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Cyberonics, Italy’s Sorin Merge to Create Medical Technology Leader

Italian medical device maker Sorin and its smaller U.S. peer Cyberonics Inc (CYBX.O) announced a merger on Thursday to create a global leader in cardiac surgery and neuromodulation with an equity value of $2.7 billion.

The all-stock deal values the Italian company at about $1.4 billion, a 14.2 percent premium to its market capitalization before the deal was announced.

Cyberonics will hold a 54 percent stake in the new company and Sorin the rest. The business will be based in Britain and apply for dual-listing on Nasdaq and the London Stock Exchange.

Sorin’s boss Andre-Michel Ballester will become chief executive and the board will be equally balanced between Sorin and Cyberonics.

At Wednesday’s closing price, Cyberonics had a market value of $1.6 billion, or $400 million more than Sorin. The difference is due to better growth prospects, said Martin Brunninger, an analyst at broker Jefferies, although Sorin’s shares soared more than 25 percent on Thursday.

Sorin’s sales account for over 60 percent of the combined entity’s total sales.

Cyberonics had around $290 million in 2014 revenues, two production facilities and 650 employees, compared to Sorin’s sales of nearly $1 billion, 10 manufacturing sites and 3,900 workers.

The deal is expected to boost earnings per share from next year and pre-tax cost synergies between the two companies are estimated to total $80 million by the end of 2018.

Brunninger said the deal gives the new company a critical mass to maintain and win large tender-driven hospital accounts.

“Beyond operational synergies, we see strong R&D overlaps, which makes the NewCo an interesting medical technology play in an otherwise commoditizing industry,” he said, adding the new group could become a takeover target.

The deal brings together two market leaders in cardiac surgery and neuromodulation, or stimulation of the vagus nerve, a superhighway connecting the brain to the rest of the body.

The combined company will also be a major player in cardiac rhythm management and research programs addressing heart failure, “with an initial commercial launch in Europe anticipated in coming weeks,” the companies said in a joint statement.

Cyberonics shareholders will receive one share of the new company for every share held, while Sorin shareholders will receive 0.0472 of a share for each Sorin share owned. Sorin was advised by Rothschild.

The exchange ratio implies a premium of 14.2 percent to Sorin’s closing share price on Feb. 25. Shares in Sorin were halted from trading for excessive gains on Thursday and were indicated 27 percent higher at 2.79 euros by 1123 GMT (0623 ET).

The deal was approved by the board of the two companies. Cyberonics shares will cease trading on the Nasdaq and Sorin shares will stop trading on the Milan exchange.


Telescopic Contact Lens Zooms In With A Wink

Telescopic contact lens

The prototype device. Pic: Eric Tremblay and Joe Ford. Courtesy of EPFL.

A telescopic contact lens that can zoom in and out with the wink of an eye has been unveiled by researchers.

The latest prototype, which offers hope to some of the 285 million people estimated to be visually impaired worldwide, was revealed at the American Association for the Advancement of Science annual meeting in California.

The 1.55mm thick lens contains an extremely thin, reflective telescope.

Small mirrors inside bounce light around, expanding the perceived size of objects and magnifying the view, similar to looking through low-magnification binoculars.

Telescopic contact lens

The 1.55mm-thick lens. Pic: Eric Tremblay and Joe Ford. Courtesy of EPFL.

Optics specialist Eric Tremblay from the Ecole Polytechnique Federale de Lausanne in Switzerland also debuted complementary smart glasses that recognise winks – but ignore blinks – allowing the wearer of the contact lenses to switch between normal and magnified vision.

The user winks with their right eye for magnification and the left for normal vision.

First released in 2013 and refined since then, the hi-tech optical device magnifies objects 2.8 times.

Mr Tremblay said: “We think these lenses hold a lot of promise for low vision and age-related macular degeneration (AMD).”

The sight disorder is the leading cause of blindness among older people in the West.

Funded by the Defense Advanced Research Projects Agency (DARPA), the lenses were meant to serve as a form of bionic vision for soldiers.

Mr Tremblay stressed the device was still at the research stage, but was hopeful it could eventually become a “real option” for people with AMD.

He said: “It’s very important and hard to strike a balance between function and the social costs of wearing any kind of bulky visual device.

“There is a strong need for something more integrated, and a contact lens is an attractive direction.”

The telescopic contacts are currently made using a rigid “scleral” lens, unlike the soft contacts most people wear.

And while larger, Mr Tremblay said they were safe and comfortable.

The lenses are made from several precision-cut pieces of plastic, aluminium mirrors and polarising thin films, along with biologically safe glues.

Because the eye needs a steady supply of oxygen, the scientists have worked to make the device more breathable, using tiny air channels roughly 0.1mm wide within the lens.

The research team, which includes the University of California, San Diego, as well as experts at Paragon Vision Sciences, Innovega, Pacific Sciences and Engineering, and Rockwell Collins, said the device represented a “huge leap” forward.

There are glasses already on the market for people with AMD that have mounted telescopes, but tend to be bulky and difficult to use.

They also do not track eye movement, so the wearer has to tilt their head and position their eyes in a certain way to use them.


J&J in the Process of Selling off Cordis.

J&J readies to rid itself of Cordis–for as much as $2B to Cardinal Health


A deal that was rumored this summer now looks like it’s ready to come to pass. Johnson & Johnson ($JNJ) is ready to sell off its Cordis business to Cardinal Health for as much as $2 billion, according to report by Bloomberg. Cordis has elicited multiple offers from bidders, some of whom may still be in the running.

The Cordis division focuses on coronary and peripheral vascular disease. This includes diagnostic and interventional products such as catheters, balloons, stents, wires and vascular closure.

J&J has seen massive revenue growth on the biopharma side and is working to bring medical devices up to par. In 2014, worldwide medical device sales for J&J were $27.5 billion, a decrease of 3.4% from the prior year. Excluding the net impact of M&A activity, including the June divestiture of Ortho Clinical Diagnostics, J&J’s medical device business had underlying operational growth of 1.5%. By contrast, its pharma sales were up an impressive 14.9% to $32.3 billion in 2014.

The company said its best device performers were its orthopedic, electrophysiology and biosurgicals products.

Alex Gorsky

When queried about the rumors of a potential Cordis sale on its January earnings call, J&J chairman and CEO Alex Gorsky responded that the company is interested in remaining in cardiovascular devices, but that it’s focusing its strategy.

“We think can really make a difference for patients, where we think the markets are promising for the future in terms of reaching more patients, expanding share, volume growth, some pricing stability,” he said. “And so, we’re going to continue to evaluate our portfolio to make sure that we’re consistent with our strategy and as it relates to cardiovascular.”

Biosense Webster is J&J’s electrophysiology business, which has been fueling its cardiac device growth. “Cardiovascular growth was driven by a 16% worldwide increase in our BioSense Webster business due to strong growth of the ThermoCool SmartTouch Catheter,” Gorsky said on the January earnings call.

Without Cordis, the conglomerate would still have 11 businesses devoted to medical devices and diagnostics including BioSense Webster, as well as the troubled orthopedic and neurological focused DePuy Synthes, Janssen Diagnostics and advanced surgical care units Ethicon and Ethicon Endo-Surgery.

If a Cordis divestiture occurs, it wouldn’t stand alone as a recent med tech departure for J&J. Last June, J&J sold Ortho Clinical Diagnostics to private equity firm The Carlyle Group for $4.2 billion.

J&J acquired Cordis for $1.8 billion in 1996. But after acquiring the company, it was unable to keep up the pace of innovation and slipped in the race to create the stent market.


Medical business targets Middle East as it looks to replicate NHS

A healthcare manufacturing and distribution company is eyeing the Middle East to help it expand further.

Selby-based GBUK says that the UK healthcare market is very mature and that the Middle East offers great opportunity as the governments in that region look to replicate the UK’s NHS.

Mark Thompson, CEO at GBUK, told The Yorkshire Post: “There’s a lot of London-based hospitals that are helping set up hospitals in the Middle East and whilst we in the UK may think that the NHS is not great, because we hear all the horror stories, around the world they really look up to the NHS.”

GBUK unveiled a new warehouse yesterday, which is intended to help aid its expansion plans, as well as to store contingency stock for the domestic market.

Mr Thompson said a lot of business who suffer a disaster, such as fire, go out of business if they don’t have contingency stock, as they can’t satisfy customer needs.

Being an NHS supplier the firm needs to “morally” take up the slack should a disaster occur at one of its warehouses said Mr Thompson and that was the reason for the new building.

He said: “Because we’re supplying goods to the NHS and we’re a business, we looked at contingency as being very important.”

Earlier this year, GBUK were at the Arab Health exhibition and in 2014 was at the medical trade show MEDICA in Germany.

“When we look at expansion there’s only so much you can expand in a mature market and the UK is a mature market,” Mr Thompson said.

At MEDICA, the firm saw interest in its products, but the Middle East market is the one most likely to offer new opportunities.

Mr Thompson said: “We are interested in Europe but again Europe is a fairly mature market.

“In the Middle East and Africa there is more and more money being spent by the governments in regards to the health of the nation and there’s new hospitals being built, new technologies.”

Although Mr Thompson believes the NHS could do more in certain aspects of cure and prevention, he said: “I think the NHS is up there with the best.”

The company’s new custom-built sustainable warehouse was opened by Selby MP Nigel Adams.

Prime Minister David Cameron made a vow to cut red tape when he came to power, but Mr Thompson said that red tape is still a hindrance to businesses.

He said: “I think the biggest challenge for anybody at the moment is red tape. The amount of red tape there is around businesses has grown dramatically and Mr Cameron, when he came to office, said he was going to cut red tape. I’ll be honest I’ve not seen any evidence of that.”

The North Yorkshire-based business currently employs 55 people and is anticipating turnover of £18m at the end of its financial year in June.

GBUK, which provides suction devices such as catheters and external devices that allowing feeding through a tube, hopes that expansion will see turnover reach £23m by the end of 2016.

Mr Thompson said the new warehouse will now give them 1 million cubic feet of space across the site in North Duffield, Selby.


WHO Urges Shift to Single-use Smart Syringes


Smart syringes that break after one use should be used for injections by 2020, the World Health Organization has announced.

Reusing syringes leads to more than two million people being infected with diseases including HIV and hepatitis each year.

The new needles are more expensive, but the WHO says the switch would be cheaper than treating the diseases.

More than 16 billion injections are administered annually.

Normal syringes can be used again and again.

But the smart ones prevent the plunger being pulled back after an injection or retract the needle so it cannot be used again.

Dr Selma Khamassi, the head of the WHO team for injection safety, told the BBC News website: “This will hopefully help eliminate the 1.7 million new hepatitis B cases, the 300,000 hepatitis C cases and the 35,000 HIV cases every year, and all those we don’t have figures for, such as Ebola and Marburg.”


Nightmare in Cambodia

Mom Heng
The abbot, Mom Heng, has now been prescribed retroviral drugs after being infected with HIV

The people of the farming community of Roka in Cambodia are living through exactly the nightmare scenario that the World Health Organization wants to stamp out with a new policy on syringes.

In wooden huts and farmhouses dotted among paddy fields, families are struggling to cope with the bombshell of a sudden and frightening mass infection of HIV.

To the astonishment and shock of this rural backwater, babies, schoolchildren and even the 82-year-old abbot of the local Buddhist temple, who is celibate, have all tested HIV-positive.

And there is one common factor that links them, directly or indirectly: nearly all of them received injections from an unlicensed doctor suspected of reusing his syringes.

The virus would have been spread from one patient to another, resulting in an escalating tally of infections that now stands at 272, with further rises expected as more tests are carried out.

Four of the victims – three elderly women and a baby – have since died.


This is also a problem in rich Western countries.

An outbreak of hepatitis C in the US state of Nevada was traced back to a doctor who used the same syringe to give anaesthetic to multiple patients.


Standard syringes cost between two cents (1.3p) and four cents. The smart syringes cost between four and six cents.

The WHO describes it as a “small increase”. However, the tiny difference in the price of one needle becomes huge when it is scaled up to 16 billion injections.

Dr Khamassi added: “Injection safety is, I think, the most cost-effective way to prevent all these diseases.

“If we compare the price of most expensive syringes to the cost of treatment for an HIV case, or a hep C case, there is no comparison.”

The WHO is also calling for sheathed needles that prevent doctors accidentally pricking their fingers.

This has happened many times during the Ebola outbreak in West Africa.

But they would treble the cost of the syringes and the WHO says these would have to be introduced “progressively”.

Reuse of traditional syringes greatly increases the risk of infection

The WHO is calling on industry to expand production and find ways of reducing the cost of the safer needles.

Marc Koska, head of Safepoint – which campaigns to stop the reuse of syringes – told the BBC: “It’s totally, totally possible.

“We’ve already done this with immunisation, which represents less than 10% of the injections given in the developing world, and that has been a fantastic success.

“Now we’re targeting the 90% of what we call curative injections.”

But the measure will not be the end of the typical syringe.

They will be needed for needle exchange programmes for drug users as well as in some treatments in which multiple medicines are mixed in the syringe before being injected.



Scanadu: The ‘Star Trek’ Medical Tricorder Becomes a Reality


Star Trek type tricorder is now a reality with Scanadu

In 2013, a man bilked investors into funding a medical device that worked like the Star Trek tricorder. He even named it after the grumpy doctor who used in on the iconic show — The “McCoy Home Health Tablet.”The man’s “investment opportunity” was a scam, and according to the National Post, he was convicted for bilking people out of their money. However, just a little over a year later, a new tricorder like device, called the Scanadu Scout, has become a reality. And it works.

The device, pictured below, works by placing it on a patient’s forehead. In a matter of seconds, a sensor measures vitals such as heart rate, temperature, blood pressure, and oxygen levels. It even provides a complete ECG reading.

Scanadu medical scanner

Scanadu medical scanner.




The device came about after a successful crowdfunding campaign, and begins shipping to backers at the end of July, 2015.

The Scanadu is the invention of Walter De Brouwer, a Belgian entrepreneur, who came up with the idea after his son suffered brain damage from a fall.

De Brouwer told CNN that he got his inspiration from Star Trek, which he said was “more than just a movie, it was a business plan.”

The tricorder in Star Trek was only used by a doctor, but De Brouwer says that the Scanadu can be used by anyone.


Philips Completes Acquisition of Volcano

Acquisition expands Philips’ global leadership position in image-guided therapy market

Amsterdam, the Netherlands and San Diego, CA, US – Royal Philips (NYSE: PHG; AEX: PHIA) today announced that it has completed the acquisition of Volcano Corporation (NASDAQ: VOLC). Volcano’s financial results will be consolidated as part of Philips’ image-guided therapy business group as of February 17, 2015. Volcano generated sales of approximately USD 400 million in 2014 and employs approximately 1,800 employees. Philips’ long-standing partnership with Volcano, the retention of key management members and in-depth preparations will facilitate the integration into Philips’ image-guided therapy business group.“The completion of the Volcano acquisition is an important milestone in our strategy to become the leading systems integrator in the fast growing image-guided minimally invasive surgery market and accelerate our growth in that market,” said Frans van Houten, Chief Executive Officer of Royal Philips. ”The combination of Volcano’s broad portfolio of imaging and measurement catheters and Philips’ leading interventional imaging solutions allow us to provide our customers with an integrated solution to improve procedural outcomes at a decisive stage in the health continuum. ”

In image-guided treatments of the heart and blood vessels, there is increased clinical evidence which demonstrates that the use of imaging and measurement catheters in conjunction with interventional X-ray imaging helps improve procedural outcomes. Such catheters are single-use disposables, and Volcano is the only company in the industry with leading positions in both IVUS (intravascular ultrasound) catheters that are capable of producing ultrasound images of the interior of blood vessels and FFR (fractional flow reserve) catheters that are used to assess  the blood flow. The acquisition complements Philips’ existing portfolio of interventional X-ray and ultrasound imaging equipment, navigation systems, software and services, and creates new sources of recurring revenue streams.

The acquisition of Volcano occurred through a merger under Section 251(h) of the General Corporation Law of the State of Delaware following the successful completion of Philip’s previously announced tender offer to purchase all outstanding shares of common stock of Volcano for USD 18.00 per share in cash, without interest, less any applicable withholding of taxes. The tender offer expired at 9:00 a.m., Eastern Time, on February 17, 2015. As of the expiration of the tender offer, approximately 49,220,771 shares (including 2,967,581 shares tendered pursuant to guaranteed delivery procedures) were validly tendered and not properly withdrawn in the tender offer, which represented 94.8% of the outstanding Volcano shares, according to the depositary for the tender offer. All conditions to the tender offer having been satisfied, Philips accepted for payment all shares that were validly tendered and not properly withdrawn. Philips is financing the acquisition through a combination of cash on hand and the issuance of debt.

As a result of the merger, all remaining Volcano shares were converted into the right to receive USD 18.00 per share in cash, without interest, less any applicable withholding of taxes, the same price that was paid in the tender offer.

Volcano has requested that NASDAQ files a Form 25 with the United States Securities and Exchange Commission causing the delisting of Volcano’s common stock from NASDAQ.  Volcano’s common stock will cease trading prior to the opening of trading on February 18, 2015.


The NHS’s Chaotic IT Systems Show no Sign of Recovery


When you walk into my GP’s surgery, the first thing you see is a screen on the receptionist’s counter. Displayed on it are the words (all in capitals) “TOUCH THE SCREEN TO ARRIVE FOR YOUR APPOINTMENT”. Being pedantic, the first time I saw it I pointed out to the receptionist that I had arrived for my appointment. She grimaced. I then asked if the medical implications of asking every patient to use the same touchscreen during, say, a flu epidemic had been considered. Another grimace. It was, she explained, “a new system”.

This system was provided by Epic Systems, a US corporation based in Wisconsin, which may explain why its software designers seem unfamiliar with the verb “to arrive”. It’s one of eight major vendors of healthcare information systems, all of which are based in the US, and it got its foot in the NHS door quite a long time ago. My doctor’s surgery has been using it for a while. At the beginning, the system’s user-interface was abysmal and dysfunctional. Now, several years on, it’s merely ugly. But at least it works.

On 26 October, our local hospital, Addenbrooke’s, which is run by Cambridge University Hospitals Foundation Trust (CUHFT), made an excited announcement on its website. “A new patient record system to improve patient care at Cambridge University Hospitals has been switched on. eHospital went live across the Trust this morning at 02:00. The new system will improve the quality of care for patients by ensuring that doctors, nurses and other clinical staff can access relevant patient information wherever they are, at the click of a button and on bespoke software that has been designed by and for clinicians.”

The hospital’s chief information officer declared that he and his colleagues were “delighted that this revolutionary new system has now gone live. It is the biggest single investment the Trust has ever made in the quality of patient care, and will make a real difference for everyone who comes into the Trust… Instead of having to wait for paper records to be delivered to the ward, nurses are able to bring up patient notes on their handheld devices. Patients will get their medication quicker, nurses can spend more time with their patients and people who are treated here will get home sooner.”

Now spool forward to 2 November, when I received an email from a friend who had broken her foot and gone to Addenbrooke’s.

“I had the bad luck to arrive the day after the hospital switched on to its ‘revolutionary new patient record system’, eHospital,” she wrote. “My son and I got to A&E at about 9pm to find posters up everywhere boasting about this, the usual endless queue of waiting patients and most of the staff clustered around computers, unable to do anything until they had logged on, and apparently finding constant glitches.

“Both patients and staff were really struggling,” she went on. “It’s not just teething troubles. The staff I’ve spoken to have huge doubts about the system itself – they say there was some consultation with them, but their responses were very selectively received. I doubt if they consulted patients. From the patients’ point of view,” she wrote, “it is quite dehumanising. Staff now approach [while] gazing at a mobile device and trying to find you on it; then they check you in with a wrist barcode. There is no time for conversation or even often for eye contact. Some of this might improve as they get more confident with the system but they are deeply unhappy with the change in culture and they say all the real nurses will leave.”

My friend’s observations cannot be dismissed as the biased grumblings of a pissed-off patient. They are confirmed in an official report to the local health committee by Jessica Bawden, director of corporate affairs, Cambridgeshire and Peterborough Clinical Commissioning Group. “On the evening of Saturday 1 November,” Bawden reported, “the Epic system became unstable. The decision to switch to a read-only version of the software was taken at approximately 11.15pm. Following expert technical advice and action from suppliers, the system was restored at 2.27am. Business continuity plans were deployed and a ‘major incident’ across the system was declared. All agencies came together during the night to support CUHFT; for example, all ambulances were rerouted to different hospitals for a five-hour time period.”

Just for the avoidance of doubt, this is not an anti-NHS rant. Addenbrooke’s is a pretty good hospital. And the NHS badly needs a paperless health-records system. This is just the latest instalment in a long-running saga in which British public institutions display their inability to introduce complex IT systems without causing chaos and distress.

We’ve been screwing up like this for two decades. Isn’t it time we tried learning from our mistakes?


Obese Could Lose Benefits if they Refuse Treatment – PM

Overweight man eating fast food

People who cannot work because they are obese or have alcohol or drug problems could have their sickness benefits cut if they refuse treatment, the PM says.

David Cameron has launched a review of the current system, which he says fails to encourage people with long-term, treatable issues to get medical help.

Some 100,000 people with such conditions claim Employment and Support Allowance (ESA), the government says.

Labour said the policy would do nothing to help people to get off benefits.

Campaigners said it was “naive” to think overweight people did not want to change their lives.

There is currently no requirement for people with alcohol, drug or weight-related health problems to undertake treatment.

‘A life of work’

Mr Cameron has asked Prof Dame Carol Black, an adviser to the Department of Health, to look at whether it would be appropriate to withhold benefits from those who are unwilling to accept help.

Announcing the proposal, he said: “Some [people] have drug or alcohol problems, but refuse treatment.

“In other cases people have problems with their weight that could be addressed – but instead a life on benefits rather than work becomes the choice.

“It is not fair to ask hardworking taxpayers to fund the benefits of people who refuse to accept the support and treatment that could help them get back to a life of work.”



Bottles of alcohol

By political correspondent Alex Forsyth

David Cameron sees the wide-ranging welfare reforms introduced in this Parliament as part of a “moral mission”.

He has said they give new hope to people who have been written off by helping them back to work.

He also knows taxpayers who fund the welfare state like policies which ensure benefits only go to those who need them.

So despite criticism of what some see as an increasingly punitive benefits regime, the Conservatives are floating a new suggestion – possible sanctions for those claimants who refuse help to overcome treatable conditions.

On the same day, during a speech in Wales, Labour’s leader will pledge to continue his attack on tax avoidance.

So David Cameron runs the risk of being seen as someone wanting to crack down on some of society’s most vulnerable, while Ed Miliband targets the wealthiest.

The truth is both party leaders are trying to persuade “hard-working families” that they’re on their side.


Similar proposals have been considered by the government before.

In 2010 and 2012 the Conservatives considered plans to remove or cut benefits for drug and alcohol addicts who refused treatment.

At the time the plans were met with concern by charities, who said there was no evidence benefit sanctions would help addicts engage with treatment.

Disabilities Minister Mark Harper said people who were overweight or had alcohol or drug problems needed treatment to get back to work

Dame Carol welcomed Saturday’s announcement, saying: “These people, in addition to their long-term conditions and lifestyle issues, suffer the great disadvantage of not being engaged in the world of work, such an important feature of society.”

And Minister for Disabled People Mark Harper told the BBC the right interventions could be “very successful”.

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Case study

Terry Hogan, 45, from Ashton-under-Lyne, has been on incapacity benefit – before it became ESA – since 1992 and is also on a weight-management course.

He suffers from fibromyalgia, osteoarthritis, type-2 diabetes, depression, lymphoedema, cellulitis, and Klinefelter’s Syndrome.

He said his illnesses had caused him to become more sedentary, which in turn led to him putting on weight.

“When I was well enough I did voluntary work,” he told the BBC.

“In 2012 I became incapacitated to the point where everything I do leaves me tired and in pain.

“I don’t think this review is helpful. If you’re overweight on sickness benefits, forcing someone to lose weight and cutting benefits won’t help the individual. There may be underlying causes to weight gain.

“I still walk on crutches, am in a lot of pain all of the time, and take a lot of painkillers. I do want to lose weight but it’s not that simple.”

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Susannah Gilbert, from obesity support group Big Matters, said the policy “wouldn’t be feasible”.

She said: “I think it’s naive to think that people don’t want to change their life. Many of them have tried every diet under the sun and they still have a weight problem, so to think they don’t want to have help isn’t true.”

Not helping

Labour’s shadow minister for disabled people, Kate Green MP, said the announcement did “nothing to help people off benefits and into work”, adding: “David Cameron’s government has stripped back funding for drug support programmes and their Work Programme has helped just 7% of people back to work, so it is clear the Tory plan isn’t working.”

The UK Independence Party also said it was “another example of the way that this government bullies those it has decided are beyond the pale”.

Deputy chairman Suzanne Evans said: “The government obviously doesn’t care about those with weight or addiction problems, it is just ideologically driven by its contempt for those on benefits and its need to get the benefits bill down at all costs.”

ESA was introduced in 2008 to replace incapacity benefit and income support, paid because of an illness or disability.

It requires claimants to undertake a work capability assessment to see how much their illness or disability affects their ability to work.

Once a claim is accepted, those receiving ESA get up to £108.15 a week.

Some 60% of the 2.5 million people claiming ESA have been doing so for more than five years, government figures show.



Whistleblowing: NHS crushes those who speak out, Sir Robert Francis QC warns

The NHS should exploit the idealism of its doctors and nurses – not crush those put patients first, warns Sir Robert Francis, ahead of his landmark report on whistleblowing

Sir Robert Francis QC is poised to publish the results of a landmark inquiry into perhaps the greatest NHS scandal – the failure of the health service to take heed when its own doctors and nurses warn that patient safety is at risk.

His review has taken two months longer than expected, after he was deluged with more than 18,000 submissions.

Senior doctors and nurses told how their careers were left on the scrapheap, after they tried to alert NHS managers of unsafe practices and cost-cutting risking lives.

Sir Robert was appointed by the Health Secretary to lead the review last June, after chairing a public inquiry which scrutinised years of appalling care at Mid Staffs Hospital, where staff who tried to speak out told how they were bullied, and even afraid to leave hospital grounds unescorted.

Just before he was appointed to lead the review, he told The Telegraph of his fears about the culture of the NHS – and why his own son gives him a vested interest in the future of the NHS.

As chairman of the Mid-Staffs inquiry, Robert Francis QC heard devastating testimonies about basic failings in patient care, for more than 3 years, from almost 300 witnesses.

But for the barrister, 64, equally compelling messages came from one source far closer to home.

While Mr Francis (now Sir Robert) spent three years hearing about the worst behaviour distorting the values of the health service, until his inquiry reported in 2013, his son was making his way in life as a trainee doctor.

“I have a personal investment in the future of the NHS, in that regard,” said Sir Robert, speaking from his legal chambers, off Fleet Street, last May.

“I have learned from my son, and from other trainees, that we can learn a lot from the fresh eyes and idealism that doctors and nurses have when they start out. It is so important to exploit that, and not to crush it.”

Sir Robert believes that many of the worst failings in the NHS occur when clinical staff become powerless — are left “shrugging their shoulders” rather than challenging poor care.

He was encouraged, he says, by changes introduced by the Government to improve openness and transparency, including an overhaul of NHS regulation, ratings for hospitals and improvements to training of staff.

But he feels more should be done.

In particular, the leading QC wanted changes in the law to put the onus on staff to speak out if patient care is at risk – specifically a legal duty of candour to be placed on health professionals.

“We do need to protect individuals by making sure they feel safe to report things to their employers,” he says. “I felt a statutory duty would have assisted that — too often those who raise concerns about things that go wrong become unpopular with colleagues and they need some form of protection.”

He also raises concerns about “complacency” in the health service, with too great a tolerance of errors and failings in care which can prove catastrophic.

“The vast majority of those receiving care in an NHS hospital get perfectly acceptable care,” Sir Robert says. “The trouble is it’s no use being satisfied or complacent — if we ran our airline industry on the same basis planes would be falling out of the sky all the time.

“We’ve just got to change the attitude that because it’s provided by the state, it’s all right for a number of people to be treated badly — well, it’s not. Airlines would go out of business very quickly if they worked that way.”

Sir Robert suggests that deference to medical professionals — “allowing them a God-like status” — and pride in the NHS have stifled political debate about its failings.

But he believes the culture of the NHS is changing, crediting Jeremy Hunt, the Health Secretary, for a “refreshing change” of approach in standing up for patients, suggesting that his predecessors — from both parties — tended instead to act “as a spokesman for the NHS”.

He also suggests too many hospitals use financial problems as an excuse for poor care. “If you can’t afford to look after your old people or your children safely that’s just unacceptable,” he says, “and I don’t believe when it comes down to it that lack of money is a justification.”

A month after the interview, Sir Robert was appointed to lead the first ever inquiry into the treatment of those who try to blow the whistle on poor care.

As he made a public call for evidence, he told The Telegraph that he feared too many had been hounded out of the NHS by “a culture of denial and fear”.

Sir Robert said increasing numbers of whistle–blowers had contacted him since his public inquiry reported in 2013.

“Since the inquiry I’ve had a lot of people talk to me about the culture of fear that prevents people speaking out,” he said.

Sir Robert said the Mid Staffs inquiry had exposed the “consequences for patients when there is a ‘closed ranks’ culture” – and warned that every time the NHS treated a whistleblower badly, yet more were deterred from “doing the right thing”.

The inquiry has heard from senior doctors and nurses who say they were hounded out of their jobs, with some losing their homes, careers, and health, after going public about their concerns.


In response, the Government is expected to outline changes in the training of doctors and nurses, to emphasise the importance of whistleblowing, in a bid to change the culture of the NHS.

A new watchdog, the Commission on Education and Training for Patient Safety, will aim to change the culture of the NHS, so that all staff – whatever their rank – are encouraged to speak up if they see risks to patients, regardless of where the fault lies.

Mr Hunt has already promised an annual review of 2,000 deaths a year, to determine just how many could have been avoided, with the right care.

The annual review will be used to monitor NHS performance, and hospitals will be assigned estimates of how many deaths might have been avoided, given their safety record.

Mr Hunt told the Telegraph the reforms are “the most profound change to happen while I am Health Secretary” and would mean the NHS followed the lessons of the airline and nuclear industries, which have radically improved their safety record.”



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