District nurse numbers under pressure

Community matron Temba Ndirigu Image caption Visits from community matron Temba Ndirigu means Maurice can get care at home

District nurses play a vital role in keeping patients out of hospital by providing care in their own homes, but official figures show their numbers have nearly halved since 2010.

In the Seacroft area of Leeds, community matron Temba Ndirigu is driving to see his first patient of the day.

He pulls up in front of a semi-detached house and calls out a cheery "Hello!" as he steps through the front door.

In a front room converted into a bedroom, he finds Maurice Welbourn and his wife Nora.

Maurice has suffered a stroke, throat cancer, diabetes and has liver problems, all of which have left him dependent on the support of his wife and the community health team.

Nora has also developed Parkinson's disease, meaning Maurice's main carer is also herself in need of support.

Image copyright BBC News

She says that without people like Temba, her husband would constantly be in and out of hospital.

"No matter what time of the day, you can ring them any time, the district nurses, you know, the carers.

"I wouldn't be able to keep him at home without them."

Despite the complexity of his health problems, Maurice is a fairly typical patient for a community health team working in one of the more deprived parts of Leeds.

And for Temba and his colleagues, working in a community setting, rather than hospital, presents its own challenges.

"In a hospital, it is your environment, you know what you're doing, you're more or less in charge.

"In someone's home, the tables are completely reversed.

"You are a guest in their home, and this sense of being alone, it's just you and the patient or the family.

"There are all these people looking at you to make a decision or come up with a plan and that can be quite difficult."

Back at base, the phones are ringing as the team try to manage a growing number of cases and it's not easy.

Constant pressure

Service manager Lucy Hall is trying to schedule the team's appointments for the next day, while at the same time knowing there will be unexpected calls.

"For the past 18 months we have been really busy, it seems to have stepped up a notch.

"The problem is we just don't know what's coming through the door the next day

"So when the hospitals have a big surge in referrals or a big surge in bed management, we often see the outcome of that."

But as well as meeting the demand for services, there is a problem in the supply of staff qualified and willing to do this complex and demanding work.

Thea Stein is the chief executive of Leeds Community Healthcare NHS Trust, which runs the district nursing team in Seacroft.

"We do constantly struggle with the supply of staff to do the job we need done," she says.

Image copyright BBC News Image caption Thea Stein, chief executive of Leeds Community Healthcare, says staffing is a constant struggle

Official figures also show a 46.4% drop in full-time district nurses working for the NHS in England from May 2010 to July 2017.

Some of that drop may be down to nurses moving to work for other health organisations outside the NHS.

But the Royal College of Nursing says the data reflects a recent survey it carried out that suggested community teams are being stretched to the limit.

And Ms Stein says that keeping patients at home and out of hospital is a daily battle.

"We just have pressure day in and day out to do it.

"If services like mine aren't there, 24/7, our hospitals are completely full."

Next we are back on the road with staff nurse Lisa Heyward, this time to check up on Colin, who has problems with his legs.

Keeping patients like Colin at home rather than in hospital is central to plans for the future of the NHS in England.

This is work often unseen, requiring dedication and compassion.

But it is vital if the health service is to cope with the growing number of frail, older people living with multiple health conditions....

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Scots teen in bid for 'life-changing' bionic legs

Mark SweeneyImage copyright Mark Sweeney Image caption Mark Sweeney has been a wheelchair user since an operation on his spinal cord when he was 11.

When Mark Sweeney was left paralysed from the waist down by an operation on his spinal cord, he and his family were left devastated.

Becoming a wheelchair user aged just 11, he was left angry and resentful, unable to ride his bike and play with his friends.

But now aged 18, the teenager is hoping to get back on his feet for the first time in seven years with the help of a "bionic suit".

And the aspiring actor hopes the life-changing kit could even help him land his dream role in the BBC's River City.

The technology is known as a ReWalk exoskeleton suit[1] and it enables people with certain conditions to walk independently using "robotic legs".

With the help of his family, Mr Sweeney, from Motherwell, is trying to raise the £80,000 needed to buy the hi-tech suit.

He told BBC Radio Scotland's Kaye Adams programme[2] of his reaction when he successfully tested the technology.

"The feeling is indescribable," he said."I was incapable of crying, I burst out laughing instead."

Image copyright Mark Sweeney Image caption Mr Sweeney said he quickly learned how to use a suit during testing.

Mr Sweeney was born with a series of spine and brain conditions, including Spina Bifida, and he spent much of his childhood in hospital, undergoing dozens of operations.

He was able to walk but his spinal cord became progressively weaker and after surgery on a cyst, he was left paralysed.

"I woke up in a blind panic because I couldn't feel anything, I couldn't move," he recalled."I immediately started questioning my mum, saying 'what the hell has happened to me?'"

He said it led to him becoming more isolated."The life I was leading, I was forced to stop," he said."I was doing everything a kid of that age would do, going out on my bike, playing with my friends, but I couldn't do any of that."

His mother, Margaret Sweeney, said her son was left "very, very angry and resentful" by his sudden paralysis and it had a dramatic effect on family life.

"Every single day in life the whole family is affected," she said.

When she discovered an advert for the exoskeleton ReWalk suit online, she worked tirelessly to set up a "test-drive" for her son.

Acting career

Before he tried the device, he was warned that it could take three weeks of training before he would be able to walk successfully.

"On the first day, within three minutes of putting Mark in the suit, he got up and walked away," said his mother.

Mr Sweeney, who is studying administration and IT at college, believes the suit could give him the independence he craves.

"Most people take their mobility for granted but once you lose it, you realise what it was you were able to do which you now can't," he said.

"It would make a lot of difference, it would make my life so much easier," he added."Even towards my possible acting career, it would open up so many gateways because I would be able to do more stuff.

"It would make my life so much more independent.I would be able to go places by myself without tiring out from pushing my chair or relying on someone else to push me."

Spencer Watts uses an exoskeleton suit after securing funding from the Matt Hampson Foundation[3] earlier this year.He is paralysed from the waist down after a motorbike accident as a teenager.

He told BBC Scotland it had transformed his life."I've got two young children and just walking along to the park with them, looking down at them and them looking up at me is just awesome."...

References

  1. ^ ReWalk exoskeleton suit (rewalk.com)
  2. ^ BBC Radio Scotland's Kaye Adams programme (www.bbc.co.uk)
  3. ^ Matt Hampson Foundation (matthampsonfoundation.org)

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NI child heart patients going to Dublin triple in number

Heart surgeryImage copyright Getty Images Image caption Twenty-three children travelled from Northern Ireland to Dublin for heart surgery so far this year

The number of children from Northern Ireland receiving heart surgery in Dublin has almost tripled this year.

Between January and September, 23 children travelled to Our Lady Children's Hospital in Dublin, compared to just eight in all of 2016.

There has also been an increase in adolescent patients from the Republic travelling north for treatment.

Children's heart surgery services at Belfast's Royal Victoria Hospital (RVH) ceased in 2015.[1]

Leading world heart specialists who attended a weekend conference in Belfast were told the all-island Congenital Heart Disease (CHD) Network is delivering better outcomes for children across Ireland.

Keynote speaker Dr Christopher Caldarone, from the Hospital for Sick Children in Toronto, Canada, told BBC News NI that countries had a lot to learn from the network.

"I am looking forward to learning how the network is evolving here," he said.

Image caption Dr Christopher Caldarone said countries had a lot to learn from the all-Ireland network

"We have a complex network in Ontario where we have patients cared for on four or five different sites.

"We use a lot of teleconferencing, a lot of sharing of information.We can learn from our colleagues in Belfast and Dublin who are already working together."

Family close-by

A number of heart families also attended to share their experience.

Annette Savage and her daughter Rianna said the service meant that care was provided just 100 miles away.

Rianna, an 11-year-old pupil at St Louise's Comprehensive College in Belfast, said being treated at Our Lady's Hospital meant all her family could be close-by.

"Being in Dublin meant my two brothers could come and visit me.It also meant my mum and my dad could stay," she said.

"The nurses were the same throughout my stay which was great because I got to know them."

Image caption Rianna Savage said being treated at Our Lady's Hospital meant all her family could be close by

Rianna's mum Annette said she could not imagine having to travel to England while leaving the rest of the family in Belfast.

"Initially Rianna had gone to have a stent inserted, but required emergency open heart surgery," she said.

"We weren't expecting it and while it was traumatic, not being too far from home was great in that family came down and, as I am diabetic, at the last minute they were able to bring me all my medication too.

"It was stressful - but it could have been worse.We just took the positive out of what was a bad situation."

The CHD Network is the first integrated clinical network to operate on an island-wide basis.

It emerged following a commitment from the Irish government and NI Executive in 2015 to create a "world-class patient and family-centric CHD service for the island of Ireland".

The network was launched after health ministers on both sides of the border accepted the recommendations of an international working group led by Dr John Mayer from Boston Children's Hospital.

Image caption Heart specialists attended a weekend conference in Belfast

Dr Frank Casey, a consultant paediatric cardiologist in Belfast, said the past year has seen significant progress.

"We have worked very hard to accommodate the difficult group of patients, including the urgent and emergency patients and that was a very big worry for us in Belfast," Dr Casey said.

"Also fewer have to travel to England so that is working for children and their families."

Lars Nolke a Cardiologist at Our Lady's Children's Hospital in Dublin's Crumlin area said the network was proving a success.

"The surgical part of the programme is growing and will continue to grow as Crumlin continues to increase and we can extend our capacity," he said....

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Breast cancer tumours 'larger' in overweight women

Overweight woman's torsoImage copyright Getty Images

Cancerous breast lumps are less likely to be detected in overweight or obese women before the tumour becomes large, a Swedish study has found.

These women may need more frequent mammograms to help spot early tumours, say researchers, but experts say more evidence is needed.

In the UK, women aged 50-70 are invited for screening every three years.

Some women judged to be at higher risk of breast cancer are already offered more frequent screening.

This might be a woman with a strong family history of breast cancer, for example.

Being overweight also increases a woman's risk of developing breast cancer, but it is not currently considered for setting breast screening intervals.

Obesity risk

The Karolinksa Institute study involved 2,012 women who developed breast cancer between 2001 and 2008.

The women had been receiving mammograms every 18 months to two years, as standard in Sweden.

The researchers looked at how large the tumours were at diagnosis, as well as the women's body mass index (BMI), a measure of obesity.

The team found women who were overweight were more likely to have a larger tumour when detected either at their mammogram or between screenings.

This might be because their breasts were larger and therefore the tumour was harder to find, or because their tumours grew at a faster rate, the study's lead author Fredrik Strand told the BBC.

Larger tumours tend to carry a worse prognosis.

More frequent screenings

Dr Strand said:"Our study suggests that when a clinician presents the pros and cons of breast cancer screening to the patient, having high BMI should be an important 'pro' argument.

"In addition, our findings suggest that women with high BMI should consider shorter time intervals between screenings."

But Sophia Lowes, from Cancer Research UK, said the study, which is being presented at the annual meeting of the Radiological Society of North America, did not provide enough evidence to support changing how often women are screened.

"Breast screening has harms as well as benefits.

"It saves lives by helping detect breast cancer at an early stage, but harms include some women being diagnosed with a cancer that would never have caused them problems in their lifetime.

"The time between screening is designed to help the benefits outweigh the harms overall."...

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