All hospitals have been told to go for foundation trust status

NHS hospitals will be looking to exploit a host of "exciting" opportunities to move into private health markets, bosses say.

Self-governing hospitals – known as foundation trusts – have had their private income capped to date, but this is to be lifted in the NHS overhaul.

The Foundation Trust Network believes the move will spark a burst of innovation in the sector.

But campaigners said they were worried NHS services would be harmed.

To get foundation trust legislation through parliament in 2003, ministers agreed to a cap on private work to ensure the hospitals remained true to their NHS traditions.

This has stopped some of the leading hospitals in the NHS competing with private firms for patients.

But that will now change under the proposals unveiled in Monday's White Paper. Health Secretary Andrew Lansley said he wanted to create a "vibrant" industry of social enterprises by scrapping the rule and ordering all NHS trusts to become foundation trusts within three years.

Sue Slipman, director of the Foundation Trust Network, said the move would make a big difference.

"It is exciting for foundation trusts. We will have to wait to see what exactly happens, but there are huge opportunities to innovate."

She said one of the most obvious areas for expansion would be in fertility services where treatment on the NHS is severely restricted.

"In the past these patients have had their NHS cycles and then left for private treatment. That is money that has been lost to the system."

She also said mental health trusts may be interested in offering talking therapies to businesses for their workforce health schemes.

Joint ventures with the private sector may also prove popular, she added, covering both services and the development of drugs.

Overstretch concerns

University College Hospital in London has already gone down this route with a private US health firm which has located a private unit on its site for cancer treatment.

The firm leases the space as well as paying for the NHS services its uses, such as intensive care, radiology and cleaning and catering.

The trust has also established a joint venture with a private firm to provide pathology services.

Sir Robert Naylor, the chief executive of the trust, said: "These initiatives bring in money which can then be reinvested in NHS services."

Many NHS hospitals also operate their own private wings, although most of these only bring in a small amount of income. The exceptions are specialist centres such as the Royal Marsden cancer hospitals and Moorfield Eye Hospital.

But John Lister, of the union-funded pressure group Health Emergency, said he had concerns.

"Hospitals could overstretch themselves in chasing private patients which in turn takes away from the NHS side of it.

"It also creates perverse incentives whereby they stand to make more money by getting patients into their private wings.

"They say money is reinvested in services, but I am not sure this is always the case. Some of these hospitals have huge surpluses, the money is moved around and does not end back where it should. If we get more and more of this, it will be a step towards the privatisation of the health service."

A spokeswoman for the Department of Health said trusts were not being privatised.

"This isn't about turning foundation trusts into profit-driven bodies. The legislation will make clear that they are social enterprises and give them more control over their own futures."

Better cancer drugs are one reason for the survival improvements

Survival rates for some cancers have doubled over the past four decades, a charity has said.

People with breast, bowel and ovarian cancers, and non-Hodgkin's lymphoma, are now twice as likely to survive for at least 10 years than in the 1970s.

Cancer Research UK's figures show leukaemia survival is now four times as high, although the charity warned there was still much work to do.

The Department of Health said it was "delighted" by the findings.

Launching a television campaign, the charity said investment in research was key to further boosting survival.

The figures go back to the early 1970s and include estimated survival rates for the latest diagnoses made in 2007.

In breast cancer, 10-year survival has jumped from less than 40% to a predicted 77% currently.

And half of people diagnosed with bowel cancer are now expected to survive at least 10 years compared with 23% in the 1970s.

For ovarian cancer and non-Hodgkin's lymphoma, survival has increased from 18 to 35% and from 22 to 51% respectively.

In cancers such as oesophageal cancer and myeloma, although survival rates are still very poor at below 20%, rates have improved almost threefold over the past few decades, Cancer Research UK said.

However, some other cancers have shown little improvement, most notably lung and pancreatic cancer, the figures show.

‘Real progress’

Professor Peter Johnson, Cancer Research UK's chief clinician, said: "There are many reasons for our continuing success in the fight against cancer, including faster diagnosis, better surgery, more effective radiotherapy and many new drugs, all developed using the knowledge that our laboratory research has given us."

He said with further investment in research, he expected the trend to continue.

Professor Michel Coleman, an expert in statistics at the London School of Hygiene and Tropical Medicine, who calculated the figures, said the survival data reflected "real progress" in cancer diagnosis and treatment.

"Ten-year survival figures for patients diagnosed in 2007 are of course predictions, but they are derived from the latest national data on cancer patient survival – and for most cancers, the true 10-year survival for these patients will turn out to be higher than we report."

The figures prompted Professor Mike Richards, the Department of Health's national cancer director, to say: "We are delighted to note these improvements in cancer survival.

"Improving health outcomes is a key priority for the coalition government and will be a major focus of the forthcoming review of the Cancer Reform Strategy."

Harpal Kumar, Cancer Research UK's chief executive, said the improvements being seen in cancer care were "encouraging, but we have to do better".

"We need to develop even more effective treatments that can prolong life further and we need to ensure that each individual patient has optimal treatment."

The genetic samples are stored in a huge freezer in Stockport

The most comprehensive health study in the UK has reached its goal of enrolling 500,000 adults.

UK Biobank volunteers have undergone medical checks, answered health and lifestyle questions and given genetic samples, to be stored for decades.

The aim of the gene bank is to improve the prevention, diagnosis and treatment of a wide range of conditions, such as cancer, heart disease, and dementia.

Scientists hope to work out why some develop diseases while others do not.

Recruitment to the project began three years ago and was open to adults aged 40-69. Around one in 50 Britons in that age range took part.

Each of them attended an assessment centre where they answered questions on their health, lifestyle, diet, memory, work and family history.

They also had measurements of their blood pressure, pulse rate, height, weight, body fat, vision, fitness grip strength, bone density and lung function. Samples of blood, saliva and urine were given for long-term storage and analysis.

Volunteers to the project were told that it was not intended to help improve their health, but that of future generations.

Dr Tim Sprosen, chief scientist at UK Biobank, applauded the generosity of volunteers.

"By putting together a vast amount of data together now on people's health, with the samples, we will get reliable answers to the kind of questions they want to know.

"How can I, as I get older, avoid diseases like dementia or cancer and how can I improve the life of future generations – my children and my children's children?"

Dr Sprosen said much of the interesting research would not be done for at least another decade.

"In 10 or 20 years time, we will be able to analyse things in the samples that researchers haven't even thought about yet.

"We are custodians of this resource. The next generation of scientists, who might still be in primary school today, will use new tests and be able to unlock new secrets as to how we prevent disease."

‘Confidentiality protected’

The genetic samples will be stored in a huge freezer in Stockport. They will be analysed over the next three decades for a range of health studies.

The health of everyone who has taken part will be tracked through the coming decades via their medical records.

Scientists at UK Biobank say the confidentiality of participants would be rigorously protected. Data used by researchers will not include personal identifying details.

UK Biobank, which has so far cost about £65m, was set up by the Department of Health, Medical Research Council, Scottish Government and the Wellcome Trust charity.

It is also supported by the Welsh Assembly, and health research charities such as the British Heart Foundation and Cancer Research UK. Volunteers were recruited from across England, Scotland and Wales.

A spokesman for Biobank said they would have liked to have recruited volunteers from Northern Ireland, but it would not have been possible to transport the genetic samples intact.

The gene increases the risk of breast cancer

Men who carry a faulty gene have a one in 15 chance of getting breast cancer by the time they are 70, a study says.

The figure was put forward by researchers from St Mary's Hospital in Manchester who analysed 321 families with the BRCA2 gene.

The faulty gene causes hundreds of UK cases of breast cancer in women every year, and can be passed on to both sexes through the generations.

But experts said breast cancer in men was still very rare.

There are about 300 cases in Britain each year compared with more than 45,000 among women.

The research, published in the Journal of Medical Genetics, involved data from families with the faulty BRCA2 gene living in and around Manchester and Birmingham.

Among the families, 16 men who were first degree relatives of known BRCA2 carriers had developed breast cancer between the ages of 29 and 79. Another eight cases occurred in second degree relatives.

Analysis showed the risk of breast cancer among men with a faulty BRCA2 gene was 7.1% by the age of 70 and 8.4% by the age of 80.

Lead researcher Prof Gareth Evans, from St Mary's Hospital in Manchester said: "There is a one in 1,000 chance of developing breast cancer as a man in the general population.

"Men don't have to have a faulty copy of BRCA2 to get breast cancer, but the highest risk for men is if they have a faulty copy of the gene."

But he added it was important for men who know they have the gene or who are from a family with a history of carrying the gene to be aware of the risk.

Nell Barrie, from Cancer Research UK, said: "Most men who have a relative with breast cancer will not be at an increased risk of developing it.

"This study looked only at men who carry a very specific faulty gene and the numbers of men who carry this gene are likely to be small.

"If a man has a very strong family history of breast cancer and is worried about his risk he should discuss it with his doctor."

VIEWPOINT
By Professor Neena Modi, Royal College of Paediatrics and Child Health

Are children getting the treatments they need?

In this week's Scrubbing Up, Professor Neena Modi, vice president for science and research, at the Royal College of Paediatrics and Child Health argues that not carrying out more research on children is hampering treatment options.

Should children be used for research?

Children and young people are being denied the right to benefit from clinical research.

There is a mistaken and outdated notion that they need to be protected from clinical research, but the reality is that children are being harmed by not being included.

The importance of children taking part in clinical research cannot be underestimated.

Children are not small adults; the medicines and treatments children receive need to be trialled and shown to be effective in them, and not simply assumed to be from the results of research in adults.

Better treatments needed

Without properly conducted studies many children will continue to be given inferior treatments.

There are many instances where an established treatment has been shown to be ineffective or harmful when subjected to rigorous and objective evaluation.

For example, it was only after many years of painstaking research that the routine use of oxygen to resuscitate babies at birth was found to be harmful.

Understandably parents may be concerned about involving their sick child in research and want to protect them from 'rogue' researchers. But protection should not mean prevention. Children need high quality research, not "no research".

Parents who have the process of clinical research explained to them usually want their children to have the opportunity to participate, but unfortunately this does not always happen.

Attitudes to children's research, even among regulatory bodies can be illogical and therefore confusing to parents.

A clinical trial aims to demonstrate that one treatment is superior to another, therefore there will be a group that benefits and one that will not.

This is not unethical because if the research was not conducted, many patients would continue to receive the inferior treatment. For example, babies would still be receiving the formerly accepted 'best' treatment of routine oxygen for resuscitation at birth and many would die or suffer as a result.

An honest dialogue should explain clinical uncertainty and that, although the possibility of risk cannot be totally eliminated, it is minimised through research regulation.

This means that there are extensive measures in place to ensure that studies are well designed, that any possible risk is minimised, and that there are processes to identify harm.

Children deserve the right to participate in research designed to improve outcomes and reduce uncertainty about treatments.

Promoting research

Health professionals and government need to do more to promote research to benefit children. The number of doctors who are educated in research methods has shrunk as the way in which universities are funded and doctors are trained has changed.

There are over 3,000 paediatric consultants in the UK but only 165 are research leaders. Not all doctors need to be research leaders but all health professionals should be trained in research methods.

Less than one in 10 NHS paediatric consultants has identified time for research, in contrast to one in four adult physicians.

What needs to change?

Parents must insist on the right of their children to participate in clinical research. Patient demand was instrumental in improving outcomes for adults with HIV and breast cancer.

New generations of doctors and nurses must be equipped with research skills.

Health services managers and regulators must ensure a supportive NHS research environment.

Research must be portrayed honestly and responsibly by the media and they must be well informed in order to reliably educate the public.

The responsibility to enable more children to benefit from research rests with all of us – parents, health professionals, managers and the media.

What do you think? Would you allow your child in a clinical trial?

Hyperemesis gravidarum affects up to 2% of pregnancies

Some women experience morning sickness so severely they consider aborting an otherwise wanted pregnancy. Is enough being done to help women who suffer so profoundly?

The shadow of Thalidomide, the 1960s anti-nausea drug which led to severe birth defects, is thought to be one reason for the wariness on the part of some doctors to offer treatment for the often misleadingly named sickness that strikes at any time of day.

And for most women, it can be kept in check with small, regular meals and taking ginger or peppermint in various guises, until it eventually subsides with the progressing pregnancy.

But in its rarest form, hyperemesis gravidarum, a woman is unable to keep down any food or drink, and usually needs hospitalisation with intravenous fluids and medication to safeguard the health of both her and her baby.

It is thought to affect up to 2% of all pregnant women.

While there is no data on the number of women who terminate their pregnancies as a result, research from the US suggests about 15% of those who suffered had had an abortion because of the condition and a further 10% had come close.

A conference to be held at Warwick University next week is to call for guidelines to be drawn up to ensure that women across the country receive better support, and will hear that earlier intervention in the community could stop women ending up in hospital.

"We think there is a postcode lottery of treatment and some GPs clearly have fears around prescribing ant-nausea medication. Thalidomide still casts a shadow," said University of Lincoln health psychologist Dr Brian Sallow, who has organised the meeting in collaboration with Pregnancy Sickness Support.

"But we also want to challenge some of the prevailing presumptions about sickness in pregnancy and this idea that somehow women are just making a fuss."

Causes unclear

There are a number of anti-nausea medications. As with most medication, these are not specifically licensed for use in pregnant women but doctors can use their professional judgement.

The antihistamines promethazine and cyclizines are the drugs most commonly used to treat morning sickness in the UK, reducing nausea and vomiting in the majority of those who take them.

A study that looked at more than 200,000 women found babies born to women who had taken an antihistamine during their pregnancy were no more likely to have something wrong with them than babies whose mothers had not taken one.

But the advent of any new medication specifically targeted at morning sickness is unlikely, in part because of the difficulty of clinical trials involving pregnant mothers but also because the mechanisms behind pregnancy nausea are not properly understood.

"It may be because no-one really knows what causes it that some health professionals are a bit sceptical about it," said Lorna Phelan, a consultant and spokesperson for the Royal College of Obstetricians and Gynaecologists.

"And it's a balancing act, as you do not want to scare or indeed overtreat the woman experiencing normal pregnancy nausea who will go home and in a couple of weeks feel much better.

"But this is something we take very seriously. Women have died as a result of this."

Sue Macdonald, of the Royal College of Midwives, said time constraints on staff could mean some pregnant women were unclear about when normal nausea tipped over into the abnormal and help should be sought.

"We as professionals need to be sure that we are always tuned in, and that we pick up on what a woman who doesn't want to make a fuss is telling us.

"We need to make sure that women know what to look out for, and know that this is something they can always talk to their midwife or doctor about.

"This subject isn't as high profile as it should or could be."