Press releases Monday 7 February to Friday 11 February 2011

Please remember to credit the BMJ as source when publicising an article and to tell your readers that they can read its full text on the journal's website (http://www.bmj.com).

(Analysis: Private finance initiatives during NHS austerity)
http://www.bmj.com/cgi/doi/10.1136/bmj.d324

It is time to reopen private finance initiative (PFI) contracts say leading public health physician, Professor Allyson Pollock, and colleagues on bmj.com today.

Professor Pollock, who is based at the Centre for International Public Health Policy at the University of Edinburgh, argues that "NHS PFI contracts are not good value and are endangering patient care".

Since 1997 most large-scale public capital investment in the UK has been through PFI purchasing schemes where investment banks and building companies raise the finance for public infrastructure projects.

In England, 101 of the 135 new NHS hospitals built between 1997 and 2009 were paid for under PFI (90% of the £12.2 billion committed under successive building programmes).

The authors explain that debt repayments amounting to £42.79 billion are due under the contracts and that the annual repayments will increase just when public spending is being cut back.

Evidence of high cost of PFI investment relative to public financing is well established, they say, and the high interest charges set by banks together with returns demanded by equity investors are not justified by the risks involved.

In a number of schemes, annual debt repayments to the PFI consortia were between 1.49 and 2.4 times higher than the amount that would have been charged to the UK government if they had borrowed the money themselves, a one hospital for the price of two policy. They add that "PFI interest rates have risen since the banking crisis and are exacerbating the serious financial difficulties of PFI hospitals and the NHS as a whole."

A report from the National Audit Office (June 2010) says contract monitoring of PFI projects is deficient and that some trusts are paying more for PFI services than needed. This lack of control over PFI costs has serious implications for the quality and levels of NHS care, conclude the authors.

According to Professor Pollock, "the taxpayer and NHS patient is paying several times over: the multi billion pound government bail out of the banks coupled with the debts incurred on PFI schemes underpin the current reductions in public expenditure and public services. Cuts in NHS funding and the high cost of PFI debt charges translate into staff redundancies, service closures and reductions in access to and quality of care for patients."

They also question the affordability of PFI in the current financial climate and argue that it is time to reopen and evaluate the contracts. They say "the recent government rescue of the banks to the tune of hundreds of billions of pounds following the financial crisis in autumn 2008 presents an ideal opportunity for reopening the contracts."

They add that "the current situation which privileges investor returns at the expense of public health care and services and NHS staff cannot be allowed to continue".

Contact:
Allyson Pollock, Centre for International Public Health Policy, University of Edinburgh, Scotland, UK
Email: allyson.pollock@ed.ac.uk

(2) Almost three quarters of BMJ readers think English healthcare will be worse in five years

Click here to view full poll results:
http://resources.bmj.com/bmj/interactive/polls

Almost three quarters (72%) of BMJ readers think healthcare in England in five years' time will be worse or much worse compared with now, a BMJ poll shows today (Tuesday 8 February 2011).

The results also show that just over one in ten (11%) think it will be better while only 4% believe it will be much better and 13% think it will be the same.

A total of 1,183 votes were cast on bmj.com over the last 14 days.

Commenting on the results, BMJ Editor in Chief Dr Fiona Godlee said: "These results reflect a consensus of concern among healthcare professionals about the government's plans for the NHS in England in these exceptionally tight economic times. The BMJ shares the widely held fear that the reforms could destabilise the NHS and damage patient care."

(3) Experts urge even greater caution in use of x-rays during pregnancy and infancy

(Research: Early life exposure to diagnostic radiation and ultrasound scans and risk of childhood cancer: case-control study)
http://www.bmj.com/cgi/doi/10.1136/bmj.d472

Clinicians should be careful about using x-rays on pregnant women and infants because of the potential for a slight increase in the risk of children developing cancer, concludes a new study published on bmj.com today.

The study is consistent with what doctors have long suspected, and why women of childbearing age are always asked about the possibility of pregnancy before being x- rayed.

A UK-US collaborative study found small increases in risk of cancer for children who had x-rays at ages less than three months and in children whose mothers had undergone an x-ray while pregnant. These increases were not statistically significant. The researchers report no increased risk from ultrasound scans.

Researchers studied the childhood cancer risk associated with exposure to radiation and ultrasound scans during gestation (in utero) and in early infancy.

Previous studies of children born between the 1940s and the 1970s, when radiation doses were likely to be higher, found in utero x-ray exposure to be associated with an increased risk of childhood cancer, particularly leukaemia. The effect of medical radiation on young children has been less clear.

Although diagnostic x-rays and other radiological imaging procedures to the abdomen and pelvis of pregnant women are rare, there are concerns about the growing use of computed tomography (CT) scans and other types of higher-dose imaging procedures on younger children.

Furthermore, much of the existing data are based on interviews, allowing for the distinct possibility of misclassification, recall bias, or both as regards exposure.

Researchers compiled data on 2,690 children with cancer and 4,858 healthy children from the UK Childhood Cancer Study (UKCCS). All children were born between 1976 and 1996. Data on exposure to radiographic and ultrasound examinations were collected from medical records

A total of 305 children received 319 radiographic and related examinations while in utero and 170 children received 247 diagnostic x-ray examinations in early infancy. A total of 13,723 in utero and 138 early infant ultrasound scans were carried out.

Researchers measured the risk of childhood cancer overall, and leukaemia, lymphoma, and central nervous system tumours specifically.

Results showed a slightly heightened risk following in utero exposure to x-rays for all cancers and for leukemia, though neither was statistically significant.

Exposure to diagnostic x-rays in early infancy was found to be associated with a small, non-significant extra risk for all cancers and leukemia, as well as increased risk of lymphoma, but this finding was based on small numbers (only seven cases).

The researchers conclude: "Our results, which indicate possible risks of cancer from radiation at doses lower than those associated with CT scans, suggest a need for cautious use of diagnostic radiation imaging procedures to the abdomen/pelvis of the mother during pregnancy and in children at very young ages."

Contact:
Preetha Rajaraman, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
Email: ncipressofficers@mail.nih.gov

(4) Is it time for all skiers to wear helmets?

(Editorial: The protective effects of helmets in skiers and snowboarders)
http://www.bmj.com/cgi/doi/10.1136/bmj.d857

In a bid to decrease brain injuries from skiing and snowboarding accidents, experts in an editorial published on bmj.com today are calling for more public awareness to promote ski helmets.

Dr Gerhard Ruedl and colleagues from the Department of Sport Science at the University of Innsbruck in Austria say there is convincing evidence that ski helmets protect against head injury. They argue that one way to increase helmet use is to ensure that they can be easily hired or included in skiing packages.

The authors say that the debate about ski helmets has intensified after a few fatal skiing injuries in Europe and North America. On New Year's Day in 2009 a politician wearing a helmet collided with a woman who was not wearing one. The politician survived but the woman did not. In March 2009, actress Natasha Richardson died after a traumatic head injury while skiing in Canada; she was not wearing helmet.

A recent study concluded that general head injury was reduced by 35% when ski helmets were used and this rose to 59% for children under 13. "Wearing a ski helmet seems to make sense to prevent head injuries in all age groups," say the authors.

They acknowledge, however, that there are some arguments against helmets. There is a theory, they say, that helmet use may provide a false sense of security and result in riskier behaviour. One study found that helmet use is higher in more skilled skiers so perhaps "the use of a helmet is not necessarily associated with a higher level of risk taking but primarily with a higher level of skill" they suggest.

Ultimately the authors believe the evidence points to helmets having a protective effect and say that action needs to be taken to increase helmet use.

Contact:
Gerhard Ruedl, Postdoctoral Researcher, Department of Sport Science, University of Innsbruck, Innsbruck, Austria
Email: gerhard.ruedl@uibk.ac.at

Emma Dickinson
Tel: +44 (0)20 7383 6529
Email: edickinson@bma.org.uk

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