VIDEO: Cameron defends NHS reforms

VIDEO: Cameron defends NHS reforms: The prime minister has defended the government's NHS reforms saying they had the support of thousands of GPs across the country. BBC News

Fears grow over NHS plans future

Fears grow over NHS plans future: A series of talks between ministers and medical leaders have been taking place as concerns mount about the overhaul of the NHS in England. BBC News

Hospital boards ''need to let go of power''

Hospital boards ''need to let go of power'': Power and control must be passed to clinical teams if benefits of service-line management are to be realised, says report Public Service

Defining mental health services: promoting effective commissioning and supporting QIPP

Defining mental health services: promoting effective commissioning and supporting QIPP: In mental health there has not been a consistent set of definitions that describe what is meant by an inpatient bed. This has led to difficulty in benchmarking and understanding patterns of performance. NHS Confederation

Learning disability reports

Learning disability reports:

The CQC has published further reports as part of its review of learning disability services.

• Reports


• CQC - review of learning disability services

The management code

The management code:

This new Code of Conduct lays out expected behaviours from those managing healthcare services.

• Code of conduct


• Institute of Healthcare Management - publications

Summary of guidance important for general practice

Summary of guidance important for general practice: Key points from NICE guidance published in January 2012 NICE

Heart attack deaths fall by 50%

Heart attack deaths fall by 50%:

NHS data shows mortality rate at half the 2002 level, with fewer people smoking and better NHS care contributing factors

The number of people dying from a heart attack has halved in the last decade, with falling rates of smoking, greater use of statins to lower cholesterol, and better NHS care thought to be behind the fall.

Fewer people in England are suffering a heart attack, and fewer of those who do are dying as a result, according to research by Oxford University reported in Thursday's British Medical Journal.

They used official NHS data on hospital admissions and mortality to study 840,175 men and women who between them had 861,134 heart attacks between 2002 and 2010.

Overall, mortality rates among men fell by 50% and among women by 53%.

The steepest falls in heart attacks were noted among middle-aged people. Rising rates of diabetes and obesity among younger people is thought to lie behind their not seeing the same dramatic drop.

Professor Peter Weissberg, medical director of the British Heart Foundation, which funded the study, said: "This impressive fall in death rates is due partly to prevention of heart attacks by better management of risk factors such as smoking, high blood pressure and cholesterol and due partly to better treatment of heart attack patients when they reach hospital."

Despite the welcome downward trend, "far too many heart attack victims still die from a cardiac arrest before medical help arrives. Many of these deaths could be prevented by rapid cardiopulmonary resuscitation," added Weissberg.

Improvements in the NHS's ability to prevent heart attacks, and better treatment of those who have one, were identified as key factors by the researchers. The Guardian

Medical Colleges considering position on NHS reforms

Medical Colleges considering position on NHS reforms: The medical establishment has 'continuing concerns' about the NHS reforms and cannot support the Government's Health Bill, it has emerged. The Daily Telegraph

Doctors told to blow the whistle or be struck off

Doctors told to blow the whistle or be struck off:

Doctors who fail to raise concerns about sub- standard patient care could be struck off, according to whistle-blowing guidance published yesterday. The Independent

NHS to usher in genetic medicine

NHS to usher in genetic medicine:

Government ministers yesterday promised to put the NHS at the forefront of the revolution in genetic medicine and perhaps eventually see everyone having the three billion letters of their genome fully sequenced. The Independent

Medical chief highlights importance of vitamin D

Medical chief highlights importance of vitamin D:

Vitamin D was in the headlines today, with many papers reporting that a quarter of all toddlers are deficient in the nutrient and that childhood rickets is on the rise. The vitamin plays several important roles in the body, including regulating the balance of nutrients needed for strong, healthy bones.

The vitamin has fallen under the spotlight as Chief Medical Officer for England, Professor Dame Sally Davies, is reportedly contacting health professionals to highlight the need to prescribe vitamin D supplements to at-risk groups. There are already extensive guidelines on circumstances where people should take vitamin D supplements, but the move seems designed to increase use of the pills, which are available on prescription, or even free to individuals with a raised risk of deficiency.

An independent advisory committee is also researching and reviewing current recommendations on vitamin D, but the results of this extensive analysis are not expected until early 2014.

While vitamin D deficiency may have increased in recent years, rickets is still a rare condition. That said, it is entirely preventable and vitamin D supplementation can be of great importance to at-risk groups such as toddlers and young children.

What is vitamin D and why do we need it?

Vitamin D plays an essential role in maintaining good health. It has several important functions, including helping to regulate the amount of calcium and phosphate in the body. These substances are needed to keep bones and teeth healthy.

Without adequate vitamin D, bones can become thin, brittle and misshapen. In extreme cases this can lead to rickets in children, a condition involving a softening of the bones that can lead to fractures and deformity. In adults softening of the bones is usually called osteomalacia, and may cause pain and muscle weakness.

Vitamin D has many other important roles in the body including regulating cell growth, neuromuscular and immune function, and reduction of inflammation. Even years after its discovery, there is still ongoing research examining the various other functions vitamin D might perform in the body.

According to the Scientific Advisory Committee on Nutrition (SACN), a group of experts that advises the government about all aspects of nutrition, some evidence suggests that vitamin D may be important in preventing other diseases including cancer, cardiovascular disease and multiple sclerosis, although it points out further research is needed before any definite conclusions can be drawn.

How can I get vitamin D?

The best source of vitamin D is sunlight on the skin. The vitamin forms under the skin in reaction to a type of ultraviolet ray called UVB. UVB rays are more powerful in the summer, and experts advise exposing the skin to regular, short periods of sun during the summer months, without sunscreen, which blocks UVB rays. However, it is important to ensure that the skin does not burn.

Vitamin D is also found in a small number of foods but it is difficult to obtain enough vitamin D from diet alone. Good sources of vitamin D include oily fish (such as salmon and sardines), eggs, cheese and meat. In the UK, all margarines and infant formula milks are fortified with vitamin D. It is also added to other foods such as breakfast cereals, soya and some dairy products, but usually only in small amounts.

Breastfed babies get their vitamin D from their mother’s breastmilk, which makes it especially important that breastfeeding women have adequate vitamin D levels of their own.

Vitamin D is also available in supplement form. Women and children participating in Healthy Start can get free supplements containing vitamin D. Some doctors sell vitamin D supplements or supply them free of charge to those not eligible for Healthy Start.

Who needs vitamin D supplements?

The current advice is that most people should be able to get all the vitamin D they need by getting enough sun and eating a healthy balanced diet. However, the Department of Health says the following people may be at risk of vitamin D deficiency and recommends they take daily vitamin supplements:

• all pregnant and breastfeeding women


• all children aged six months to five years old


• all people aged 65 or over


• people who are not exposed to much sun – for example people who are housebound and those who cover up their skin for cultural reasons


• People who have darker skin, such as people of African Caribbean and south Asian origin. Their bodies are unable to produce vitamin D as easily.

You can buy single vitamin D supplements at most pharmacies and supermarkets. Pregnant women who take vitamin D as part of a multivitamin should avoid supplements containing vitamin A (retinol), which can be harmful in pregnancy.

Can too much vitamin D be harmful?

The Department of Health says that taking 25 micrograms (0.025mg) or less a day of vitamin D supplements is unlikely to cause any harm. But taking high doses of vitamin D over a long period could weaken your bones.

Is rickets really on the rise?

Yes. In 2007 SACN published an update paper on vitamin D which, it said, highlighted “the prevalence of low vitamin D status throughout the UK population and the re-emergence of rickets in certain subgroups”.

However, while it would appear that a relatively high proportion of children do not get enough vitamin D, rickets is still a rare disease in the UK and there is certainly not an epidemic of the condition, as might be supposed by reading some news articles. That said, the condition is entirely preventable, and so there is a need to ensure parents and children have access to vitamin D supplements wherever appropriate, such as through the Healthy Start scheme.

What will happen next?

Last year the government launched a review of vitamin D supplementation, which is due to report in the next few years. In the meantime, Dame Sally is reportedly contacting health professionals to ensure they offer advice on vitamin D supplementation to those at risk, so that they can avoid health problems associated with deficiencies of this important nutrient.

Links To The Headlines

Experts review vitamin D advice. BBC News, January 25 2012

Vitamin D awareness in decline, say doctors. The Guardian, January 25 2012

A quarter of UK toddlers are lacking Vitamin D. The Independent, January 25 2012

Rickets returns as 1 in 4 toddlers found to be lacking in vitamin D. Daily Mirror, January 25 2012

Vitamin D deficiency in UK a 'major problem'. The Daily Telegraph, January 25 2012

NHS Foundation Trust Annual Reporting Manual 2011/12

NHS Foundation Trust Annual Reporting Manual 2011/12: The NHS Foundation Trust Annual Reporting Manual 2011/12 provides guidance to foundation trusts on producing their annual reports and accounts. Monitor