thisweek OPIOIDS ON SESAME STREET page 87 • VAPING HARM page 88 • VACCINATIONS page 90 NorthWales East Midlands Unfilledvacancies Fewertraineesfeweradsfewerphysicians Hospital trusts have cut back on advertising For example, North Wales had the highest Andrew Goddard (left), of the for consultant physicians despite the large proportion of unsuccessful appointments, Royal College of Physicians, number of vacancies, a report has warned. at %, and the East Midlands failed to fi ll and the BMA’s Rob Harwood have urged the government to The annual census of consultant % of advertised posts. tackle workforce shortages and higher specialty trainee physicians P hysicians were asked about their found that, as in previous years, a high working environments. A third (%) of number of advertised consultant physician trainees said their morale was worse than posts in England and Wales were unfi lled a year ago. Reducing rota gaps, fi lling (%). This was usually due to a lack of vacant consultant posts, and improving any applicants at all (%) or any suitable experiences of general internal medicine applicants (%). were crucial to improving working lives, However, the report on the census said the report said. LATEST ONLINE that this year there was a big reduction Andrew Goddard, president of the Royal (%) in the number of consultant posts College of Physicians of London, said the GPwhoestimated being advertised. “A number of factors results refl ected a wider crisis in the NHS. patients’vitalsigns may have contributed to this fall, including “There simply aren’t enough doctors to treat withoutmeasuring the lack of trained HSTs [higher specialty the number of patients in need,” he said. themisstruckoff trainees] to meet the demand in shortage “We’re calling on the next government UShospitalis specialties and the deteriorating fi nancial to double the number of medical students accusedofkeeping situation within the NHS, but this is a and to better support eff orts to retain current vegetativepatient worrying pattern,” the report said. staff . Only then will we be able to provide alivetoboost itstransplant The census, conducted on behalf of all the sustainable and eff ective healthcare.” survival rate UK physician colleges , was sent to Rob Harwood, chair of the BMA’s consultant physicians, from whom Consultants Committee, said the survey USjuryorders Johnson& eligible responses were received (%). showed the eff ect of shortages on doctors’ Johnsonto It was also sent to higher specialty wellbeing. He said, “The NHS must foster a paybnto trainees, of whom responded (%). supportive culture. Only if doctors are looked manwith It found that areas in the UK with fewer after can they care properly for patients.” gynaecomastia consultants per patient population were Abi Rimmer, The BMJ linkedtorisperidone also the most likely to struggle to fi ll posts. Cite this as: BMJ ;:l the bmj | 19 October 2019 85 SEVEN DAYS IN Care gaps leave chronically ill prisoners at risk of transfer without medication Every day around 120 prisoners with chronic conditions are moved between prisons in England, but gaps in care mean many risk being denied medication, says a report. In its report the Healthcare Safety Investigation Branch (HSIB)—an independent, government funded organisation—cited the case of an inmate who had many seizures after his epilepsy drugs were not transferred with him. This was “just one example of a serious outcome when medication was missed.” The branch has called for changes to improve prisoner care, including integrating the prison service’s two IT systems—one for healthcare and one for operational needs—and changing the Care Quality Commission inspection process. Currently inspections by the CQC and the prison inspectorate focus on prisoners being released, rather than on routine transfers. The report also found that some prison health departments have only one authorised prescriber on site when transfers occur, creating “single points of failure.” Eamonn O’Moore, Public Health England’s health and justice lead, said, “The report provides valuable insights which will guide the work of partner organisations.” GETTY IMAGES Elisabeth Mahase, The BMJ Cite this as: BMJ 2019;367:l6003 Interstitial cystitis a moral responsibility” to uphold scenarios. “This capacity is an NICE recommends drug for children’s rights, which included important part of our members’ chronic bladder condition being healthy, she said. preparations,” he said. NICE has reversed its decision “Stockpiles are also in place, and not to recommend the drug Severe obesity in primary some companies have already pentosan polysulfate sodium school leavers hits new high sourced alternative ferry routes.” for treating bladder pain New data showed that 4.4% of syndrome with glomerulations year 6 schoolchildren in England Tuberculosis or Hunner’s lesions in adults were classified as severely obese, J&J is urged to cut (49%; 17 052) involved children who have not responded to other the highest rate on record. Figures bedaquiline price who had been scalded by hot treatments, after negotiating a from NHS Digital showed that the People protested outside Johnson food or liquid, the International confidential price discount with rate of severe obesity in 10-11 & Johnson’s offices in cities Burn Injury Database showed. the manufacturer. Pentosan year olds had increased for the around the world to put pressure Over half of admissions in 2018 polysulfate sodium may be better fourth consecutive year, up from on the company to lower the price (51%; 1576) involved children than pregabalin, gabapentin, and 3.7% in 2014-15. The prevalence of bedaquiline, which is used to aged 0-2 years. As part of a “safe bladder instillations, although of obesity also increased in treat drug resistant tuberculosis. tea campaign” the Royal College the evidence is not high quality, reception year children (ages The drug costs nearly $1200 of Surgeons of England and the said NICE. Pentosan polysulfate 4-5), rising from 9.5% in 2017-18 (£957) for a course of treatment British Burn Association urged sodium should be used in to 9.7% in 2018-19. through the Global Drug Facility, the public not to drink hot drinks secondary care, it said, and could a UN scheme to keep drug costs while nursing a child, to test the benefit 1000 people a year. Brexit down for poorer countries. But water before putting a child in the Government announces researchers have said it can be bath, and not to leave children Child obesity extra drug freight capacity produced for a quarter of the unattended in the kitchen. Government has moral The Association of the British price. The charity Médecins Sans duty to act, says ex-CMO Pharmaceutical Industry (ABPI) Frontières has called for the price Workforce The UK government is falling short welcomed the government’s to be halved to scale up treatment Boosting staff wellbeing in its efforts to curb childhood announcement that it had signed and save lives. helped trusts’ CQC ratings obesity and must introduce extra freight capacity contracts Initiatives to increase staff tougher legislation to protect to help ensure that drugs still Childhood burns engagement and make children’s health, said England’s enter the UK after Brexit. Surgeons warn of leadership teams approachable former chief medical officer, Sally Mike Thompson (right), lifelong effects helped to improve NHS trusts’ Davies. In a hard hitting report, ABPI chief executive, said Almost half of child ratings from the Care Quality her last after nine years in the the industry would admissions to Commission, a report by NHS role, she warned the government do everything it specialised NHS Providers found. Improvements was currently “nowhere near” could to ensure burn services were remarkable given the achieving its ambition to halve people get their in England and challenging environment, childhood obesity by 2030. The medicines Wales in the said the organisation, which government had “a duty as well as in all Brexit past five years represents NHS trusts. 86 19 October 2019 | the bmj SIXTY SECONDS MEDICINE ON . SESAME Environment Plastic straws and cups STREET AND Single use plastics will are to be phased out OPIOIDS be cut in NHS hospitals of England’s hospitals High street names and suppliers TODAY’SSHOWISBROUGHTTOYOUBY including Marks & Spencer and THELETTER? W H Smith are backing a call by “O” for opioid and the number 5.7 million. NHS England’s chief executive, Shockingly, that’s the estimated number of Simon Stevens, to reduce single US children under the age of 11 who live in households with a parent with a substance use plastics in hospitals. They use disorder. plan to cut the use of plastic straws and stirrers from next April, BUTWHEREDOMUPPETSCOMEIN? and plastic cutlery, plates, and Mental health America’s opioid crisis has inspired the cups will be phased out over the Queen’s speech promises BETTING long-running children’s TV show Sesame following year. Stevens also urged white paper this year In the past 12 Street to introduce a character whose mother catering departments to act: if The government pledged to is battling addiction. A series of videos, the NHS halved its use of catering publish a mental health white months, 41% activities, and articles take us through the backstory of Karli (below), a “bright green, plastic it could mean more than paper by the end of 2019 setting of children yellow haired” friend of Elmo who appears 100 million fewer items each year out its response to proposed aged 11-16 have with a young girl whose parents are addicts ending up in oceans or landfill. reforms to the Mental Health participated in Act. The announcement, made in recovery. some form of Promote plant based diets in the Queen’s speech on 14 ISTHISREALLYTHERIGHTTOPIC gambling more, says report October, was welcomed by FORCHILDREN’STV? Simon Wessely, who chaired The government should do [ Cardiff Sesame Street has never been shy of tackling the independent review of more to promote vegan diets as University ] big health and social matters such as autism, death, homelessness, and foster care.