Charlie Gard case: Great Ormond Street in new court bid

Charlie GardImage copyright PA Image caption Charlie Gard has been in intensive care since October

Great Ormond Street Hospital has applied for a fresh hearing in the case of Charlie Gard following claims of "new evidence relating to potential treatment for his condition".

It comes after seven medical experts suggested unpublished data showed therapy could improve the 11-month-old's brain condition.

Previously, the High Court said it was unlikely a US doctor offering to treat Charlie would be able to cure him.

GOSH said it would "explore" the data.

Charlie's case will be heard by Mr Justice Francis on Monday at 14:00 BST, according to a High Court listing.

Image caption Under a High Court ruling, GOSH is forbidden from allowing Charlie to be transferred for nucleoside therapy anywhere

A hospital spokesman said:"Two international hospitals and their researchers have communicated to us as late as the last 24 hours that they have fresh evidence about their proposed experimental treatment.

"We believe, in common with Charlie's parents, it is right to explore this evidence.

"Great Ormond Street Hospital is giving the High Court the opportunity to objectively assess the claims of fresh evidence.

"It will be for the High Court to make its judgment on the facts.

"Our view has not changed.We believe it is right to seek the High Court's view in light of the claimed new evidence.

"Our priority has always been, and will always be, the best interests of Charlie Gard."

Under a High Court ruling, GOSH is forbidden from allowing Charlie to be transferred for nucleoside therapy anywhere.

'Tested on mice'

Seven clinicians and researchers, including the US doctor, signed a letter explaining that the treatment would be experimental for Charlie's particular condition.

They claim that "ideally" the treatment would first be tested on mice but state that, in Charlie's case, there is not time for such a trial.

Charlie has mitochondrial depletion syndrome, a rare genetic condition which affects the cells responsible for energy production and respiration and has left him unable to move or breathe without a ventilator.

Image copyright PA Image caption Connie Yates and Chris Gard raised more than £1.3m for experimental treatment for Charlie

Doctors at GOSH have said he cannot see, hear, move, cry or swallow and that his life support should be switched off because there is no chance of his condition improving.

Charlie's parents, Connie Yates and Chris Gard, raised £1.3m on a crowdfunding site to pay for experimental nucleoside therapy in the US.[1]

But they lost a legal battle with the hospital last month when judges at the European Court of Human Rights ruled further treatment would "continue to cause Charlie significant harm".[2][3]

Signatories to the new letter include a neurologist and a research fellow from Rome Children's Hospital, a scientist from Cambridge University's Mitochondrial Biology Unit and two researchers from Vall d'Hebron Institut de Recerca in Barcelona.

"In light of this new information, reconsideration of treatment for Charlie Gard is respectfully advocated," the group said....

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David Frost cardiac genetic testing service opens

Sir David and his son Miles FrostImage copyright Frost family Image caption Sir David's son Miles Frost died from an inherited heart condition aged just 31

A new genetic testing service is opening at Belfast City Hospital aimed at identifying and supporting those at risk of heart problems.

It is the first service in the UK to benefit from a fund set up in memory of the late broadcaster, David Frost.

It is estimated more than 17,000 people in Northern Ireland are living with a faulty gene putting them at high risk of sudden death or heart attack.

The cash will provide an extra nurse for a specialised unit at the hospital.

Mr Frost's son, Miles Frost, died from a heart condition called hypertrophic cardiomyopathy (HCM) aged just 31.[1]

Image caption Dr Alison Muir said the funding will allow for a new nurse

Although Sir David did not die from HCM, his post mortem found the disease was present.

Miles and his brothers, Wilf and George, were not tested for HCM before his death.

Dr Alison Muir, consultant cardiologist at Belfast City Hospital, said:"In Northern Ireland, HCM affects approximately 1 in 500 individuals, but if you imagine that we have to see their parents, siblings and children, that's a lot of people.

"Our new nurse will help us see a lot more patients each year.

"When someone dies from an inherited heart condition not only will their family be faced with the devastating loss of a loved one, they will also face the possibility that they or another family member could be affected with the condition.

"It is important they are referred to the service so we can carry out this cascade testing.

"It can be a frightening prospect so the care of a specialist inherited cardiac conditions nurse is vital to support them through the process." ...

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Contraception fails in quarter of abortions, say experts

Young woman anxious about her contraceptionImage copyright Getty Images Image caption The pill is the most popular method of contraception among women

One in four women who had an abortion in 2016 were using the most reliable methods of contraception, says the British Pregnancy Advisory Service.

More than 14,000 women, who were treated at BPAS clinics, became pregnant despite using the pill or a long-acting contraceptive.

They often spotted their pregnancy late because they hadn't expected their contraception to fail.

No method of contraception can ever be 100% effective.

But long-acting reversible methods are said to have a very low failure rate (99% effective).

Image copyright Getty Images Image caption Condoms are not as reliable a method as the pill, implants or coils

Oral contraceptive pills are by far the most popular way of protecting against unplanned pregnancy among women, but long-acting methods - known as Larcs - are catching up.

They include contraceptive injections, implants and intra-uterine devices (IUDs) or systems (IUSs).

Contraceptive pills are estimated to be 91% effective while condoms are 82% effective when used typically.

However, BPAS says unplanned pregnancies can occur if the method is not inserted properly, or if it moves or falls out.

It also says hormonal contraception, such as the pill or patch, can mask the symptoms of pregnancy because they may cause light or irregular periods.

This may be why women using these methods have abortions at a later stage than other women.

BPAS said that in 2015, more than 5% of women having abortions past 20 weeks were using Larcs, compared to around 3% of those having one at less than 19 weeks.

The legal limit for abortions is 24 weeks in England, Wales and Scotland.Women in Northern Ireland are now able to get free abortions in England.[1]


What contraception do women use?

  • 45% use oral contraceptive pills
  • 15% use an implant
  • 14% use male condoms
  • 14% use an intra-uterine device (IUD) or intra-uterine system (IUS)
  • 9% use an injectable contraceptive

Further information:NHS contraception guide[2]


Ann Furedi, chief executive of BPAS, said:Our data shows that women cannot control their fertility through contraception alone, even when they are using some of the most effective methods.

"Family planning is contraception and abortion.

"Abortion is birth control that women need when their regular method lets them down."

Out of 60,000 women who had an abortion at BPAS clinics last year, more than half were using at least one form of contraception.

The total number of abortions in England and Wales has been around 185,500 during each of the last few years.

Image copyright Getty Images Image caption Long-acting methods of contraception, like injections, are growing in popularity

Every year, nine in every 100 women using the pill, six in every 100 using the injection and one in every 100 using the IUD become pregnant.

Abortions are only allowed in Northern Ireland if a woman's life is at risk or there is a permanent or serious risk to her physical or mental health.

The sexual health charity FPA said people did not always use contraception consistently or correctly.

It also said some of the most effective methods of contraception were not always made as available as they should be.

"In a survey of GPs, we found that one-fifth don't offer the intrauterine device (IUD), and almost a quarter said they don't offer the contraceptive implant," the FPA said.

GPs told the FPA that this was partly because of a lack of training qualifications and a lack of funding.

But NICE (National Institute for Health and Care Excellence) guidance suggests that long-acting methods of contraception can reduce unintended pregnancy and be cost-effective for the NHS....

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Mental health care 'risks being over-run'

Patient with psychiatristImage copyright Thinkstock

Mental health services in England risk being overwhelmed by a combination of rising demand and staff shortages, a survey of NHS trusts suggests.

The poll by NHS Providers, which represents trusts, found seven in 10 mental health leaders expected demand to increase this year.

But fewer than one in three was confident they had enough staff to deliver services.

Ministers said extra money being invested would help improve care.

It comes as an investigation by BBC Radio 5 live Daily found the growing demand for mental health support was being felt in the ambulance service too.

Responses obtained under the Freedom of Information Act showed there was a growing number of ambulance call-outs to people suffering from suspected mental health problems.

In 2015-16, there were nearly 279,000 call-outs, up from 240,000 the previous year, according to the 13 out of 14 UK services that responded.

Louise Rubin, of the charity Mind, said part of the rise was likely to be down to an increasing trend for people with mental health problems who come into contact with the police to be transported by ambulance rather than with them.

She said this was a positive move, but it was "unlikely to be the full picture".

"We are concerned that people coming forward and seeking help for mental health problems are not getting the support they need early enough, which means they are more likely to become more unwell and reach crisis point."

'Gap between ambition and reality'

Saffron Cordery, of NHS Providers, said the biggest growth in demand was being seen in children's mental health services.

The survey carried out by her organisation received responses from 43 chairs and chief executives from 37 trusts, nearly two-thirds of the total number of mental health trusts in England.

She said the findings were concerning.

Image copyright Thinkstock

"These concerns point to a growing gap between the government's welcome ambition for the care of people with mental health needs and the reality of services they are receiving on the front line."

A Department of Health spokeswoman said:"We're committed to seeing mental health services improve on the ground."

She said by 2021 services would be getting an extra £1bn a year.Last year they were given £11.6bn.

She said that would help improve crisis resolution, home treatment teams and mental health support in A&E in particular....

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Use of WhatsApp in NHS 'widespread', say doctors

Patient recordsImage copyright Getty Images Image caption There is no effective system for sharing patient records digitally in the NHS

Doctors and nurses are using WhatsApp and Snapchat to share information about patients "across the NHS", health professionals have told the BBC.

GP Alisdair MacNair said he was aware of a number of medical groups using WhatsApp to discuss patients.

Use of internet-based messaging apps to send patient information is banned under current NHS guidelines.

NHS England told the BBC that it had no comment on the matter.

Dr MacNair said:"I have also seen chat on Facebook groups that sails pretty close to the wind in terms of discussing medical information.

"I've definitely seen stuff which is one step away from being patient identifying.

"I'm very wary of going near anything like that because of the risk of breaching data laws, but it would appear others don't seem to be aware of the risks."

The healthcare body needed to act swiftly to address the issue, or potentially face huge fines for data breaches, said Forrester analyst Kate McCarthy.

She likened current practices to the "wild west", adding that the NHS was "incredibly far behind" in the adoption of digital sharing systems.

"I am empathetic with doctors because there is a need and desire among healthcare professionals to share this information and the fact that nothing exists for them to to do so is a huge problem," she said.

"But that doesn't make it OK to share patient data on Snapchat.

"The reality is that doctors are responding to the inadequacy of what the NHS is providing.

"They are creatively trying to find better ways to provide care, but they are using non-compliant tools."

Quick and easy

The way that the UK's health service looks after data is in the spotlight following an Information Commissioner's Office (ICO) investigation into how 1.6 million patient records were shared with Google's DeepMind.

The artificial intelligence company said it wanted to develop an app to alert doctors and nurses about patients at risk of kidney injury.

The ICO found that the NHS had been in breach of data laws in the way it had allowed DeepMind to access the records.

A subsequent report from an independent panel set up by DeepMind to assess its work suggested that the NHS's use of technology was in a dire state.

It said it was the UK's largest purchaser of fax machines, adding that was a "dubious" position to hold.

Image copyright Getty Images Image caption The NHS is "incredibly far behind" in adopting digital sharing technologies, one analyst has said

Georgie Gould, a junior doctor who last year conducted her own study of how doctors were communicating, found 30% of surgeons at St Peter's Hospital in Chertsey, Surrey, were using WhatsApp as part of their day-to-day communication.

It bears out similar findings published in the British Medical Journal, which found that of 2,000 doctors across five hospitals, a third were using web-based apps to send clinical information.

An NHS consultant trauma surgeon, who did not wish to be named, told the BBC:"We use WhatsApp because it's the quickest and easiest way to communicate with a whole team or group of clinicians.

"So, if you're responding to a major incident, you can have the whole team involved and see what's coming [in terms of patient injuries] so teams can be ready."

"It can also be really helpful for junior clinicians to communicate with senior colleagues - send images of X-rays and get quick advice on the best course of action.

"However, we only use initials or bed number information, we don't identify patients."

HIV status

According to NHS England's guidelines, the use of WhatsApp is strictly banned for the purposes of sending patient data.

Instead, doctors are required to contact each other by pager or fax.

"The process is lengthy," said Dr Gould.

"If you want to send images, you have to fill in a form and give it in by hand."

Contacting colleagues by pager - which involves locating a landline, dialling a four-digit number and waiting for a reply - was equally cumbersome, she said.

Dr Gould said clearer guidelines could solve the problem.

She said:"Most doctors know that it is not OK to use full names, but is initials OK?

"Is it OK to say, 'The lady in Bed 2 is running a temperature'?

Image copyright EPA Image caption Using apps such as WhatsApp to discuss medical information is banned in the NHS

"The benefits of WhatsApp go beyond communication, it is about connecting teams and reducing hierarchies.

"I think that the problems of it could be easily solved without throwing huge amounts of money at it.

"It needs a separate app for medical conversations, with its own password," she said.

Dr Felix Jackson, who runs MedCrowd, a digital messaging service for health workers, told the BBC he saw use of WhatsApp while he was working as an anaesthetist.

"Such platforms are used extensively, but it is against the law," he said.

Anonymising data meant doctors might "just about get away with it", he added, but that would not continue forever.

"No major error has come to light yet, but it is only a matter of time before a senior doctor leaves his or her phone on the train and someone gets hold of the all the conversations about patients and suddenly someone's HIV status is made public," he said....

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