The abortion rate has dropped for the second year running in England and Wales, statistics show.

But experts said it was still too early to say whether there was a downward trend.

The total number of abortions was 189,100 in 2009 – a rate of 17.5 per 1,000 women aged 15 to 44, according to the Department of Health figures.

This compares to 18.2 in 2008 and comes after a general upward trend for the past 40 years which peaked in 2007.

The abortion rate in Scotland also fell last year to 12.4 per 1,000.

Funding

Ann Furedi, of the British Pregnancy Advisory Service, the largest abortion provider in the UK, said: "Abortion figures tend to fluctuate slightly year-on-year so we can’t call this a trend yet, especially with the background of the last few decades’ gradual rise."

And she added: "Unintended pregnancy and abortion will always be facts of life because women want to make sure the time is right for them to take on the important role of becoming a parent.

"Abortion statistics are reflective of women’s very serious consideration regarding that significant role within their current situation."

At the beginning of the 1970s the abortion rate was around the 8 per 1,000 figure, but after almost continuous year-on-year increases it rose to 18.6 two years ago.

Since then it has fallen, but experts remain cautious as in previous years there have been slight drops or a levelling off which have not been sustained in the long-term.

The figures also show that the proportion of abortions carried out before 10 weeks has risen, with many putting this down to the increase in funding which has improved access over the past decade.

The abortion rate was highest at 33 per 1,000 among women aged 19, 20 and 21, although that too has dropped since last year.

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Cuts to hospitals took centre stage in a health-themed election debate.

Maternity, children’s and A&E units are currently being revamped in England.

But health secretary Andy Burnham accused the Tories of being insincere by promising to put a temporary ban on changes if they win power.

Shadow health secretary Andrew Lansley had argued that some of the plans were against patients’ interests while the Lib Dems wanted local residents to be given more of a say.

The three health spokesmen were sharing a platform in an event jointly hosted by the British Medical Association, Royal College of Nursing, Kings Fund and NHS Confederation.

Reform of hospital services has been underway for a number of years to create centres of excellence which are supposed to be more efficient and provide better care at the same time.

It involves locating special lists of services in fewer places and is leading to some smaller hospitals losing high profile departments.

Mr Lansley said he was not against change but said proposals needed reviewing to ensure they were not "against the interests of patients".

But Mr Burnham said, "you are saying what people want to hear".

As Mr Lansley tried to explain his stance, Mr Burnham said "he had got himself into a large hole".

Tough decisions

The health secretary said his party had made difficult decisions while in power including making changes in his own back yard – in reference to changes to children’s and maternity care in Greater Manchester.

Lib Dem health spokesman Norman Lamb suggested local residents needed to be more involved in decisions.

"The decision should be taken by bodies that are democratically elected."

Clear differences also emerged in other areas.

Mr Lamb gave his backing to minimum pricing for alcohol, but both of the others were against such a move.

Meanwhile the Tories defended their policy of proposing a voluntary insurance system to provide care to elderly and disabled people.

Both Labour and the Lib Dems favour a compulsory levy.

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Methadone prescribed to pregnant women may be causing sight problems for their babies, a study in Glasgow has found.

The small-scale study showed 95% of the children investigated had poor eyesight, while a quarter also had significant developmental problems.

But the report in the British Journal of Ophthalmology said many of the women were also abusing illicit drugs.

Researchers said they could not be sure if methadone alone was responsible and are carrying out further studies.

Methadone is usually prescribed as a substitute for heroin, and is given to heroin-addicted mothers because it allows them to stabilise their life and reduces the risk of their babies being born underweight or premature.

However, most babies born to women who are prescribed the opioid during pregnancy have withdrawal symptoms known as neonatal abstinence syndrome (NAS).

Cerebral palsy

The study, carried out at the city’s Royal Hospital for Sick Children, examined the eyesight of 20 children whose mothers had taken methadone during pregnancy.

More than half of those babies (55%) had also been exposed to either benzodiazepines such as temazepam or heroin (40%) while in the womb.

All but one of the 20 babies had poor eyesight and seven out of 10 had involuntary eye movement (nystagmus), while vision had not yet developed fully in half of the children.

Twelve of the babies in the study had been treated for NAS, while the other eight had not.

Of the 12, one in three (35%) also had a squint, while a similar proportion (30%) had blurred vision or long or short sightedness problems.

One in four had impaired brain function relating to sight and the same proportion had significant developmental problems, including cerebral palsy.

The researchers said the underlying causes of the visual problems were not clear, but that further studies would be conducted to find out more.

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A virus that causes wheezing and pneumonia claims the lives of up to 200,000 children worldwide each year, a study has found.

University of Edinburgh scientists found that about 3.4 million children were hospitalised after contracting respiratory syncytial virus (RSV).

RSV is the single largest cause of lung infection in children.

The scientists hope the research will help contribute to the development of a vaccine against the infection.

The study, which has been published in The Lancet, confirmed that RSV – which infects most children before the age of two – usually causes mild cold-like symptoms, but can lead to serious illness in babies who are born prematurely or who have congenital heart disease.

It is the first time that the numbers of children dying globally from RSV before the age of five have been quantified.

The international team analysed unpublished data from developing countries as well as all the published medical research on RSV infection.

They found that about 33.8 million children become infected with RSV each year and that 99% of RSV-related deaths occur in developing countries.

The team hopes that by identifying the numbers affected by the virus, it can contribute to the development of a vaccine against the infection.

Dr Harish Nair, of the University of Edinburgh’s department of population health studies, said: "Our greatest hope of fighting this virus is to develop a vaccine, but before we can implement an immunisation programme, we need to understand exactly how big a problem RSV poses.

"This is the first time we have gathered information on such a global scale and is the best estimate we have for the number of children dying each year from this preventable illness."

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The Office of Fair Trading (OFT) has fined two tobacco companies and 10 retailers a total of £225m for "unlawful" tobacco pricing.

The firms were found to have colluded to push up prices during 2001-03.

The OFT said that there was an understanding that the price of some brands would be linked to rival brands in order to limit competition.

Retailers the Co-operative and Asda, received the heftiest fines at more than £14m each.

The other companies involved are manufacturers Imperial Tobacco and Gallaher, and retailers First Quench, Morrisons, One Stop Stores, Safeway, Sainsbury, Shell, Somerfield and TM Retail.

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Politicians are "not being open and honest" about the issue of hospital closures, a coalition of charities and patient groups says.

Jeremy Taylor, head of National Voices, said the parties were happy to talk about the need for savings and moving care into the community.

But he said they were "shying away" from the flip-side – services closing and even whole hospitals shutting down.

All the main parties claimed they had clear policies to tackle the issue.

Mr Taylor said his organisation did not oppose hospital reorganisation and in many cases it can make sense medically.

He said minor surgery and treatments for conditions such as asthma, diabetes and heart disease could often be done in GP practices.

Giving older people more support in their home to prevent falls or emergency admissions for their illnesses could also keep patients out of hospital, he added.

"Quite often people prefer this and it makes sense both financially and clinically, but it does mean wards and beds going and even whole district general hospitals closing.

Grown-ups

"But that is a taboo subject. Politicians don’t want to talk about it in the election and I don’t think that is fair. If the reasons for the changes are set out I think the public can understand it and be convinced.

"But MPs have to treat us like grown-ups."

Hospital reorganisation is already well under way. A&E and maternity services have been closed or earmarked for closure in a variety of places across the UK, including London, Greater Manchester and towns such as Blackburn and Burnley.

But Mr Taylor believes this is just the start as the health service prepares for the spending squeeze.

The NHS has been told to make between £15bn and £20bn of savings from 2011 to 2014.

Mr Taylor said: "It is clear we are going to see many more hospital reorganisations, but no-one is explaining why. You often find MPs going back to their constituencies and campaigning against closures, leaving it to local health managers to face the anger of residents."

Nigel Edwards, the policy director of the NHS Confederation, which represents managers, agreed more cuts were on the way.

"The NHS has to make some tough decisions about how it organises its services over the next five to 10 years.

"We will need to significantly rationalise services so we can cut costs and in many cases offer better care."

Crucial decision

The British Medical Association said it too would like more openness.

But a spokesman warned: "There is a crucial distinction to be made between reconfiguring services for clinical reasons – for example developments in keyhole surgery may mean patients do not need to stay overnight in hospital – and cutting them for financial reasons."

All three parties have said they are not against hospital reorganisation in principle and claimed their policies are clear.

A Labour party spokeswoman said: "Where there is a strong clinical case that changes to services will make improvements and save lives, we will back local NHS clinicians in making them.

"Where changes are not locally led and clinically justified, we will not support them."

The Tories have promised a moratorium on hospital changes if they win power, so that existing decisions can be reviewed.

A spokesman for shadow health secretary Andrew Lansley said the party was not opposed to changes, but said the decisions made so far had been "misguided and based on flawed analysis".

Meanwhile, the Liberal Democrats said they would back decisions that had been led by doctors and allowed local people a "direct say", which they said was not always happening currently.

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Nutrition needs to be made a more important part of the doctor training system, a leading expert has said.

Gastroenterologist Dr Penny Neild, who works at London’s St George’s Hospital, said training on how to spot and tackle malnutrition was "patchy".

She said medical schools and junior doctor programmes were focusing too much on the science of being a doctor rather than basic care.

But regulators said courses should give medics a "good understanding".

The issue of malnutrition has been a long-running concern in the NHS.

"The problem is that doctors do not recognise it and if it is not picked up the patients cannot be passed on to dieticians to address the problem"

Dr Penny Neild, gastroenterologist

Up to one in four patients may be at risk, research shows.

But the British Association for Parenteral and Enteral Nutrition (Bapen) campaign group has warned that doctors working both in hospitals and as GPs often miss the signs.

To address the issue, the government published a Nutrition Action Plan in 2007 encouraging better screening and staff training.

But Dr Neild, who is an adviser to Bapen, said it was now time to improve doctor training,in an article for the newly-formed Frontline Gastroenterology journal.

Nutrition is a core element in the first year of a junior doctor course, but it is not a mandatory part of medical school curriculums or many specialist training courses in the latter part of the junior doctor training programme.

Dr Neild said as a gastroenterologist she had to deal with the consequences of severe malnutrition which requires tube-feeding to be introduced.

"The problem is that doctors do not recognise it and if it is not picked up the patients cannot be passed on to dieticians to address the problem.

"Doctors are taught a lot about medical interventions, but not how to assess and manage poor nutrition."

‘Good understanding’

However, she accepted progress was being made.

The introduction of nutrition in the first year of junior doctor training has only been rolled out in recent years, while the royal colleges are looking at devising a standardised curriculum for medical schools which may well have more emphasis on nutrition.

But Dr Neild said it was important to build on this. In particular, she wanted to see specialist training – the part of the junior doctor course which enables medics to become a particular type of doctor such as GP or surgeon – incorporate tailored courses on nutrition.

The General Medical Council, which regulates medical school training and from April will take responsibility for junior doctor training, said training should already give medics a "good understanding" of nutrition.

The GMC said that while it may not be a core element in much of the training it would be covered in other parts of the courses.

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Welsh public services are facing cuts that will cause "considerable pain", according to a report.

The Auditor General for Wales Gillian Body said the NHS, councils and the police may need to cut staff hours and encourage part-time working.

Ms Body said services must work in "radically different ways" to face cuts of about £1.5 billion.

Her report warned that if organisations did not change, "they will simply run out of money".

Trade union Unison has warned against cutting staffing hours.

In her report Ms Body wrote: "Public services are going to have to deal with major change very soon.

"Our experience suggests that public services tend to change incrementally over time. But if they carry on with business as usual, they will simply run out of money.

ANALYSIS
Betsan Powys, BBC Wales political editor

Today’s report from the Wales Audit Office will send a shiver down the spine of public sector workers and management.

It’s a no holds barred examination of just where we are and where we need to get to in terms of reform – and it makes for grim reading.

It’s just 36 pages long, but in its doom laden tones, it has more in common with Franz Kafka, that dark theorist of intractable bureaucracy, than the dispassionate public auditor.

The analysis couldn’t be simpler – the medicine, one expects, will be very hard to stomach. Perhaps the key phrase in the report is this: "In considering disinvestment, public services will need to identify novel ways of reducing their staffing bills."

"Change will come one way or another. The challenge will be getting those changes right with good planning and timely decision-making."

The report says that as staff costs make up the bulk of most public services’ spending, they will need to "identify novel ways of reducing their staffing bills".

These include flexible working, with reduced hours or moving from full-time to part-time work.

‘Private sector solution’

Unison’s head of local government in Wales, Dominic MacAskill , has warned against some of the suggested changes to working practice.

He said: "Transposing a private sector solution to the public sector is fraught with difficulty.

"The reason why the private sector went to short-time working and reduced hours was a reduction in demand for manufacturing goods etc.

"With the public sector the demand is high and increasing. For example, social care demographics show an increase in demand."

Mr MacAskill said that whilst trade unions would be "happy to discuss any initiatives which reduce the necessity for redundancies", it would be misleading to suggest staffing costs could be reduced without cutting services.

"Our experience suggests that public services tend to change incrementally over time. But if they carry on with business as usual, they will simply run out of money"

Gillian Body, Auditor General for Wales

The Auditor General said public sector organisations must use evidence to prioritise services, moving resources away from non-priority areas.

She said just focusing on cutting costs without finding new ways of working would not be enough.

Chair of the Public Accounts Committee Jonathan Morgan AM said: "With significant financial cuts on the way, public bodies cannot expect to muddle through by doing the same things with less money.

"If they are to provide citizens with good quality services they need to focus more attention on finding radical new ways of working.

The Auditor General’s report also said public services would need to collaborate more effectively.

It argues public organisations need to do more to manage sickness absence, which has fallen among assembly government and NHS employees, but remained "fairly static" in local government.

Reducing the average number of days lost in the Welsh public sector by only one, it notes, is the equivalent of a cash injection of £27 million to the sector.

The report said organisations would face major challenges in engaging the public in the necessary changes, particularly where they involved new models of service delivery.

£1.5 billion cuts

The figure of £1.5 billion of cuts over three years is an estimate drawn from Institute for Fiscal Studies forecasts, based on HM Treasury figures.

The actual figure could be higher if there is a so-called ‘double dip’ recession delaying recovery or if the UK Government opts to pay off the national debt more quickly.

The Auditor General said the impact of the funding reduction could be even greater than the figures on real terms cuts suggest, because public sector budgets in Wales have risen by an average of 2.4 per cent above inflation since 2007-08.

She wrote: "There could be a total gap of around £5.5 billion between where public services would have gone had they continued with business as usual and where they are likely to end up."

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