Tag Archives: Nice

NICE urges doctors to treat dying patients as individuals

End-of-life care in England must be tailored to the needs of dying patients rather than a “tick-box approach”, the health watchdog NICE says.
Patients must be treated with respect and compassion, it said, and doctors should avoid making “snap decisions” about whether someone was dying.
The guidance is designed to address misuse of the previous system, the Liverpool Care Pathway.
Charities welcomed the new guidelines – but warned more investment was needed.
The Liverpool Care Pathway (LCP) was introduced in the late 1990s, in an attempt to ensure people had a dignified and comfortable death.
Among other things, it involved checklists prompting staff to consider whether invasive procedures, drips and drugs should be withdrawn from people in the last stages of life.
But it was phased out last year after a government-commissioned review revealed serious concerns that it was being used in the wrong way, leading to a “tick-box” culture.
Reports suggested that incorrect use of the LCP left some patients without food and water.
‘Individualised approach’
The new wide-ranging guidelines – the first national guidelines to be introduced in England – cover many of the same key principles as the LCP.
However, NICE called for a stronger focus on individual plans for each patient, saying their wishes and those of their family must be central.
Prof Sam Ahmedzai said this needed to be underpinned by a change in attitude to ensure staff had more respect for care of the dying.
“You have to look at each individual person and respect them as an individual person, ask them about their wishes,” he told BBC Radio 4’s Today programme.
“Some people may want interventions, may want tests to carry on. Others may want to stop all those things. Some people may want fluids, others may not want fluids. So respecting the individual and not having a one-size-fits-all approach.”
The expert panel acknowledged that recognising whether someone is in the last few days of life can be difficult.
Staff should seek guidance from senior colleagues if there were uncertainties and avoid snap decisions, the panel said.
The guidelines emphasise that patients must be monitored for improvements on a daily basis. Staff are offered information on how to spot signs that death is imminent.
Hydration
The document also looked closely at hydration for people in their last few days of life.
Previous reports suggested that when the LCP was used incorrectly some patients were left so thirsty they tried to suck water from sponges used to moisten their mouths.
The new guidance says anyone who is capable of drinking should be encouraged to do so if it is safe and family and friends should be able to help.
But despite these recommendations, experts say there is a lack of evidence about whether giving or withholding fluids can prolong or shorten life in these circumstances.
Lord Howard, chairman of Hospice UK, welcomed the guidelines but said there would be real challenges putting them into practice.
“There can never be ‘a tick-list approach’ towards caring for the dying and this guidance must be underpinned by greater investment in training and education for all staff involved in end-of-life care.
“This is crucial if we are to avoid the failings of how the Liverpool Care Pathway was implemented,” he added.
Source BBC News

Home care visits ‘must last at least 30 minutes’

Carers should spend at least 30 minutes on home visits to older people in England as part of a new gold standard for services, new guidance says.

The National Institute for Health and Care Excellence guidance follows reports of carers making visits of 15 minutes and less.

NICE recommends a package of measures, which also includes ensuring people’s carers are not changed too frequently.

But it acknowledged extra money would be needed to fund the measures.

Earlier this week, 20 organisations, including charities, care providers and the NHS, published a joint submission to the Treasury ahead of the government’s Spending Review in November to urge ministers to protect social care as is being done for the NHS.

What is home care?

  • The term covers services provided in people’s homes, such as help with washing, dressing and eating
  • Unlike NHS services, people have to pay for care, with only the poorest receiving state help, funded and organised by local councils
  • About 500,000 people in England currently receive home care – with over 70% of those getting contributions from councils
  • Another 1.5 million rely on family and friends for support

Find out more about care at the BBC’s cost of care website.

Use the BBC’s care calculator to find out how much care costs where you live.

This is the first time NICE has issued guidance to the social care sector – it has traditionally focused on NHS services.

But its remit has been extended as part of a growing recognition that social care services – care homes and home help funded by councils – have a direct impact on the NHS.

The guidance recommends:

  1. no visits of less than 30 minutes, except for follow-ups to a longer visit earlier in the day, for example to check if someone has taken medicine.
  2. ensuring people know their carers, using the same ones as much as possible
  3. carers be trained to recognise and respond to health problems such as dementia and diabetes
  4. greater coordination between the NHS and care services
  5. older people be told in advance if their carer is going to be late or not turn up – and plans put in place for those at risk

NICE deputy chief executive Prof Gillian Leng said good quality home care could actually save money as it was less expensive than “care homes or hospitals”.

“Without good support, older people can suffer from social isolation, malnutrition or neglect,” she said.

“They may also be at risk of injuring themselves, perhaps from a fall or other accident.”

UK Homecare Association chief executive Bridget Warr, who chaired the group of experts behind the guidance, said while some elements of the guidance would not cost extra, more money was needed to afford what was being recommended.

“We cannot duck the issue,” she added.

A Local Government Association spokeswoman said: “Sadly, the rise in short visits is just one of the symptoms of a social care and support system that is under enormous financial pressure.”

The government said spending plans would be set out in November, but it pointed out that social care would benefit from extra investment in the NHS as a dedicated pot had been set aside to help joined up care between the two sectors.

Care Minister Alistair Burt said he wanted to see the sector provide “great care”.

“This guidance will not only provide reassurance for countless families who rely on this care but for the thousands of workers who want the time and support to be able to give people the care they deserve,” he said.

Source BBC News

New NHS death guidelines ‘worse than Liverpool Care Pathway’

New NHS guidelines on “end of life” care are worse than the Liverpool Care Pathway and could push more patients to an early grave, a leading doctor has warned.

Prof Patrick Pullicino, one of the first medics to raise concerns over the pathway, said the national proposals would encourage hospital staff to guess who was dying, in the absence of any clear evidence, and to take steps which could hasten patients’ death.

The Liverpool Care Pathway – which meant fluids and treatment could be withdrawn, and sedation given to the dying – was officially phased out last year, on the orders of ministers.

It followed concern that under the protocols, thirsty patients had been denied water and left desperately sucking at sponges.

Last week the National Institute of Health and Care Excellence (Nice) published new 32-page guidance for hospital staff on end-of-life care.

Writing for the Daily Telegraph, Prof Pullicino said the plans repeat features of the pathway which made it so dangerous, compounding them with even more lethal errors.

The Nice proposals call on hospital staff to identify a list of “signs” and “changes” – such as agitation or fatigue which could suggest a person is entering the last days of their life, before drawing up a plan for their care, which could see fluids withdrawn.

Prof Pullicino, professor of clinical neuroscience at the University of Kent, said such signals were not reliable evidence on which to forecast imminent death, and that it was dangerous to base treatment decisions on a turn for the worse.

“Diagnosis of who was imminently dying was the core problem of the Liverpool Care Pathway and is no better in the Nice document,” he said. “It includes a cookbook list of features that may suggest someone is dying but is totally inadequate to make a diagnosis and is not evidence-based. So we are back at the LCP in terms of the risk of putting patients who are not dying onto inappropriate and potentially lethal treatment.”

The neurologist said patients should be given “good quality compassionate care” not a set of protocols based on poor evidence.

The pathway was axed following a review led by Baroness Neuberger, which said patients “should be supported with hydration and nutrition unless there is a strong reason not to do so”.

The new guidance says dying patients who are able to drink should be given water if they seek it.

But it also says patients should also be told “death is unlikely to be hastened by not having clinically assisted hydration” – such as a drip.

Prof Pullicino said the claim was “completely untrue,” stating that lack of hydration would kill anyone who cannot drink.

He accused Nice of a “disaster of misinformation, distortion and ambiguity” in its advice.

The neurologist – who had a patient survive 14 months after being taken off the care pathway – said all patients should be given adequate nutrition and hydration regardless of their prognosis.

“Dehydration was a central mechanism of the deaths on the LCP. Despite the removal of the LCP, I still frequently witness severely dehydrated elderly patients on hospital wards.

“Unless it becomes standard, and monitored by the Care Quality Commission, that hospitals are obliged to give nutrition and hydration adequate for patients’ physiological needs at all times and regardless of prognosis, end-of-life care is going to remain lethal,” he writes.

The guidelines, which are now out to public consultation, also encourage the use “anticipatory prescribing” as early as possible, giving hospital staff access to pain relief and sedatives without having to call for a doctor.

The neurologist said the practice was one of the most dangerous aspects of the previous pathway, allowing nurses to increase the dose of medication and hasten death.

Although the LCP was officially withdrawn last year, the neurologist said he regularly received reports from relatives desperately trying to obtain “active” care for patients who were denied it because they were deemed to be dying.

Earlier this year the Royal College of Nursing and charity Macmillan Cancer support said some hospitals had not changed their practices since the pathway was officially axed.

A NICE spokesman said: “Recognising when someone is approaching their last few days of life and making sure they are as comfortable as possible can be difficult for families and healthcare professionals alike. The NICE guidance, which is being developed by an independent group of experts through a rigorous process of evidence analysis and public consultation, will support the NHS to provide high-quality and compassionate care.

“The draft guideline is open for public consultation and we welcome any comments from healthcare professionals and stakeholders, as well members of the public, as they help inform the final guidance. Draft recommendations include the use of multiprofessional teams to provide care; creating individualised care plans; involving the person and their loved ones in decisions about their care, including the use of medicines; and supports the use of fluids.”

Source The Telegraph

Shock as NICE halts work on nurse staffing levels guidance

The National Institute for Health and Care Excellence has suspended with immediate effect its work to determine safe staffing levels across the NHS, an internal email has revealed.
The creation of the programme of guidelines on safe staffing levels was a recommendation of the Francis report into care failings at the former Mid Staffordshire NHS Foundation Trust and the decision to halt it has sparked strong criticism from nursing workforce experts.
Together with new NHS rules requiring trusts to publish data about nurse staffing levels, the NICE guidance has been widely credited with helping drive the recruitment of permanent nursing staff in recent years.
The instruction to stop the programme was contained in an email from NICE chief executive Sir Andrew Dillon to members of the safe staffing programme, which was sent on Wednesday and  seen by Nursing Times’ sister title Health Service Journal.
“I have taken the decision to suspend further work on our safe staffing programme, including any further meetings of the advisory committee,” said Sir Andrew in the message.

He suggested the move was in response to a speech made earlier in the day by NHS England chief executive Simon Stevens at the NHS Confederation conference in Liverpool.
Mr Stevens announced that he had asked chief nursing officer for England Jane Cummings to consider rolling work on safe staffing levels into NHS England reviews of urgent and emergency care, maternity and mental health services.
The move would replace what Mr Stevens called the “more mechanistic approach to the setting of nurse staffing ratios” being used by NICE.
Sir Andrew’s email continued: “Given this announcement, it would not make sense to commission further work from the programme.”
However, it was described as “dangerous for patients and a backward step” by Susan Osborne, the chair of the Safe Staffing Alliance campaign group and a former nursing director.
She said she was “shocked” at the decision. “They are not recognising that trusts up and down the country are operating on unsafe staffing levels which must be compromising patient care,” she said.
“This is burying something because it is telling you the answer you don’t want to hear,” she added.
In his report on Mid Staffordshire, Sir Robert Francis said NICE should draw up “evidence-based tools for establishing what each service is likely to require as a minimum in terms of staff numbers and skill mix.”

Sir Robert said: “Adoption of these practices, or at least their equivalent, is likely to help ensure patients’ safety.”
Following the inquiry report, NICE was asked by Department of Health to draw up guidelines to ensure adequate nurse staffing levels for nine healthcare settings including acute wards, A&E departments, maternity, mental health, and community services.
Guidance on safe staffing for nursing in adult inpatient wards in acute hospitals was subsequently publishing in July last year, followed in February this year by guidance on safe midwifery staffing for maternity settings.
Meanwhile, a draft version of guidance on safe nurse staffing in A&E was put out for consultation in January. The final version was due to be published in May but was held up by the ban on politically sensitive announcements in the run-up to the general election – the period known as “purdah”.
And, as reported by Nursing Times, NICE issued a call for evidence on safe staffing for community nursing at the end of April as the start point for its next guideline.

Sir Andrew’s email makes clear that guidance already published by the programme – for adult acute wards and maternity settings – will remain in force.
However, the move puts into question the future of draft guidance issued by NICE on A&E departments, which suggested a range of minimum nurse staffing ratios.
A source close to the safe staffing programme said the decision to halt the programme had come “out of the blue”. “While the NICE process is far from perfect it was at least independent and considered evidence,” they told Health Service Journal.
Nursing workforce expert and research fellow at Southampton University Professor Jane Ball criticised the programme’s suspension.
She said: “I’m disturbed this decision should be taken when the dangers of a lack of an evidence-based approach and not considering the risks of making changes to staffing levels were described so graphically by Sir Robert Francis in his report on Mid Staffordshire.
“This is a decision I don’t understand and I fail to see how it can be a good thing,” she said.
The guidelines on acute inpatient wards are considered to be one factor that has driven demand for nursing staff and contributed to the runaway costs of agency spending and overseas recruitment.
The decision to stop the safe staffing guidance programme comes in the wake of public pronouncements this week on the need to reign in agency spending from both Mr Stevens and health secretary Jeremy Hunt.
It is currently unclear whether the decision to halt the programme was taken entirely by NICE or was the result of pressure from NHS England.
The government, which originally announced the programme in response to the Francis report, has remained silent so far.
In a statement from NICE, Sir Andrew said: “Making sure that hospitals and community services are safely staffed remains an important priority for the NHS. The guidance that NICE has already published on safe staffing levels in adult acute wards and in maternity settings was widely welcomed and will continue to be used.
“The announcement by Simon Stevens of a review of the approach to setting safe staffing levels means that the work to secure safe levels of staffing in A&E departments and in mental health and community settings is likely now to be taken forward as part of NHS England’s wider programme of work to help the NHS deal with the challenges it is facing over the next few years,” he said.
“NICE stands ready to support this work using the experience we have gained over the last two years,” he added.
Danny Mortimer, chief executive of NHS Employers organisation, said: “Employers have found NICE guidance on staff staffing levels supportive, but they also tell us they need a conversation about how judgments about safer staffing are applied in practice, particularly by regulators.
“We look forward to working with NHS England chief nursing officer Jane Cummings, as she takes this work forward,” he said.
 
Source The Nursing Times

NICE ‘sets price too high for NHS medicines’

The price the NHS in England agrees to pay for new medicines is too high, causing more harm than good overall, an analysis suggests.

University of York researchers say the special cancer drugs fund is particularly poor value, diverting money from other patient services.

They argue the drugs advice body, NICE, has set its price threshold too high.

But NICE says lowering prices could force the NHS to close the door on newer therapies.

The health service has to balance the costs of new treatments alongside investments made in more routine care.

To do this the National Institute for Health and Care Excellence (NICE) uses a measure called quality-adjusted life years (QALY).

A similar approach is used in Wales and Northern Ireland.

The formula looks at the cost of using a drug for a year and weighs it against how much someone’s life can be extended and improved.

At current limits, if a medicine costs more than £20,000 to £30,000 per QALY, it would not generally be recommended as cost-effective.

But researchers at York say the level should be closer to £13,000 to provide the most benefit across the NHS.

They argue that when NICE recommends the purchasing of drugs at higher prices, funds are diverted from other services and could lead to increased deaths from cancer, heart and lung and gut diseases across the NHS.

A separate pot of money, the cancer drugs fund, does allow for more expensive life-extending medications.

But the report suggests that for every healthy year gained by this fund, five QALYs could be lost across the NHS.


‘Price matters’

Co-author Prof Karl Claxton said: “Our research makes the unidentified NHS patients who bear the real costs a little more real.

“The increasing pressure to approve new drugs more quickly at prices that are too high will only increase the harm done to NHS patients overall.”

But Sir Andrew Dillon, chief executive of NICE, said: “Unless you think that drug companies will be prepared to lower their prices in an unprecedented way, using a threshold of £13,000 per QALY would mean the NHS closing the door on most new treatments.

“At the other end of the spectrum, we obviously can’t just say yes to anything and everything.

“We don’t have enough money – and anyway, not everything is worth having.

‘Achieved a balance’

“And drug companies need the discipline of a critical market to make sure that price matters.

“Over the last 16 years, we’ve achieved a balance between these two extremes that reflects what we believe the public expects the NHS to do.”

The research is funded by the National Institute of Health Research and Medical Research Council.

Scotland has a different system for assessing drugs, used by the Scottish Medicines Consortium.

Article was sourced from BBC

New drug for pancreatic cancer turned down

The NHS drugs rationing body has ruled that a drug for pancreatic cancer that can extend lives of patients is too expensive to be given before other treatments have been tried.

Pancreatic cancer is often diagnosed late meaning patients often live for only two to six months.

The drug, nab-paclitaxel, also known as Abraxane, has been shown to extend life by an average of two months but some have survived for two years.

The guidance from the National Institute for Health and Care Excellence is out for consultation.

The drug is available in Wales and is under consideration in Scotland.

A study published earlier this year found one year survival rates rose from 22 per cent to 35 per cent and at two years they doubled from 4 per cent to 9 per cent.

The drug was originally licensed for breast cancer and costs £8,000 a year.

Alex Ford, chief executive of Pancreatic Cancer UK, said: “We are extremely disappointed by this recommendation. It is particularly galling that NICE have refused to consider Abraxane under their End of Life Criteria, given the extremely poor prognosis for pancreatic cancer patients who, on average, only live two to six months from diagnosis.

“There are currently very limited treatment options available and Abraxane is needed to allow more patients to benefit from life extending treatment. We urge NICE to reverse their recommendation and allow Abraxane to be routinely accessed by eligible patients in England.”

Ali Stunt, founder and chief executive of Pancreatic Cancer Action said: “This recommendation is bad news for pancreatic cancer patients, their families and loved ones, who will rightly be angered by NICE’s position.

“Pancreatic cancer has the worst survival outcomes of any of the most common cancers and we badly need new treatments like Abraxane to be approved.

“Moreover, this decision will potentially put English patients at a disadvantage to their neighbours in Wales given that the Welsh Medicines Strategy Group gave a positive recommendation for the use of Abraxane in Wales only last week. Pancreatic Cancer Action calls on NICE to reconsider their decision and add Abraxane to their list of approved drugs in England.”

In the guidance it was calculated that because of the short extension in life expectancy and the cost of the drug it was not cost effective. The calculation came out as twice as high as normally approved by NICE.

There are also serious side effects including bleeding, increased risk of infection, tiredness and breathlessness, numbness or tingling in fingers and toes, gastrointestinal problems; aching joints and muscles, tiredness, feeling sick and hair loss.

Sir Andrew Dillon, chief executive of NICE, said: “Unfortunately the development of new treatments for pancreatic cancer has been very limited in recent years.

“Although a number of newer treatments including nab-paclitaxel have been introduced, we are disappointed that, when considering the impact of side effects as well as how effective the treatment is the evidence fails to show that it works any better for patients than other treatments already provided by the NHS. It is also more expensive.”

A 28 day course of treatment would cost an average of £1,481 per patient.

Source The Telegraph

NHS says no to new breast cancer drug Kadcyla

A pioneering new breast cancer treatment will not be routinely available in England and Wales, the NHS drugs advisory body NICE is proposing.

The drug – Kadcyla – adds six months of life on average to women dying with an aggressive form of breast cancer.

NICE criticised makers Roche for not setting an affordable price, in its updated draft guidance.

The drug costs £90,000 per patient but Roche said it had offered a lower – undisclosed – price in recent talks.

The two organisations have been in negotiations since the first draft guidance from NICE (the National Institute for Health and Care Excellence), rejecting the drug, was published in April.

Cancer drugs row: A sign of things to come?

There is a real sense of sadness – and anger for that matter – that the new breast cancer drug Kadcyla looks unlikely to be made routinely available on the NHS, something that is obvious from the bitter language being used by both sides.

The decision by England’s official NHS advisory body, the National Institute for Health and Care Excellence (NICE), to reject Kadcyla prompted manufacturers Roche to claim the system was “broken”.

NICE – not known for its strong use of language – responded by saying it was “really disappointed” in the approach taken by the drugs firm.

Price row

While this latest guidance is only the final draft version, there tends not to be any major changes when the official recommendations are published – normally a few months after this stage.

The original cost of Kadcyla worked out at £90,000 per patient – that is based on the standard 14 months of treatment.

Roche’s Jennifer Cozzone: “NICE is the first organisation to say no to Kadcyla”

Roche said it had offered to lower the price “substantially”, but NICE said the new price – which is not being disclosed – made little difference.

Kadcyla is used to treat people with HER2-positive breast cancer that has spread to other parts of the body and cannot be surgically removed.

About a fifth of breast cancer cases are HER2-positive, and it is thought this drug could benefit 1,500 women a year.

It works by seeking out and destroying cancerous cells, attacking them from within.

Its novel action means it is unlikely to cause the side-effects, such as hair loss, seen with many other types of chemotherapy.

Doctor inspecting x-rays

Doctor inspecting x-rays For advanced cancer, the aim is remission rather than cure

Kimberley Mawby, 44, who managed to get the drug through a trial at London’s Royal Marsden Hospital, described it as “amazing”.

She said: “I can have a great life. I don’t feel ill, the side-effects are so minimal I lead a really normal life.

“And I know how much it costs but at the end of the day you can’t put a price on your life and that’s what [Roche] are asking people to do.

“For all the people out there that need this drug, I really believe they should be able to get it”

‘Huge blow’

NICE chief executive Sir Andrew Dillon said: “We are really disappointed that Roche were not able to demonstrate more flexibility.

“The company is well aware that we could not have recommended Kadcyla at the price it proposed.”

Jennifer Cozzone, head of health economics and pricing at Roche, said: “We’re very disappointed with this decision and, frankly, not just for patients who would have had the opportunity to receive Kadcyla with a positive decision.

“Considering Kadcyla is the eighth medicine in a row that NICE has declined to make available to women with advanced breast cancer in the UK, we don’t believe this is a question of the price of Kadcyla.

“We believe that this is an issue with how NICE considers medicines in advanced breast cancer.”

Sally Greenbrook from Breakthrough Breast Cancer: “It is a brilliant drug but incredibly expensive”

Dr Jayson Dallas, of Roche, added: “NICE’s rejection of Kadcyla demonstrates quite simply that their current system is broken, not fit for purpose and in need of a complete overhaul when it comes to advanced cancer.”

Mia Rosenblatt, head of policy and campaigns at Breast Cancer Campaign, said the news was a “huge blow”.

“It is vital that this is not the end of the line for Kadcyla in respect of NICE approval, and we ask NICE and Roche to urgently revisit their negotiations to find a solution.

“It’s not too late to review the cost of the drug,” she added.

It means the only way women will be able to get access to the treatment is through the Cancer Drugs Fund, for which their doctors would have to make special requests.

Since April more than 200 women have been given Kadcyla in this way, but the Cancer Drugs Fund is due to end in 2016.

While the guidance applies to England, Wales have said they will follow suit. Officials in Northern Ireland and Scotland are considering the NICE recommendations. None of them currently funds the drug.

Source BBC News

Safe nurse staffing levels could cost £414m, says NICE

Ensuring safe nursing staff levels on adult hospital wards will cost the NHS up to £414m, according to an official estimate by the National Institute for Health and Care Excellence. But some leading nurses say the true cost will be at least double that.
The impact assessment estimated the cost of implementing the NICE staffing guidance for adult acute wards, which was published earlier this month, could be anything from £0 to £414m.
The guidance said less than two registered nurses on a ward at any time was a patient safety “red flag” that required action, and acknowledged a ratio of more than eight patients to one registered nurse could increase the risk of a red flag occurring.
Last week NICE followed up the guidance by publishing a separate analysis on its predicted financial impact. NICE said a realistic mid-point when it came to the cost would be around £207m – a 5% increase on current planned staffing levels.
However, it said the extra costs of safe staffing were likely to be offset by savings from fewer pressure ulcers and healthcare-acquired infections, shorter stays in hospital due to more effective care and reduced risk of being sued because of poor care.
“Implementing the NICE guidance is unlikely to have significant financial impact in many trusts but it is possible that a headline additional cost of 5% could be incurred – building over more than one year – but it could well be less,” said NICE chief executive Professor Gillian Leng.
However, some have warned the calculations may be a serious under-estimate, given the majority of trusts appear to be understaffed – as reported by Nursing Times last week.
“It is an underestimate and probably needs to be at least twice that,” said Susan Osborne, chair of the Safe Staffing Alliance campaign group. “In fact I would say it should be a minimum of 1.25bn to ensure safe staffing now.”
Unison’s head of nursing Gail Adams said it was hard to put a figure on the cost of ensuring safe staffing, but she feared the NICE calculation was “a conservative estimate”.
“To be fair to NICE, it’s quite a difficult piece of work for them to undertake,” she said. “You don’t know whether it’s going to be a band 5 or a band 8 nurse that’s needed to look after a patient, so it is hard to put a figure on it.”
Source The Nursing Times

Safe nursing levels recommended

Patients are at risk of harm if a nurse has to care for more than eight people on a ward during the day, draft NHS guidance suggests.
The National Institute for Health and Care Excellence (NICE) said hospitals in England should be wary about that workload being exceeded.
But it stopped short of stipulating one to eight was an absolute minimum, saying flexibility might be required.
The Department of Health said the number of front-line staff had risen.
While individual hospitals are currently allowed to set their own nurse staffing levels, NICE was asked to look at the issue by ministers.
They had promised to explore safe staffing levels following the public inquiry into the Stafford Hospital scandal.
NICE said in its draft guidance that in a situation where the recommended ratio of at least one nurse to eight patients had not been met, the hospital should be able to explain why.

‘Red flag’

There could be cases, for example, where patients’ illnesses and needs were less serious, and, therefore, it would be wrong to set strict thresholds, it said.
But the guidance recommends nurses raise the alarm – or a “red flag” – when care is being compromised, no matter what the ratio.
That could include situations where there are not enough staff to help patients use the toilet, monitor their vital signs or administer medication.
NICE deputy chief executive Prof Gillian Leng said: “There is no floor or ceiling number on the required number of nursing staff that can be applied across the whole of the NHS.”
She said decisions about the number of nursing staff should “allow flexibility on a day-to-day or shift-by-shift basis”.
Speaking to Radio 4’s Today programme, Prof Leng added that while there was “no magic number” for staffing levels, “care needs to be tailored to the patient’s needs”.
BBC health correspondent Nick Triggle said: “It is already accepted that in areas such as critical care ratios are essential.
“But applying this to general wards is another matter – and could have major implications for overall nurse numbers.”
The guidance, which is now being consulted on before the final recommendations are made in the summer, applies to general acute wards.
Specialist areas such as maternity, paediatrics, and accident and emergency will get their own guidance at a later stage.
Many hospitals have already started paying close attention to nurse numbers; for example, a number publicly display actual staffing levels on wards along with what they should be.
NHS England wants this to become routine across the health service, while later this year hospitals will have to submit their staffing levels each month so they can be displayed on the NHS Choices website.

‘Sensible’ guidance

Royal College of Nursing general secretary Peter Carter said: “For any patient to receive substandard care is unacceptable.
“Nurses will be hoping that once the full set of guidelines is completed, the NHS will never again be so vulnerable to short-term financially-driven decisions about patient care.”
He told the Today programme that it was important a ratio of one nurse to eight patients did not become mandatory as there were some settings – such as neonatal wards – where one-to-one care is needed.
To have a situation where “the minimum becomes the maximum” is “in no-one’s interests”, he added.
The guidance does not go far enough, according to former NHS Trust chairman Roy Lilley.
He said: “If you go on holiday and you fly, the steward to passenger ratio is prescribed in law. If you leave your kids at a creche, the carer to kids ratio is prescribed in law.
“If you got to a football ground, the steward to spectator ratio is prescribed in law. But if you leave your granny in a hospital ward, it’s left to one of Gillian Leng’s red flags.”

‘Step forward’

A spokesman for the Foundation Trust Network, which represents hospitals, said the guidance was “sensible” and supported what many trusts were already doing, however.
“Local nursing and clinical teams are best placed to make the judgement on what is best for their patients,” he added.
The guidance also applies to Wales, although it will now be up to ministers there whether it will be applied.
In Scotland, hospitals are already routinely monitoring and publishing staffing levels – although there are no recommended minimums.
Health Secretary Jeremy Hunt said: “NICE’s work on staffing is a major step forward – for the first time in its history, the NHS will have the evidence it needs to make sure that nurses are able to spend enough time with their patients.”
A Department of Health spokesman said the number of admin staff and managers in hospitals had been cut since 2010 but there were 5,100 more nurses working on wards.
“We have increased the NHS budget in real terms and are clear that hospitals must balance their books whilst ensuring compassionate, quality care for all. We know this can and is being done,” he said.

Source BBC News

Breast cancer drug is too expensive for the NHS: Nice

Doctors said it was a ‘huge blow’ to women and warned that unless the decision is overturned it will be the eighth consecutive drug for advanced breast cancer to be blocked by the NHS rationing body, Nice.

However, the National Institute for Health and Clinical Excellence draft guidance said Kadcyla was not effective enough to justify the cost.

At £90,000 per patient and giving patients an average of 5.8 extra months of life, it is six times more expensive than drugs normally approved for use on the NHS.

Patients have successfully appealed to the Cancer Drugs Funds on a case by case basis for Kadcyla which works against one in five breast cancers known as HER 2 positive.

Final guidance will be issued later this year.

Dr Caitlin Palframan, Senior Policy Manager at the charity Breakthrough Breast Cancer said: “The drug appraisal process in England, and the cost of drugs, must change if prospects for patients are going to improve.

“Drug development and research is moving at a pace that the system can’t seem to keep up with.

“Kadcyla is a very impressive drug that has been shown to extend life by up to six months in HER 2-positive secondary breast cancer patients, and with more manageable side effects than alternative drugs.”

Professor Paul Ellis, Consultant Oncologist at King’s College London said: “Kadcyla represents a significant advance in HER 2-positive breast cancer, so for Nice to issue negative preliminary guidance is a huge blow.

“The drug tackles the disease in a different way to any other breast cancer medicine and provides women with valuable extra time with their families and loved ones – time that you cannot put a price on.

“Not only this, Kadcyla is also much better tolerated by women than current standard treatment options, causing much less in the way of traditional chemotherapy associated side effects. As such, the quality of life of women taking Kadcyla is significantly improved.”

Emma Pennery, Clinical Director at the charity Breast Cancer Care said: “It’s extremely disappointing news for those living with advanced breast cancer and their families that yet another treatment has not been recommended by Nice.

“Kadcyla can mean those facing limited treatment options live longer and with fewer severe side effects, such as being sick, vastly improving their quality of life.”

Sir Andrew Dillon, NICE Chief Executive, said: “We had hoped that Roche would have recognised the challenge the NHS faces in managing the adoption of expensive new treatments by reducing the cost of Kadcyla to the NHS.

“This drug is already being funded through the special Cancer Drugs Fund. Our job is to recommend whether it should transfer into the NHS budget. We are very aware of the importance that people place on life-extending cancer drugs and a decision not to recommend a cancer treatment for routine NHS funding is never taken lightly.

“We apply as much flexibility as we can in approving new treatments, but the reality is that given its price and what it offers to patients, it will displace more health benefit which the NHS could achieve in other ways, than it will offer to patients with breast cancer.”

He appealed to the drug manufacturer, Roche, to do more to make it available.

Source The Telegraph