharmacies in India and Swaziland. The website works with NHS clinics to check the medicines are genuine.

Will Nutland, at the London School of Hygiene and Tropical Medicine, has set up a website that gives people information on how to give themselves PrEP.

He told the magazine: “We need to be very cautious at this stage, but I can’t see what else it can be.

“Something extraordinary has happened in the last 12 months.”

Sheena McCormack, of the London clinic 56 Dean Street, says the fall in infection rates is unlikely to be due to more condom use, as rates of other sexually transmitted diseases such as syphilis were about the same in 2016 as the year before.

Although PrEP use has been rising in other countries, in the UK it was low until a sudden surge in the the last year, an increase that coincided with the launch of I Want PrEP Now and Nutland’s website.