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ME exercise therapy guidance scrapped by Health watchdog Nice

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ME exercise therapy guidance scrapped by Health watchdog Nice

A disputed therapy that encourages people with ME to gradually increase physical activity will no longer be officially recommended, a health watchdog said, marking a victory for campaigners.

The controversial treatment, called graded exercise therapy, has been removed from guidance given by the National Institute for Health and Care Excellence (Nice) for diagnosing and managing myalgic encephalomyelitis, which is also known as chronic fatigue syndrome.

The long-awaited landmark guidance had been due in August but was put on hold following concerns from some groups over its contents. It is thought some health professionals had been unhappy with some of the recommendations made by Nice.

The campaign group ME Action UK had urged Nice to publish the guideline – which said graded exercise should not be recommended – without delay, saying evidence demonstrated that graded exercise “harms most people with ME” and that any evidence supporting its use “was deemed to be of low or very low quality by the independent Nice guideline committee”.

Charities and patient groups had been fighting for greater recognition of the condition as a medical illness rather than psychological problem. Graded exercise therapy (GET) involves incremental increases in physical activity to gradually build up tolerance. Patient groups have argued that its use suggests those with ME have symptoms due to inactivity.

ME is thought to affect about 250,000 people in the UK and has been estimated to cost the economy billions of pounds annually. The condition includes sufferers experiencing mental fogginess, pain and a debilitating loss of energy.

It can affect anyone, including children, but is more common in women, and tends to develop when people are in the mid-20s to mid-40s age bracket. Treatments have included, besides graded exercise therapy, medication to control pain, nausea and sleeping problems, as well as cognitive behavioural therapy.

Sian Leary, from ME Action UK, said not publishing the guideline in August had been “devastating to thousands of people with ME” whom she said had been “seriously harmed by graded exercise therapy”.

Nice held a roundtable meeting in London in October with professional organisations and representatives from interested patient groups to discuss key issues around the guideline.

The new guideline says that ME/CFS is a complex condition where there is no “one size fits all” approach to managing symptoms, and adds that any therapy would depend on patient preferences and should not represent a fixed increase in activity.

The guideline says people should be given a personalised plan that is reviewed regularly. Nice said this was designed to help people understand their energy limits so they could reduce the risk of over-exertion worsening their symptoms.

The guideline also recommends a route to earlier diagnosis for those with ME/CFS, reducing the time-span for persistent symptoms from four months to three before a diagnosis is made.

Lady Finlay, consultant in palliative medicine and vice-chair of the guideline committee, said: “ME/CFS is a complex long-term condition that causes disordered energy metabolism and can be profoundly disabling. Those with ME/CFS need to be listened to, understood and supported to adapt their lives.

“The committee members involved in this guideline have worked particularly hard to ensure care becomes more empathetic and focused on the individual’s needs.”

Prof Chris Ponting, at the Institute of Genetics and Molecular Medicine, University of Edinburgh, said: “The new Nice guidelines will improve the lives of people with ME worldwide, well beyond England and Wales. They will improve awareness that graded exercise often makes ME symptoms worse.

“Nice took due care and attention developing these guidelines, applying their rigorous methods and listening to highly regarded professionals and lay people. Low and very low-quality scientific evidence was rightly discarded.

“Graded exercise therapy and cognitive behavioural therapy cannot now be offered as cures. The new guidelines vindicate the longstanding views of many people with ME, their carers and families.”

Prof Peter White, emeritus professor of psychological medicine, at Queen Mary University of London, said: “Having looked after many patients with this illness I worry that this guideline seems to suggest that patients need to learn to live with CFS/ME, rather than be helped to recover from it.

“Nice have banned graded exercise therapy, in spite of it being found to be helpful in a major Cochrane systematic review, while recommending an energy management programme which involves ‘staying within your energy limits’, for which there is little evidence for it helping, and some evidence that it doesn’t.”

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Nurses reject NSIWC circular on allowances

Lagos nurses, midwives suspend 3-day warning strike

The National Association of Nigerian Nurses and Midwives, Federal Health Institutions (NANNM-FHI), has rejected a recent circular issued by the National Salaries, Income and Wages Commission (NSIWC).

The association called it unfair and dismissive of the role of nurses in federal health institutions.

The circular, No. SWC/S/04/S.218/III/646, dated June 27 and titled “Review of Allowances for Medical/Dental Officers in the Federal Public Service,” was criticised for excluding nurses from key allowance revisions.

Rising from an emergency National Executive Council (NEC) meeting on Thursday in Abuja, the association said the circular failed to recognise the important contributions of nurses, who account for between 60 and 70 per cent of the healthcare workforce.

NANNM-FHI President, Nurse Morakinyo-Olajide Rilwan, told journalists that the circular was issued without prior consultation with the association, in spite of its impact on a major segment of healthcare professionals.

He said the document did not address critical allowances due to nurses, including shift, uniform, specialist, call duty, and retention allowances.

“Nurses run intensive shifts, spending extended hours with patients and their relatives. Yet, our current shift allowance is just 8.5 per cent of our salary, despite a 2009 circular approving 30 per cent of basic salary,” Rilwan said.

He added that nurses are required to change uniforms multiple times daily due to the nature of their duties, stressing that uniform allowance should reflect this reality.

“Uniforms are essential, not optional. At a minimum, we need three uniforms a week,” he said.

Rilwan said the selective application of the specialist allowance was discriminatory and unfair to nurses with specialist qualifications.

He noted that nursing includes several specialist cadres who deserve equal treatment.

He called on the Federal Government to prioritise the retention of trained nurses, who are increasingly migrating abroad in search of better conditions

“Nigeria has the nurses, but we are losing them due to poor welfare and policy neglect,” he said.

Rilwan also urged the government to reconstitute the Governing Board of the Nursing and Midwifery Council of Nigeria, saying it had remained dormant for years.

He added that nurses must also be included in the boards of Federal Health Institutions, as they represent the largest workforce in the sector.

He expressed concern over the removal of nurse educators, especially those on grade levels 7 and 8, from clinical duties, in spite of their role in training student nurses.

“The same circular states that trainers should be paid. Yet, those training others are being sidelined,” he said.

The NANNM-FHI president further demanded internship placements for university-trained nurses to enable them to participate in the National Youth Service Corps (NYSC), recommending a centralised system to ensure uniformity and quality.

He also called for the creation of a Department of Nursing within the Federal Ministry of Health.

“While we have a Director of Nursing, there is no actual department. There should be directorates for training, statistics, and clinical practice within that framework,” he said.

Rilwan said the association was open to engagement and dialogue with the government and would allow time for an appropriate response.

However, he warned that failure to act could lead to industrial action.

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Lagos to begin mandatory health insurance enforcement for residents

The Lagos State Government has vowed to begin the enforcement of compulsory health insurance policy for residents.

A Thursday statement noted that the Permanent Secretary, Lagos State Health Management Agency, Dr Emmanuel Zamba, said the enforcement would begin in earnest in early 2026, in line with the Executive Order signed by Governor Babajide Sanwo-Olu in July 2025.

She made this known at the Ilera Eko Providers Forum held at the Lagos Sheraton Hotel, Ikeja, where key stakeholders across the health insurance value chain, including healthcare providers, health maintenance organisations, and technical partners, gathered to review progress and discuss future implementation strategies.

The order mandates that residents must show evidence of enrolment in a health insurance scheme before accessing public health services, excluding emergencies.

‘We want all residents to be aware and onboard before enforcement begins’, the permanent secretary said, urging residents to embrace the scheme as a financial protection tool.

‘We are finalising our emergency services programme to ensure that no Lagos resident is denied urgent care’.

‘People in emergencies must be treated without first presenting an insurance ID’, Zamba added.

To further strengthen identity management and prevent fraud, Zamba disclosed that LASHMA had partnered with the Lagos State Residents Registration Agency to roll out biometric card readers across health facilities.

‘This will eliminate impersonation and ensure only genuine enrollees benefit from the scheme’, she said.

He also highlighted the agency’s expansion into diagnostics, telemedicine, and virtual care initiatives designed to extend access to remote and underserved populations.

‘Even if there is no facility near you, you can dial a toll-free number or use our app for a live consultation with a doctor, 24/7.

‘We have also installed virtual booths in marketplaces to provide health education and consultation services on the go’ he explained.

The Ilera Eko Providers Forum, according to Zamba, is not just a platform for information dissemination but a critical feedback mechanism.

He announced that LASHMA would now host quarterly provider engagement meetings to receive and act on feedback from partners, with a view to improving the scheme’s responsiveness.

‘This is a partnership, and like all successful partnerships, it must be mutually beneficial. We are here to listen, dialogue, and find lasting solutions together’, he said.

The permanent secretary noted that the state currently has over 865 accredited providers, ranging from primary healthcare facilities to specialists in dental and eye care, as well as community pharmacies.

‘Healthcare providers are now the gatekeepers of our scheme’, Zamba said, adding: ‘We are training them not just to offer care but to enrol clients right at their facilities as part of our broader strategy to drive up enrolment figures’.

Zamba revealed that over 400 providers had so far been trained under the newly established Ilera Eko Academy, a platform aimed at equipping providers with the tools and knowledge to actively support enrollment and implementation efforts.

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Lagos state govt move to curb activities of unprofessional skincare producers

The Lagos State Government has announced plans to regulate and curb the activities of unqualified practitioners in aesthetic medicine,skincare.

The state Commissioner for Health, Professor Akin Abayomi, disclosed this while speaking at the 19th Annual General Meeting and Scientific Conference of Nigerian Association of Dermatologists (NAD).Travel packages

“We all know that there is an explosion in aesthetic dermatology around the world and it is not peculiar to Lagos.

“As a government, we are very concerned about this trend of unqualified people masquerading themselves as experts in aesthetic dermatology which focuses on skincare.

“These quacks administer a whole lot of treatment options that can be dangerous.

“And so, the regulatory arm of the ministry, Health Facility Monitoring and Accreditation Agency, is looking into this exploding phenomenal in Lagos.

“We want to work with NAD who are experts to define the limitations of these quacks and ensure they are under close scrutiny by government to ensure residents are not exposed to quackery,” he said

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