‘Giving babies with spina bifida a chance’

Ruth and her mum

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Ruth with her mum, Jacquie

One in every 1,000 pregnancies in Britain is affected by a spine or brain defect such as spina bifida. Actress Ruth Madeley, who herself has the condition, looks at how things have changed since she was born, 31 years ago, and the groundbreaking surgery that is now possible while babies are still in the womb.

Spina bifida has always been part of my life and something that I have accepted – but it has never been something that I have fully understood.

Things are very different now to when Mum was pregnant with me.

She wasn’t given much hope about what I’d be able to do – or even if I’d survive. Now parents-to-be are given much more information – and there’s the possibility surgery could improve their babies’ lives’

I never thought I would have the opportunity to sit in and watch that revolutionary surgery being carried out – on a baby with spina bifida before it was even born – and see, in that very moment, the bravery of the mother who willingly underwent this huge procedure to ultimately help her child.

In the operating theatre, the number of people wearing scrubs was more than I had ever anticipated – the team was made up of over two dozen medics – and outside the theatre doors, the mother was saying goodbye to her husband before she and her baby were put under anaesthetic.

Watching the couple hug one another made it hit home that the mother wasn’t just putting her own life in someone else’s hands but her unborn baby’s life too.

‘Close to home’

The surgeons’ aim was to close the open hole in the baby’s spine and push the exposed nerves back inside the membrane around the spinal cord – and each member of this extraordinary team was responsible for ultimately keeping both mum and baby alive during this major operation.

A successful operation would help to alleviate some of the additional health complications that can come with spina bifida, such as hydrocephalus (where water accumulates on the brain), bladder, bowel and kidney problems and severe walking difficulties or paralysis.

My experience of surgery has always been when I have been the one on the operating table; so, to be able to witness this ground-breaking surgery was somewhat surreal – and very close to home for me personally.

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Ruth was able to watch the surgery on an unborn baby with spina bifida

I could only imagine what my own mum would have done in this position, if such surgery had been available when she was carrying me.

For any parent, finding out that their child has spina bifida must be extremely challenging and worrying.

My mum’s experience from her obstetrician 31 years ago was very negative when they discovered I had spina bifida just six weeks before I was born.

They told my mum that I would never walk and that I would have many other health complications – not offering my family much hope for me at all.

Termination was never an option for my mum but, met with such negativity from professionals, she was naturally very worried about my health and whether I would live or not.

‘Giving babies a chance’

However, with the great medical and scientific advancements that have happened since I was born, many women expecting a child with spina bifida today should now have a much more positive and hopeful outlook for their babies.

This surgery is not about eliminating spina bifida or saying it should not exist – it is about giving more unborn babies who are diagnosed with spina bifida the chance to reduce the other symptoms that come with this disability, while still being able to grow in the womb.

There is no cure – babies who have the foetal surgery will still have spina bifida when they are born – but their physical strength and overall health are improved.

So surely, having such ground-breaking surgery available for more people can only be a positive thing.

Spina bifida is part of my DNA and something that I fully embrace in my life.

Without it, I wouldn’t be in the position I am to have created this documentary.

I feel privileged to be able to share my own personal journey of learning more about foetal surgery, medical science and what spina bifida means in today’s world.

Horizon: Spina Bifida & Me is on BBC Two at 21:00 on Thursday, 26 July.

Why suntan lotions don’t work for most

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People are getting less than half the sun protection they expect from suntan lotions, according to research.

But the problem isn’t the lotion, it’s our slapdash application of it, King’s College London scientists say.

In theory, using sun protection factor (SPF) 15 sunscreen should be enough to stop sun damage.

But in reality, people need SPF 30 or 50 to be safe, say the study authors, who carried out experiments with volunteers in their lab.

Factor 50 lotion applied in the typical way would, at best, provide 40% of the expected protection, lead researcher Prof Anthony Young says.

His team measured how much protection people got from wearing different amounts of suntan lotions with varying SPF strengths.

How to apply it

Sunscreen needs to be applied thickly enough, which many of us fail to do.

SPF ratings are based on the assumption that a 2mg blob will cover 1 sq cm of skin.

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That means you should apply at least six full teaspoons (36g) to cover the body of an average adult.

More than half a teaspoon to:

  • each arm
  • the face, neck and ears

More than one teaspoon to:

  • each leg
  • chest and abdomen
  • back

Areas such as the sides of the neck, temples and ears are commonly missed, so take extra care and apply liberally.

It is also easy to forget to reapply sunscreen as often as necessary.

The British Association of Dermatologists advises:

  • Put it on 15 to 30 minutes before going out in the sun, to allow it to dry
  • Top up again shortly after heading outdoors, to cover any missed patches and ensure you’re wearing a sufficient layer
  • Reapply at least every two hours and immediately after swimming or if it has rubbed off

Some lotions say they are water resistant, meaning they retain some sun protection properties after immersion.

However, up to 85% of a product can be removed by towel drying, so you should reapply after swimming, sweating, or any other vigorous or abrasive activity.

Another important factor is the reflection of the Sun’s rays, which can greatly increase the power of the radiation: snow by up to 85% increase, sand by up to 17% and water by up to 5%.

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People with fair skin that burns easily, many moles or freckles, red or fair hair and light-coloured eyes are most at risk of sun damage.

Sunscreens should not be used to stay outside longer or just to avoid more reliable protective measures such as clothing and shade

Nina Goad, of the British Association of Dermatologists, said: “This research demonstrates why it’s so important to choose an SPF of 30 or more.

“It also shows why we shouldn’t rely on sunscreen alone for sun protection, but we should also use clothing and shade.”

The heatwave is set to continue across many parts of the UK this week.

Public Health England advises people try to keep cool and take shelter.

“To beat the heat, try to keep out of the sun from 11:00 to 15:00, walk in the shade if you can, apply sunscreen and wear a hat if you have to go out in the heat,” it says.

“Also try to carry water with you when travelling.”

Antidepressant prescriptions for children on the rise

Over 950,000 antidepressants have been prescribed to under 18's since April 2015

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More than 950,000 antidepressants have been prescribed to children since April 2015

The number of antidepressants prescribed to children in England, Scotland and Northern Ireland has risen over the past three years, figures obtained by BBC’s File on 4 reveal.

In England, there was a 15% rise. Scotland saw a 10% increase. And in Northern Ireland the number rose by 6%.

In total, there were 950,000 prescriptions issued between April 2015 and March 2018.

Experts have linked the rise to waits for specialist mental health services.

Antidepressants should prescribed to children only under close supervision.

NHS England, NHS Scotland and the Health and Social Care Board in Northern Ireland all say they are committed to improving child mental health services.

NHS Wales was unable to provide prescription figures because it does not hold the data requested.

The figures were obtained by Freedom of Information requests and relate to a group of powerful antidepressants known as selective serotonin reuptake inhibitors (SSRIs).

The total number of prescriptions rose from 290,393 in 2015-16 to 330,616 in 2017-18.

The steepest increase was seen in the youngest patients, those aged 12 and under, where the number of prescriptions rose on average by 24%, from 14,500 to almost 18,000.

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Mental health charity Young Minds links increases in antidepressant prescriptions to the length of Camhs waiting times

Dr Bernadka Dubicka, who chairs the child and adolescent faculty at the Royal College of Psychiatrists, said: “Currently only one in four children and young people are treated for their mental health problems.

“The fact that prescriptions for antidepressants are rising could reflect a slow but steady move towards treating everyone who is unwell.

“But the importance of giving children access to psychological therapies cannot be overstated.

“What we don’t know from today’s data is why these antidepressants are being prescribed, and how.

“It is vital that they are being used judiciously, monitored carefully, and the risks and benefits of taking them are assessed in each individual case.”

The mental health charity Young Minds says waiting times for specialist child and adolescent mental health services (Camhs) have been increasing too, making it difficult for families to get support.

Marc Bush, chief policy advisor at Young Minds, said: “The government recently suggested that the average waiting time for general access to Camhs is around 12 weeks, which is a long time to be in distress.

“And that is why front-line professionals are turning to prescription pads, because they’re thinking, ‘I’m seeing someone in front of me in crisis with a level of distress I don’t want to leave them with – how do I offer them some kind of alleviation from that?'”

In rare cases, antidepressants can trigger thoughts of suicide and self-harm in children.

And the National Institute for Health and Care Excellence (NICE) has clear guidelines:

  • Prescriptions should be written by a child psychiatrist within Camhs, not GPs
  • Antidepressants should be offered only concurrently with psychological therapies
  • The patient must be monitored to check for adverse reactions

However, File on 4 has heard concerns these guidelines are not always followed.

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Reece Burrowes, 17, killed himself soon after being prescribed the antidepressant Sertraline

Reece Burrowes, 17, was found dead in a park in south-east London on 6 December 2015, days after being prescribed an antidepressant called Sertraline by his GPs.

Although the inquest into Reece’s death recorded a verdict of death by suicide and no blame was assigned to Reece’s doctors or Sertraline, File on 4 has been told several of the NICE prescribing guidelines were not followed by doctors.

Reece’s stepfather, Simon Banks, said: “There are NICE guidelines, which you know in theory they should follow, but I know one of the concerns is that their thinking, ‘If I do refer them to Camhs, there’s potentially a waiting list.’

“From what we’ve gone through, our view would be don’t give the medication, and wait.

“But I can imagine it’s a very difficult call for the doctor to make.”

Dr Shruti Garg, a Camhs consultant at the Manchester Foundation NHS Trust, said problems with young people transitioning out of Camhs services could also be leading to increases in prescription rates.

“Camhs services across most parts of the country cover only up to the age of 16 – adult mental health services start at 18, so there is a gap for the provision of services across these services.”

The Department of Health in England told the BBC it had pledged £1.7bn to transform Camhs.

This, it said, would help to provide greater access to a wider range of therapies, although there would still be patients who would benefit from antidepressants.

In Scotland, Minister for Mental Health Clare Haughey said young people’s mental health was a priority and £5m has been invested to create a taskforce to improve Camhs services.

The Health and Social Care Board in Northern Ireland said the vast majority of referrals accepted into Camhs were seen within nine weeks and it was currently planning to spend an extra £1m on Camhs projects.

If you, or someone you know, have been affected by mental health issues, you can access resources online via BBC Action Line.

File on 4: Counting the Cost: Anti-depressant Use in Children is on BBC Radio 4 at 20:00 BST on 24 July.

Parents of premature babies face a further trauma – PTSD

Mother holding premature baby's hand

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Suzanne Ruart’s son Aiden spent three months in a neonatal unit as a result of being born three months early. A year after her son came home Suzanne realised she’d been suppressing symptoms of post-traumatic stress disorder (PTSD).

“After the first time I saw him resuscitated I developed a crippling anxiety that every time I walked into the neonatal unit there would be bad news, and this anxiety has never really left me since.

“I manage it now because I talk a lot about it, but at the time all focus was on Aiden, and so I never let myself think about the feelings I was going through.”

New research by the charity Bliss has found that 62% of parents of premature babies reported they had no access to formal psychological support, such as counselling or talking therapies, while their baby was on a neonatal unit.

Of the survey of 589 parents, 16% of parents were diagnosed with PTSD after their time on the neonatal unit.

More than a third said their mental health was “significantly worse” and just 8% felt they’d received the right amount of formal psychological support.

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Suzanne Ruart

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Suzanne experienced a placenta abruption where the placenta detaches before birth which puts baby and mum at risk – she had an emergency caesarean

Suzanne said she was told that Bliss offered counselling, but that during the first few days everything was a blur so she didn’t take up the offer.

“I needed support on those first few nights when I went back to my hospital room alone, without my baby or husband or any family, and lay and cried the entire night through thinking I may well have changed the future of my little baby by delivering him early.”

In the following months, she said that while watching her son having painful procedures she could “physically feel” what he was going through.

“I would have done anything to take the pain instead of Aiden but you just have to stand by and watch.

“Then there is the heartbreak of seeing parents whose babies are not doing as well as yours. The awe of watching the doctors and nurses fight for a little life is inspiring but you see the broken-hearted parents being assisted out of the ward and your heart breaks for them.

“I also felt a strange sense of guilt at times that my baby was on his way up – and they were devastated with no hope left.”

Bliss says all parents on neonatal units should have access to psychological and social support, including a trained counsellor.

A Department of Health and Social Care spokesperson said: “We are committed to giving every mother and baby the best start in life. This is why we have invested £365 million to transform perinatal mental health services, so that 30,000 more women each year can access specialist care.”

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Suzanne Ruart

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Aiden was born at 27 weeks and three days – he went home the day after his due date

Suzanne thinks more support is needed to “let parents know that it’s OK not to be OK.”

“There is so much focus on keeping positive and on how the baby is doing – rightly so – that you don’t feel you should show it when you aren’t coping – you just try to keep upbeat.”

The survey also found that 45% of parents said they had no access to formal psychological support when they needed it after leaving the neonatal unit.

“On the day I left the neonatal unit to take Aiden home, I cried like I have never cried before,” says Suzanne.

“Some of it was tears of joy to be taking him to where he belonged – albeit on oxygen and a list of drugs – but mostly it was because I didn’t want to leave my neonatal unit family who had supported me so amazingly.

“I was also scared about taking the baton of care over from them. How would I cope when things went wrong and would I be strong enough to do it alone?

“This fear crept into my sleep and I woke many nights screaming in bed that Aiden was dead.”

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Suzanne Ruart

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Aiden – pictured with his sister – is now four, and starts school this year with no obvious mental or physical problems

She said it was “terrifying” and “very isolating” as you are confined to your home, keeping your baby away from germs and you can’t go out to baby groups.

“Around a year after he was home – just as he came off his oxygen support – I had a very powerful, vivid and crippling flashback that made me realise that I had been suppressing many symptoms of PTSD.”

She thinks it needs to be made clearer to parents of premature babies that they are at risk of PTSD, and that it is normal to feel overwhelmed by the experience.

“Once I realised that, I knew I had to do something so I looked for advice online and I faced into the memories I’d been suppressing.

“Now, four years on, I can still occasionally be blindsided by a memory, a sight or a sound, but I feel like I am much stronger mentally now that I have recognised that I needed help.”

Opioids: Why ‘dangerous’ drugs are still being used to treat pain

A selection of pills

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The widespread use of opioids to treat pain frequently prompts concerns about addiction and even deaths. So, why are these sometimes dangerous drugs still being given to patients?

Much stronger than many of the other options, opioids are among the world’s most commonly prescribed painkillers.

These drugs – including morphine, tramadol and fentanyl – are used to treat pain caused by everything from heart attacks to cancer.

But in the UK they were recently linked to the deaths of hundreds of elderly hospital patients, while the US is battling a well-documented opioid epidemic.

Why not just use other painkillers to avoid the risk of harm?

A worldwide problem

Opioids work by combining with receptors in the brain to reduce the sensation of pain – and they are highly effective.

However, opioid receptors are present in areas of the brain responsible for breath control and high doses can dangerously reduce the rate of breathing – the cause of almost all opioid deaths.

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An inquiry into the UK’s Gosport War Memorial Hospital said more than 450 people died between 1989 and 2000 from administration of “dangerous” amounts of opioids without medical justification.

In the US, the increasingly widespread prescription of opioids to treat long-term pain has led to an epidemic of addiction. In 2016, a record 11.5 million people in the US misused prescription opioids, and there were 42,249 deaths from overdoses.

In England, GPs prescribed 23.8 million opioid-based painkillers in 2017 – a rise of 10 million prescriptions since 2007. More than 2 million working-age people were thought to have taken a prescription painkiller that was not prescribed for them in 2016-17.

There were more than 2,000 deaths in England related to opioid overdose in 2016, the highest since records began. But unlike the US deaths, these largely related to heroin rather than forms of opioid available on prescription.

What are opioids?

  • A large group of drugs used mainly to treat pain
  • Includes naturally occurring chemicals like morphine and codeine, as well as synthetic drugs
  • Codeine, morphine and methadone are among opioids judged by the World Health Organization as essential for treatment of pain and end-of-life care
  • Some opioid medications – methadone and buprenorphine – are used to help people break their addictions to stronger opioids like heroin

Consistent relief

One of the reasons opioids are so widely used is that – when used correctly – they are a particularly useful form of painkiller. They can be given to patients in a variety of ways and in many different forms.

Morphine can be given orally or through injection; other opioids can be given through patches, lozenges or under-the-tongue tablets.

The Gosport report focused on syringe drivers, a method of delivering a drug under the skin, to provide a constant dose of an opioid for consistent pain relief.

This can be a useful form of pain relief at the end of someone’s life as it means there is no reliance on the patient being able to swallow or absorb the drug. Syringe drivers also help doctors adjust dosage as necessary.

However, at Gosport War Memorial Hospital, syringe drivers were reportedly used when they weren’t justified, or to deliver inappropriately high doses of opioid.

A distressing reaction

Despite their benefits, the problems associated with these medicines are clear.

For decades, scientists have tried to develop opioids that work without causing the problems of addiction and misuse.

Some have added extra ingredients deliberately to cause a distressing reaction. For example, added to opioid tablets, the antidote naloxone largely has no side-effects if the medication is taken orally, but causes severe “cold turkey” withdrawal symptoms if the tablet is crushed and injected by a dependent user.

Implants and slow-release injections which wear off over a much longer timeframe have also been investigated.

A particular problem occurs when the need for pain relief is long-term – when the evidence for the benefit of opioids is less clear.

In the US, one cause of the opioid epidemic is over-prescribing, particularly among those with long-term pain.

More like this

For people with acute pain, opioids can be used alongside other drugs – including commonplace painkillers like paracetamol, ibuprofen and aspirin.

When treating patients who are dying, meticulous assessments of the causes of pain are needed to understand the best way to improve it, while minimising potential side-effects.

For example, cancer patients with pain as a result of nerve damage caused by chemotherapy might first be treated with paracetamol and a tricyclic antidepressant.

If that doesn’t help, or the patient is in more severe pain, opioids may be introduced – again, this is often in combination with other drugs.

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Media captionThe heroin-ravaged city fighting back against drug companies

For people who are dying, opioids are very often the most effective way to relieve pain. Anywhere between 30% and 94% of people with advanced cancer are thought to experience pain and about half of cancer patients were prescribed an opioid in the last three months of their life.

If used appropriately, and used in amounts appropriate to patients’ symptoms, opioids are not only safe, they are essential for good symptom control.

The events in Gosport and the addiction crisis in the United States have put the medical profession’s use of opioids under intense scrutiny.

Better education and training might be one way to make sure they are used appropriately for those who might benefit, so that potential harms are avoided.

About this piece

This analysis piece was commissioned by the BBC from experts working for an outside organisation.

Dr Katherine Sleeman is a National Institute for Health Research clinician scientist and honorary consultant in palliative medicine at the Cicely Saunders Institute, King’s College London.

Prof Sir John Strang is director of the National Addiction Centre at King’s College London’s Institute of Psychiatry, Psychology & Neuroscience. He has worked on ways to improve adherence to treatments and to reduce abuse of opioids, including joint work with the pharmaceutical industry, as well as the development of antidotes for overdoses. More details of his work can be found here.

Edited by Eleanor Lawrie

Low NHS morale is ‘heartbreaking’ says Matt Hancock

Matt Hancock

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Seeing how NHS staff feel “undervalued” is “heartbreaking”, the new Health Secretary Matt Hancock has said.

In his first speech since taking the job, Mr Hancock said he was horrified at the level of bullying reported by staff.

The British Medical Association welcomed the sentiment but said it needed to be underpinned by action.

Mr Hancock, the former digital and culture secretary, also pledged £487m for technology in the NHS.

‘Tech transformation coming’

Of the money pledged, £412m will be used to improve technology in hospitals and to give more patients access to health services at home.

The remaining £75m will be put towards replacing paper systems with electronic ones – a move intended to reduce medication errors.

It comes after it was revealed last week that some hospitals are still reliant on fax machines.

Addressing staff at West Suffolk Hospital on Friday, Mr Hancock said: “Let this be clear: tech transformation is coming.”

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Some of the funding will go towards replacing paper systems with electronic ones

Mr Hancock also spoke about his love for the NHS, which he credited with saving his sister’s life after she had a horse-riding accident.

Professional rider Emily Gilruth, 41, was in a coma for four days after she fell and hit her head while competing at Badminton Horse Trials in May last year.

Speaking publicly about the accident for the first time, Mr Hancock said: “Last summer my sister sustained a very severe head injury. It was touch and go and her life was saved by the intensive care unit at Bristol’s Southmead Hospital, where she stayed for a week, most of it in a coma.

“Thanks to their care she has now recovered.”

He added: “I love my sister and the NHS saved her life, so when I say I love the NHS, I really mean it.”

Addressing NHS staff concerns, Mr Hancock pledged to champion the workforce and announced a consultation exercise on workforce issues.

The British Medical Association has previously said that GPs are leaving the profession at an increasing rate due to feeling undervalued, fuelling a crisis in the sector.

Mr Hancock also called for an end to the “over-prescription of unsophisticated drugs”, focusing instead on approaches that address a person’s physical and mental well-being.

‘Sorely let down’

Shadow health secretary Jonathan Ashworth said patients would feel “sorely let down” that reducing waiting lists “isn’t the first priority of the new health secretary”.

“Investment in technology is welcome but years of Tory austerity has seen hospitals build up a £5bn repair backlog, resulting in clinicians nationwide using hundreds of pieces of equipment that are years out of date, as recently revealed by Labour.

“And commitments to prevention will ring hollow without reversing the substantial cuts to public health budgets, which are set to reach £800m by 2020/21.”

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Mr Hancock takes on the job of health secretary as the NHS develops its 10-year plan.

Prime Minister Theresa May has pledged to increase health spending by £20bn a year in real terms by 2024.

After the speech the new health secretary was asked whether he had any plans to change existing NHS targets.

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Media captionMatt Hancock said the NHS has asked for “a set of targets that are more clinically appropriate”

These include treating, assessing or discharging 95% of patients within four hours of arriving at A&E in England. The target has not been met since 2015.

Mr Hancock said he had been asked by the NHS to consider whether they were still “clinically appropriate”.

He said while these targets were set by government “we’ve got to make sure that the targets that we set are very best for improving outcomes in patient care because that’s what I really care about”.

IVF: NHS couples ‘face social rationing’

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Media captionSarah Dean was told she was not eligible for IVF on the NHS as her husband has children from a previous relationship

The parents of the world’s first IVF baby – born 40 years ago next week – would not have got the procedure on the NHS in most of England today because of “social rationing”, a charity has said.

NHS IVF is unavailable to couples in many areas if either of them has children from a previous relationship.

One mother said not meeting such criteria was “crippling”.

Fertility Network UK said action was needed to keep fertility treatment available for all.

NHS England said it has “never been able to offer all of the IVF that people might want” and the Department of Health and Social Care added “funding for the treatment has increased”.

Figures collated by campaign group Fertility Fairness show IVF provision at all 208 clinical commissioning groups (CCGs) across England.

They show eight out of 10 CCGs do not enable access to IVF if one of the couple has children from a previous relationship.

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Louise Brown was the world’s first IVF baby

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Louise Brown was born at Oldham General Hospital on 25 July 1978

Next Wednesday marks the 40th birthday of the world’s first “test tube baby”, Louise Brown.

Her father already had children from a previous relationship, which would render the treatment unavailable to the couple in many areas today, Fertility Network UK said.

Aileen Feeney, chief executive of the charity, said: “If Louise Brown’s parents wanted to try NHS IVF today, they would be turned down by the vast majority of England’s clinical commissioning groups on social rationing grounds: although Mrs Brown was clinically infertile, Mr Brown had a child from a previous relationship.

“England pioneered the development of IVF but that achievement means far less if the people who benefit from this amazing, life-creating technology are determined by their postcode or pay packet. Fertility Network urges the government to take action now – or we are creating a society where only the more affluent will have access to IVF.”

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Media captionHappy Birthday IVF: Five things you might not know

Sarah Dean’s fertility issues started after she had cervical cancer aged 25. She had an operation to remove her cervix in 2011.

The 32-year-old and her husband Paul, from Sutton Coldfield, decided to undergo IVF treatment, but were refused treatment on the NHS as Paul had children with a previous partner.

“The NHS have been amazing for everything that I’ve had done for me but when it came to IVF being the next step, for them to then look at the eligibility and having children in the family, it was really disheartening,” added Sarah, who gave birth to son George in May following two cycles of IVF.

“I had been through so much to then be told because there’s already children in your family you’re not eligible. That was crippling because you then have to look into what are our options, it was really difficult.

“The challenge of reasoning with how can they make that decision was difficult.”

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Sarah Dean

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Sarah and Paul Dean with son George who was born following two cycles of IVF

In England, four CCGs out of 208 offer three full IVF cycles for women under 40, including access for couples with children from previous relationships.

All of those are based in the Greater Manchester area, including Oldham CCG – where Louise Brown was born.

Seven CCGs offer no IVF treatment on the NHS, including Cambridgeshire, Mid-Essex and South Norfolk CCGs.

North East Hampshire and Farnham has two different policies, with one cycle offered to people in north-east Hampshire and two to couples in Farnham.

The National Institute for Health and Care Excellence (NICE) issued guidelines in 2004 that stated women under 40 who had failed to get pregnant after two years of trying should be offered three full cycles of IVF on the NHS.

However, the recommendations are not binding and it is up to local NHS providers to decide what to offer.

An NHS England spokesperson said: “In reality the NHS has never been able to offer all of the IVF that people might want, nonetheless, the number of cycles funded by the NHS in England remain consistent.

“Improving birth rates and expanding treatment options mean more people than ever are successfully starting a family.”

A Department of Health and Social Care spokesperson said: “We are increasing funding for the NHS by an average 3.4% per year.

“The government has been clear that IVF services should be accessible to patients that meet the criteria set out in NICE guidance.”

Morrisons ‘quiet hour’ for autistic shopping introduced

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Media captionBBC Breakfast’s Tim Muffett goes shopping with Joanne Tang and her son Oscar, who has autism

Supermarket chain Morrisons has introduced a weekly “quieter hour” for autistic shoppers who struggle with music and noise.

Its 439 UK stores will dim lights, turn music off, avoid using the tannoy and turn check-out beeps down on Saturdays from 09:00 to 10:00.

The movement of trolleys and baskets will also be reduced, it says.

The National Autistic Society says it is a “step in the right direction” for those who find shopping a struggle.

The charity is encouraging retailers to take part in a nationwide “autism hour” in October.

Toy shop The Entertainer holds “quiet hours” during the first hour of opening every Saturday, when staff turn off in-store music in the company’s 145 UK stores to “create a more welcoming environment for children with autism”.

Asda said a number of its supermarkets across the country worked with local groups to run quiet hours on a regular basis. It added it was working with specialist charity groups to ensure its stores were inclusive for all. One of its stores in Manchester first introduced the scheme in 2016.

Tesco said it was not planning on rolling out the initiative nationwide, but store managers were welcome to introduce it if they felt it appropriate – as one store in Alloa, Clackmannanshire, did last year.

  • ‘Autism Hour’ helps cut shopping stress
  • What is autism?

The Morrisons scheme was introduced following a trial earlier this year in its Lincoln, Woking and Gainsborough stores. Angela Gray, Morrisons community champion at Woking, who has an autistic child herself said she’d found the changes made a “real difference”.

Stores will put signs up during the hour to let other customers know about the scheme and to highlight that it is meant to be a calm environment for shoppers.

Charlotte King, whose three-year-old son Darcy is undergoing diagnosis for autism, said the initiative was “amazing”, making it “far less stressful” for adults with autism and parents of children with the condition.

“I personally avoid taking him anywhere in shopping malls,” said the mum-of-two, from Hartley-Wintney in Hampshire.

“It is the noise, the lights, it is tannoys. It is too much for him to take in. It looks like you are a bad parent with a naughty child.

“Parents will be more relaxed knowing there will be people there that understand and won’t judge them, this will help reduce anxiety levels for everyone.”

The National Autistic Society says there are 700,000 people on the autism spectrum in the UK, who “see, hear and feel the world differently to other people, often in a more intense way”.

What is autism?

  • A lifelong developmental disability that affects how a person communicates with and relates to other people, and how they experience the world around them
  • About 700,000 people in the UK (more than one in 100) are on the autism spectrum
  • Autism does not just affect children. Autistic children grow up to be autistic adults
  • People may be under-sensitive or over-sensitive to sounds; find social situations a challenge; experience a “meltdown” if overwhelmed

Source: The National Autistic Society

Are you or your child autistic? Or perhaps you struggle with noise and music in public spaces? Share your experiences by emailing

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Thai cave rescue boys relive ‘moment of miracle’

Some of the 12 members of the Wild Boar soccer team, who were rescued from the Tham Luang cave, greet the media during a military governmental TV pool broadcasting program at Chiang Rai Provincial Administrative Organization in Chiang Rai province, Thailand, 18 July 2018

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The boys’ appearance before the media is meant to be a one-off

One of the 12 boys rescued from a flooded cave in northern Thailand this month has described the “moment of miracle” when divers found them.

Adul Sam-on, 14, the only member of the junior football team who speaks English, could only say “hello” when the two British divers surfaced.

“I was stunned because they were English so I said ‘hello’,” he said.

The boys, who were underground more than two weeks, left hospital earlier on Wednesday and are on their way home.

But first they are giving details of their ordeal in the the Tham Luang caves at a news conference in Chiang Rai.

  • The full story of the cave rescue
  • Musk apology to diver for Twitter attack

They appeared on stage in their football kit, alongside members of the Thai Navy Seals who had helped rescue them.

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The boys came to the news conference in heir football gear

One boy described how they had lived only on water from the stones of the cave. “Water is clean,” he said. “No food.”

Chiang Rai’s provincial governor, Prachon Pratsukan, said this would be the boys’ “only official media interview”, saying that there would “be no more speaking with the press after this”.

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Media captionThai cave rescue: Saying sorry to cave spirit Nang Norn

Questions submitted by journalists were vetted ahead of time, and have been screened by a child psychiatrist to ensure they do not distress the boys.

There are also plans for the boys to be ordained as Buddhist monks for a short period of time, a tradition for males in Thailand who have experienced a misfortune.

How did the boys get trapped in the cave?

They entered the Tham Luang cave in the northern district of Chiang Rai on 23 June during an excursion with their coach.

They had planned to be there for only an hour but found themselves trapped after a sudden bout of heavy rain flooded the cave complex, blocking their only way out.

  • The heroes who saved the Wild Boars
  • In pictures: How the rescue unfolded

Their parents soon informed officials they were missing, and a search and rescue operation began.

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Getty Images

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The boys survived on water dripping from the cave

Nine days passed before the boys were found by two British rescue divers.

But elation quickly turned to concern as it became clear just how difficult it would be to rescue boys who could not swim and had been weakened by their time underground with little food or light.

The dangers of the journey were underscored by the death of a former Thai Navy Seal diver, Saman Gunan, who died while taking oxygen tanks into the cave complex.

How did they get out?

A team of expert divers guided the boys and their coach through darkness and submerged passageways towards the mouth of the cave system.

Each boy was accompanied by a divers who also carried his air supply. The boys wore full-face masks, which are easier for novice divers than traditional respirators.

Sources in the rescue operation, including divers who took part, told the BBC that the boys were heavily sedated ahead of the rescue to prevent them panicking in the dark, tight, underwater passageways.

Getting to and from the trapped group was an exhausting round trip, even for experienced divers. The process involved a mixture of walking, wading, climbing and diving along guide ropes.

The boys were rescued in stages – with four boys coming out on Sunday, another four on Monday and the final four plus their coach on Tuesday.

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AFP/Royal Thai Navy

All 13 were transferred to the hospital in Chiang Rai where they received medical and psychological assistance. They are all said to be recovering well.

However, they will be watched for signs of psychological distress, which may only become evident in the months to come.

The boys have been advised against giving media interviews, which experts say could trigger a post-traumatic reaction.

Who are the boys and their coach?

Captain Duganpet Promtep, 13, is described as a motivator and highly respected by his teammates. He had apparently been scouted by several Thai professional clubs.

It was 17-year-old Peerapat Sompiangjai‘s birthday when the group became trapped in the cave. The snacks the boys brought with them to celebrate are likely to have helped them survive their ordeal.

Assistant coach Ekapol Chantawong, 25, was said to be the weakest of the group when they were found, as he had reportedly refused to eat any of the food and gave it instead to the boys.

Kent and Medway NHS hernia policy ‘may be rationing’ surgery

Hospital operating theatre

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Surgeons say the only curative treatment for groin hernia is surgery

Groin hernia patients are having to “prove their pain” and show they have complications to get surgery, the Royal College of Surgeons (RCS) has said.

In Kent and Medway, patients are having to show their hernia has grown larger or become “incarcerated” to access operations, the RCS claimed.

The RCS said harsher restrictions may amount to “rationing”.

NHS Clinical Commissioners said patients took priority but the NHS did not have unlimited resources.

A groin hernia, or inguinal hernia, is when fat, intestines or other abdominal structures protrude through a hole in the abdominal muscles.

When the patient lies down the protruding part drops back, but sometimes it gets stuck or incarcerated.

Incarceration can then lead to strangulation – when the blood supply to a section of organ or tissue is cut off, which is life-threatening, the RCS said.

Freedom of information requests by the RCS and British Hernia Society (BHS) found:

  • 52% (95 clinical commissioning groups or CCGs) require patients to suffer from pain or discomfort sufficient to impede everyday activities or working life before surgery is allowed
  • 5% (8 CCGs all in Kent and Medway) require patients to demonstrate a history of incarceration and/or their hernia increasing in size from month to month to access surgery
  • 24% (44 CCGs) had policies in line with clinical guidelines from the British Hernia Society and the Royal College of Surgeons
  • Other CCGs did not have any form of restriction in place

RCS senior vice-president Susan Hill said: “It’s difficult to prove categorically that these CCGs are introducing harsher restrictions for inguinal hernia surgery to make financial savings.

“However, we have seen a significant increase in CCGs that have acknowledged rationing surgery in other ways, for example by smoking status or BMI, to save money, so this may be the case here.”

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Surgeons described the condition as “one of the most straightforward surgical conditions to treat”

Calling on NHS England and ministers to intervene, she added: “Allowing commissioning groups, not patients with their surgeon, to make a decision to operate is putting patients at unnecessary risk of serious complications.”

David Sanders, from the BHS, said patients were being denied access to a procedure that potentially limits pain and improves quality of life.

He said: “The NHS has to be very clear about what it offers.

“Does it want a value for money service with quality and safety as a priority, or a rationed service that will inevitably put some patients at risk?”

  • Is NHS rationing a possibility?
  • NHS ‘rationing leaves patients in pain’

Dr Amanda Doyle, co-chair of NHS Clinical Commissioners, an independent body representing CCGs, said: “In cases where there is a high risk of complications or where patients are in persistent pain as a result of groin hernias, most CCGs will commission surgery.”

She said elective hernia surgery was a common procedure but still carried risks, adding: “Clinicians need to carefully consider each individual case.

“Ensuring patients get the best possible care against a backdrop of spiralling demands, competing priorities and increasing financial pressures is one of the biggest issues CCGs face.

“On a daily basis they are forced to make difficult decisions that balance the needs of the individual against those of their entire local population.

“As a result there are some tough choices that have to be made.”

Hot summer leading to ‘toxic’ algae

Loch Leven bloom

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Centre for Ecology & Hydrology

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A freshwater ecologist says blue-green algae had been a particular problem this summer

Potentially toxic algae is blooming in rivers and lochs during Scotland’s long, hot summer, scientists have warned.

Blue-green algae, which poses a health risk to humans and animals, has flourished during the warm spell.

The algae has reportedly led to the death of two dogs after they ingested the substance earlier this summer.

Now scientists are urging people to record sightings of the algae in a bid to speed up response times.

  • Lake District ‘toxic’ algae warning

Freshwater ecologist Prof Laurence Carvalho said blue-green algae had been a particular problem this summer.

“Not only has it been very warm but it has also been very dry, which means they have not been flushed out of water courses by rain,” he said.

It is posing a particular risk to dogs who appear to be attracted by the smell, he added.

Earlier this month a dog reportedly died from algae poisoning after drinking water from the River Conon, near Maryburgh in the Highlands.

A similar incident is reported to have happened in Loch Awe in May.

Skin rashes

Prof Carvalho said: “Animals will drink from water if they are thirsty and it seems dogs are particularly affected because they seem to be attracted by the smell of the algae.”

Blue-green algae are microscopic, but clump together in visible colonies up to a few millimetres in size that can rise to the surface and form thin wispy green blooms or thick, paint-like scums.

When it is ingested, it can cause damage to the liver or the nervous system in humans and animals.

People who have been swimming in or have swallowed algal scum can suffer from skin rashes, eye irritation, vomiting, diarrhoea, fever and muscle and joint pain but there is no evidence of long-term effects or death among people in the UK.

Prof Carvalho, who works at the Centre for Ecoology and Hydrology, has helped develop an app called Bloomin’ Algae which allows users to submit images of the bloom and its location.

The information will be passed on to the Scottish Environment Protection Agency, so it can inform local authorities.

He said: “The app provides an early warning system and speeds up the process of local authorities or landowners putting up signs at sites where there is blue-green algae, to warn the public of the risks.

“It will also help us understand the drivers of growth of these algae, such as the impact of climate change.”

Heatwave causes spike in insect bite calls to NHS

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Media captionThe horsefly slices a small cut in your skin and soaks up the blood

Although many of us are enjoying the balmy temperatures of this year’s heatwave, unfortunately for some, biting insects are flourishing too.

Calls to the NHS helpline 111 about insect bites are almost double the rate they normally are at this time of year.

And senior doctors are reporting incidents of patients being treated in hospital for infected horsefly bites.

Despite the heat, experts say standing water, such as garden paddling pools, where insects thrive should be removed.

Dr Nick Scriven, president of the Society for Acute Medicine, said: “We wouldn’t normally see anyone coming to hospital for a bite, but we have seen a few recently needing treatment with antibiotics which is very unusual.

“A couple of these were infected bites from horseflies. They actually give one of the nastier bites, because they take a chunk out of you.

“They can be very painful, and can take a while to heal, and as result can get infected and need antibiotics. In the worst-case scenario, they can cause cellulitis, an infection of the skin.”

According to Public Health England data on calls to NHS 111, about 9,000 people called the helpline on 8 July, around double the baseline figure which is constructed from historical data.

This chimes with the Met Office records of the heatwave. Although most of June and July was warm, temperatures peaked between 24 June and 9 July when 28 degrees was recorded somewhere in the UK every day. This happens on average only twice a decade.

Prof Adam Hart, an entomologist at Gloucestershire University, said that anecdotally horseflies were on the rise, although there is no hard data to confirm this.

“We had a wet spring, then we’ve got this beautiful hot weather which are great conditions for a lot of different insects to thrive in.”

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Dennis Ray

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Horsefly bites are increasing due to the hot weather

Dr Daniel Whitmore of the Natural History Museum’s insect division agrees: “Horseflies like hot weather in general, so they may become more active around breeding sites and farms in hot weather.

“Obviously, by wearing fewer clothes in hot weather we expose ourselves to bites more and become more attractive to the flies.

“From personal experience I’ve noticed that the likelihood of being bitten increases after a dip in the pool (or stream or river): the wet skin probably helps the flies detect us.”

But whereas most bites are relatively painless and clear up quickly on their own, the horsefly bite is noticeably more painful and more likely to get infected.

‘Rise’ in cleg bites amid warm weather

Horsefly season: how to avoid being bitten

Creating a ‘pain index’ for insect bites

Natalie Bungay, from the British Pest Control Association (BPCA) is advising the public to be pest aware.

“Horsefly bites are particularly painful because their main food source is livestock, which have a limited ability to move the fly away.

“This means they can take their food without having to worry about delivering a painful bite, as the animals are generally powerless to stop them.

“This is as opposed to mosquitoes, which extract blood through a painless bite.”

As horseflies and mosquitoes rely on wet and marshy areas to breed, the BPCA is advising the public to remove standing water from near their homes, where possible.

If bitten, Dr Scriven advises paracetamol and calamine lotion to reduce itching.

After a horsefly bite, the advice is to seek medical attention if the skin starts to get red and you develop a fever.

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