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A new report published last week by UK Health Secretary John Reid says that more than 120,000 patients have been treated since the start of the government's pioneering treatment center program, at a rate as much as eight times faster than traditional National Health Service (NHS) providers.

More than 10,000 of those patients were treated at “hos- pitals on wheels,“ the mobile cataract surgery units that were put into operation last February. Those surgical treatment centers travel around the country, allowing waiting lists for cataract procedures in the areas which they visit to be reduced dramatically.

The mobile cataract treatment centers are run by Netcare, an independent provider, and have been touring the country since February 2004.

The treatment center program was launched in April 2002 as a key part of the government's push to cut surgical waiting times and introduce choice for patients.

Treatment centers are streamlined units that provide fast, pre-booked surgery and diagnostic tests for patients. They often concentrate on procedures with the highest historic waiting times for treatment, including orthopedics and ophthalmology.

Since 2002, 29 NHS-operated treatment centers have opened, spread across England. Another 17 are in development, most of which will be open by this summer.

Reid said the success of the program has helped contribute to a “massive fall“ in the numbers of people waiting for operations. Figures published last week show the lowest number of people on the waiting list — as of the end of November — as 306 waiting more than nine months, a decline of 33,000 from the same period of 2003 since comparable data was first collected in September 1987. The overall waiting list for hospital admissions stood at 844,000, a decline of 13,000 from the October figure.

Waiting times for cataract patients are now being slash-ed to a maximum of three months — a target reached four years ahead of schedule.

The report is seen as paving the way for the government's announcement of the second wave of procurement due later this year by showcasing to patients, as well as to prospective bidders, the standard of care and fast service available in treatment centers.

Reid said, “Treatment centers play an important role in speeding up access to treatment for patients and improving quality of care and patients' experience. This is shown by the mobile cataract chain treating 10,000 patients in less than 11 months — operating at a rate almost eight times faster than traditional NHS services.“

He said the higher procedure rate is achievable “because the units are able to concentrate on a single procedure in a modern, purpose-built unit.“

The report said the mobile cataract units complete about 37 cataract operations a day, compared to about five a day on average by standard NHS providers.

The treatment centers are developing new staff roles, including peri-operative specialist practitioners, advanced nurse practitioners/advisers and healthcare assistant technicians in radiology, ophthalmology and surgery.

They are helping the government to offer all cataract patients the choice of at least two providers when they are told they need an operation. By this December, patients in England will be offered a choice of four to five providers at the point that their general practitioner decides such treatment is necessary. As of December 2008, patients will be offered a free choice of providers.

New treatments for liver damage eyed

Patients suffering from liver damage (cirrhosis) and failure may benefit from research by the University of Edinburgh and the University of Southampton that may lead to new life-saving treatments. At present, there is no cure for liver cirrhosis; the only hope of survival is to receive a liver transplant.

The Edinburgh scientists, who are from the university's Center for Inflammation Research, are collaborating with colleagues from the University of Southampton in England and the University of Cincinnati in the U.S.

For the first time, they have identified two separate populations of immune cells — macrophages — in the liver. One group causes scarring to the liver, but the next wave of immune cells, produced only a few days later, changes function to break down and reabsorb the scarring.

These findings, published in the January edition of the Journal of Clinical Investigation, will help physicians understand the mechanisms by which the liver is damaged and repaired, and may lead to future treatments.

Dr. Jeremy Duffield, one of the University of Edinburgh researchers, said, “Now that we have shown how the macrophages work, we aim to find out how to create, activate and de-activate these cells to make them repair, rather than damage, liver tissue.“

He noted that, at a time when outcomes for other diseases, such as cancers and heart trouble, have made “dramatic gains,“ liver damage “has yet to be understood, and in turn, to become treatable.“

By way of example, Duffield said that more women in the UK now die of liver failure than of cancer of the cervix. And, he said, “There has been a fourfold increase in the number of men aged 45-54 dying of cirrhosis since 1970 and a threefold increase in women of the same age group. Liver failure is also rapidly increasing in younger people, with the deaths in the UK of 500 men and 300 women aged 25-44, in 2003.“

Professor John Iredale of the University of Southampton said: “We are facing a huge increase in the numbers of patients with advanced liver fibrosis and cirrhosis. There is a huge imperative to develop new approaches to the treatment of liver scarring. Exciting insights such as these will inform the design of future therapies.“

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