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  1. Child heart surgeons to be in teams of four

    Efforts to untangle years of controversy about children's heart surgery took a step forward yesterday as ideas for future services emerged.

    They include a requirement that surgeons should work in teams of four.

    NHS England officials described their proposals as "standards" and said that future services would be commissioned against them.

    The last attempt to reorganise child hearts surgery and reduce the number of centres in the UK ended in the courts following bitter opposition from units listed for closure.

    The new standards apply to congenital heart care for both children and adults.

    NHS England says it wants services to be organised in networks - and the networks will be responsible for overseeing all decisions about surgery.

    But it will require surgeons to work in teams including at least four surgeons - and each surgeon must be responsible for at least 125 congenital heart operations a year.

    The document also allows NHS England to back away from controversial changes, stating that the risk of "destabilising" units will be a factor.

    It states: “Tough choices may be involved if it seems that the best possible outcomes would require significant changes to the way the service is configured.

    "It would then be necessary to consider whether the evidence was strong enough to suggest that the benefits to be gained would outweigh the risks of change – the upheaval, the cost, the upset, specialist care delivered further from some patients’ homes, the risk of destabilising some units or other services linked to or dependent upon congenital heart disease services.

    "At this stage it is not clear that change of this type will be needed. There may be ways for providers to meet the standards without major reconfiguration."

    The report also promises further work on the staffing of paediatric intensive care and high dependency units.

    NHS England's clinical director for heart disease, Professor Huon Gray, called for views on the proposals.

    Professor Gray said: "Patients, the public, doctors and surgeons told us the best way to improve services is to implement the same set of standards across the board."

    Clinical director for children Dr Jackie Cornish said: "Congenital heart disease services in this country already provide good, safe care, with high survival rates after surgery. 

    "But we know there are areas for improvement, and we want consistent services of the highest quality for all our patients throughout their lives, wherever they live."

  2. Rugby customs may spread dangerous skin infection

    Rugby is a game that is rough on the pitch and hearty in the changing rooms - but its customs may be causing outbreaks of a nasty skin condition, health experts warn today.

    Sharing of towels, sharing of razors and sharing of ice baths may all be responsible for passing on a strain of bacteria which can be fatal, according to Public Health England.

    The findings come from a study of one club in the south Midlands of England where researchers found four players infected with the same strain of PVL-MSSA, a kind of staphylococcus aureus bacteria. The organisms produce a toxin called Panton-Valentine Leukocidin, which normally causes boils and abscesses but can also cause necrotising fasciitis - which destroys skin and tissues.

    59 players took part in a survey and 11 admitted to regular sharing of towels while six often shared razors.

    Out of the 59, 22 had cold baths after playing and 17 reported suffering skin conditions.

    Health officials said rugby players were also susceptible because of damage to the skin from "turf burns" from falling on artificial grass.

    Dr Deepti Kumar, from Public Health England, said the organism could cause serious infection.

    Dr Kumar said: "Because it can spread easily it is important to ensure that the correct procedures are in place to limit the spread of the bacteria.

    "The investigation identified a number of high risk practices among the players which increase their chances of getting an infection, such as sharing towels and razors, and sharing ice baths with their fellow team members.

    "We would urge any sportsperson who plays a sport where cuts and grazes are commonplace to practice good hygiene and not share any item with fellow team members to reduce their risk of developing an infection.”

  3. Hadrian's Wall warning from English NHS

    Senior figures in the English NHS were set to step into the Scottish independence debate today - warning that the Scots could lose by severing their ties with English hospitals.

    NHS England medical director Sir Bruce Keogh was reported to be warning of a "Hadrian's Wall" of health.

    And NHS England chief executive Simon Stevens warned that new agreements would be needed to enable Scottish patients to get access to the highly specialist services they currently use in English hospitals.

    Reported by the Daily Mail, he has stated in a report: "Scottish patients currently make use of a number of specialist health services throughout England, such as heart/lung/and other organ transplants as well as numerous specialist cancer treatments.

    "Were Scotland to decide to cede from the United Kingdom, the legal status of Scottish patients wishing to access these services south of the border would change.

    "This would require a new bilateral agreement, or if Scotland were accepted into the EU/European Economic Area then Scottish patients could in theory be treated here on the same basis as, say, a patient from Belgium or Slovakia."

    Sir Bruce contributed an article to the paper, warning against using "emotional political soundbites" to "trivialise" the issues facing health services.

  4. Inspector ratings to be "on display"

    Hospitals and GPs may be forced to display judgements from inspectors in waiting rooms and in entrance halls, it was announced today.

    The idea is being put out for consultation by the Department of Health.

    The government sees it as the next step towards making Care Quality Commission inspections effective.

    Commission chief executive David Behan said: "People who use health and care services want to know that they are safe and of high quality. When we rate services, we think it is important that the public know what our judgement is.

    "While we publish all ratings on our website, we believe this should go further. Care homes, hospitals and GPs should make our judgements of their services readily available to the public."

    But hospital representatives warned it could cause more red tape.

    Matt Tee, of the NHS Confederation, said: “We support greater transparency but it needs to be meaningful in helping people make decisions about their care, and not add unnecessary bureaucratic burdens on our members.”


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