2017 Q2 April-June
Health and Wellbeing Policy Update: April-June 2017
I will no longer be producing a comprehensive weekly update each week after April 2017. I may continue to add a smaller number of items, occasionally.
This was a weekly update of key policy items relating to health and wellbeing (mainly in England). It is in reverse chronological order (most recent at the top). It is grouped in three month blocks: click here for other quarters. It is also available as a spreadsheet on Knowledge hub here.
28 April 2017
The Cancer Drugs Fund in England was a “huge waste of money” and could have resulted in patients suffering unnecessarily (from the side-effects of drugs), according to research led from King’s College London and published in the Annals of Oncology. It looked at 47 treatments that were being funded by January 2015 and found that only 18% met internationally recognised criteria for being clinically beneficial. Only 18 of the 47 treatments extended the patient’s life, and then only by an average of three months. The fund ran from 2010 to 2016 and cost £1.27bn. The lead researcher said it had not been monitored properly and the policy “was politically and intellectually lazy.”
The impact of Brexit on health and social care is explored by the Health Select Committee in an initial report (a planned longer inquiry has been interrupted by the general election). The committee is concerned at whether enough resources are being put in by the Department of Health and says they should consult more widely on it. They express concern about the impact on the morale of staff from the rest of the EU. They also say that Brexit will have an impact on travellers, holiday makers and people living in other parts of Europe.
Over 60,000 people a year die in hospital when they would rather die at home, according to Macmillan Cancer Support. They say that only 1% of cancer patients say they would prefer to die in hospital but in fact 38% do. The problem, they say, is partly an unwillingness to talk about death and partly a lack of health support outside hospital, such as from district nurses.
Press release: http://www.macmillan.org.uk/aboutus/news/latest_news/thousands-of-cancer-patients-die-in-hospital-against-their-wishes.aspx
Half the number of girls manage an hour of exercise a day, as boys do, by the age of nine, according to research from the University of Bristol, which involved measuring activity of 1,300 children using an accelerometer over the period of a week in their first year of primary school then again in year 4. By that time, 65% of girls were failing to meet physical activity guidelines compared to 38% of boys. It is suggested that girls become less confident in physical activity and that new ways are needed to engage them.
27 April 2017
The Better Care Fund (BCF) is “little more than a complicated ruse to transfer money from health to local government”, plugging the gap from cuts to local authority budgets, the Public Accounts Committee has said in a report. The Committee says that officials “displayed an appallingly casual attitude to the targets that had been set for reducing emergency admissions and delayed transfers of care, both of which have actually increased.” They said there was not sufficient understanding of how best to spend money across health and social care. They also said the BCF had been rendered largely redundant by the sustainability and transformation plans (STPs) but they were unconvinced that STPs would succeed where the BCF had failed in building integration. They were also critical of the STP process in being “neither inclusive nor transparent enough.”
(This item also covers two other PAC reports): https://www.theguardian.com/society/2017/apr/27/patients-struggling-to-get-gp-appointments-watchdog-finds
News release: http://www.parliament.uk/business/committees/committees-a-z/commons-select/public-accounts-committee/news-parliament-2015/integrating-health-social-care-report-published-16-17/
Links to the report: http://www.parliament.uk/business/committees/committees-a-z/commons-select/public-accounts-committee/inquiries/parliament-2015/integrating-health-social-care-16-17/publications/
Many patients are struggling to get GP appointments but plans for seven day access are still being rolled out without the Department of Health or NHS England “really understanding the level of access currently being provided or how to get the best from existing resources” the Public Accounts Committee has said, in a report. It says the Government has not evaluated the cost-effectiveness or consequences of providing evening and weekend access for all patients. The committee also expresses concern that despite some initiatives to boost GP recruitment, HEE did not manage to meet its recruitment target last year (93% of places were filled) and they are pursuing “discrete initiatives without a credible plan for how to develop a cost-effective, sustainable workforce.”
(This item also covers two other PAC reports): https://www.theguardian.com/society/2017/apr/27/patients-struggling-to-get-gp-appointments-watchdog-finds
News release: http://www.parliament.uk/business/committees/committees-a-z/commons-select/public-accounts-committee/news-parliament-2015/access-general-practice-report-published-16-17/
Links to the report: http://www.parliament.uk/business/committees/committees-a-z/commons-select/public-accounts-committee/inquiries/parliament-2015/access-general-practice-16-17/
Nearly 3m working families with children on tax credits would be £2,500 p.a. worse off because of cuts to benefits and child tax credits, the IFS has said. The changes come alongside tax reductions that largely benefit middle and high income households.
Temporary closures of children’s hospital units are being forced by lack of staff, the Royal College of Paediatrics and Child Health warns in a report. It says that 31% of paediatric inpatient units and 41% of neonatal units had to close at some point due to staff shortages in the year to September 2015. Temporary closures have continued since then. They also say that the widespread shortage of paediatric doctors and nurses is putting children’s care at risk.
Press release: http://www.rcpch.ac.uk/news/rcpch-publishes-%E2%80%9C-state-child-health-paediatric-workforce%E2%80%9D-report
Link to the report: http://www.rcpch.ac.uk/workforce
Gypsies and travellers in Wales face barriers to accessing healthcare because of discrimination, according to a report produced by the Romani Cultural and Arts Company and the NHS Centre for Equality and Human Rights, Public Health Wales. About 100 gypsies and travellers were interviewed by community champions between April 2016 and March 2017 in what is thought to be the first survey of its kind in Europe.
Ambulance trusts are struggling to meet response time targets and variation in performance between trusts is getting worse as funding increases have not kept up with demand, the Public Accounts Committee says in a report. Only 58% of transfers from ambulances to A&E were completed within the target 15 minutes, compared to 80% in 2010/11.
(This item also covers two other PAC reports): https://www.theguardian.com/society/2017/apr/27/patients-struggling-to-get-gp-appointments-watchdog-finds
News release: http://www.parliament.uk/business/committees/committees-a-z/commons-select/public-accounts-committee/news-parliament-2015/ambulance-services-study-report-published-16-17/
Links to the report: http://www.parliament.uk/business/committees/committees-a-z/commons-select/public-accounts-committee/inquiries/parliament-2015/ambulance-services-study-16-17/
Large pharmaceutical companies may abandon the UK if more is not spent on the NHS, the Association of the British Pharmaceutical Industry is reported as saying. It is suggested that the £30bn life sciences sector could be under threat.
The NHS in England needs £25bn more over the next three years, according to NHS Providers, which represents NHS trusts. It says that without £5bn a year for the three years to 2020 and £10bn for capital spending, patients’ care and waiting times will worsen. The NHS Confederation called for £8bn a year increases after 2020-21. The Health Foundation said that the NHS “cannot bridge the gap between pressures rising at 4% and funding at 1% for much longer without quality and access suffering”.
26 April 2017
Labour would end the 1% pay cap for NHS staff and reinstate the bursary for student nurses, the shadow health secretary John Ashworth has said. They would move to public sector pay being set through collective bargaining and the evidence of independent pay review bodies. They would also require NHS trusts to have regard to patient safety when setting staffing levels and ask NICE to assess whether there should be legally enforced safe staffing levels.
‘Reality check’, looking at the figures behind the proposals: http://www.bbc.co.uk/news/health-39720085
Progress in moving people with learning disabilities out of mental health hospitals has been made in the last two years, but money is not moving with patients to pay for support in the community, too many people are not having care and treatment reviews and there is uncertainty from proposed changes to local housing allowance, the Public Accounts Committee has concluded in a report. Only £1m had moved from NHS hospitals to community services, compared to the £10.8m that should have been released. They say that there needs to be a greater focus on measuring outcomes and improvements to quality of life.
Press release: http://www.parliament.uk/business/committees/committees-a-z/commons-select/public-accounts-committee/news-parliament-2015/care-learning-disabilities-16-17/
Link to the report: http://www.parliament.uk/business/committees/committees-a-z/commons-select/public-accounts-committee/inquiries/parliament-2015/care-learning-disabilities-16-17/
Seated exercises improved physical function in 12-14 weeks for 60% of participants in a pilot run by the Royal Voluntary Service and exercise specialists Move It Or Lose It. The pilot involved 60 people aged over 60. The chair-based exercises were delivered by volunteers and staff who had received two days training. Many of the participants also said they felt less lonely and unhappy after the pilot.
25 April 2017
The Government has been ordered by the High Court to produce a draft air pollution plan by 4th May, with a final version by 31st July. There had been criticism of the Government’s attempts to delay publication. The Government had been required to produce a tougher strategy by 24th April after judges ruled that the previous plans were so weak as to be unlawful. The Government had sought a delay because of the impending general election, but constitutional experts said they were on ‘dodgy ground’. The judge said the Government could go ahead despite the election ‘purdah’ period, because of the ‘exceptional public health circumstances.’
The number of food parcels handed out by the Trussell Trust increased by 6.4% last year, to 1,182,954 it has reported. In the areas where full universal credit rollout was taking place, referral rates were more than double the national average. The trust said that the six week delay before receiving benefits as part of univeral credit was increasing the demand on food banks and called for a reduction in the delay. They also said that the full online approach to benefits administration caused difficulties for claimants without internet access.
71% of patients diagnosed with cancer in A&E had already seen their GP with the symptoms, with 41% having visited the GP three times, according to research based on data on 4,367 people who visited A&E in 2010, published in the British Journal of General Practice. Some of these included difficult-to-spot cancers, but 31% with breast cancer, 41% with bowel cancer and 37% with prostate cancer had visited three or more times.
Large cuts to local authority spending amount to a dismantling of universal services, according to a report by APSE, the Association for Public Service Excellence. Spending on local government as a share of the economy has fallen from 8.4% in 2010-11 to 6.7% by 2015-16. While there has been some relative protection of social care budgets, spending on ‘neighbourhood services’ such as highways and transport, cultural services, environmental services and planning, fell by 13% between 2010-11 and 2015-16. The cuts were bigger among the most deprived fifth of councils, at 22% compared to the wealthiest, at 5%.
Press release: http://www.apse.org.uk/apse/index.cfm/news/2017/whatever-the-shape-of-the-future-government-investing-in-neighbourhood-public-services-is-vital/
Link to the report: http://www.apse.org.uk/apse/index.cfm/research/current-research-programme/redefining-neighbourhoods-beyond-austerity/
Doing moderate exercise for at least 45 minutes per session, several times a week, helps keep the mind sharp for the over 50’s, according to a systematic review and meta-analysis of 36 studies from the University of Canberra, published in the British Journal of Sports Medicine. Aerobic exercise improved cognitive abilities such as thinking, reading, learning and reasoning while muscle strengthening affected memory and the ability to plan and organise.
24 April 2017
Many children are going hungry during the school holidays, with those at risk including over a million children who receive free school meals during term time and two million with working parents but who are still in poverty, according to a report from the all party parliamentary group on hunger. It said that they had received evidence that the malnourished children started the new term intellectually weeks or months behind their more fortunate peers.
Information about the APPG including link to the report: http://www.frankfield.com/campaigns/feeding-britain-appg-hunger.aspx
Hull CCG is pooling its £400m budget with Hull City Council’s £200m for adult social care, children’s services and public health. The two bodies will retain their individual accountability for their budgets, in line with the Health and Social Care Act, but for practical, planning purposes they will work together. The CCG’s accountable officer has joined the council’s corporate management team. A new ‘committee in common’ will approve decisions by a new integrated commissioning board.
Obesity has been blamed for a rise in kidney cancer by Cancer Research UK, which says it has been responsible for an average of 2,000 cases a year in the last decade. It says that new cases of kidney cancer have risen by 40% in the last ten years. Obesity and being overweight are associated with about a quarter of kidney cancers. There are about 11,900 cases of kidney cancer in the UK each year with about 4,300 dying from it.
Implementation of the first year of the GP Forward View has been patchy and uneven, according to an assessment by the BMA. They say that “whilst there has been some delivery, there have been cases where promised funding has been severely delayed or distributed unevenly across the country.”
Walking benefits the brain by the foot’s impact signalling increased blood flow to it, according to research from New Mexico Highlands University using ultrasound to measure blood flow in 12 young healthy adults. The research was being presented to the annual meeting of the American Physiological Society in Chicago. The biggest effect is in running, but walking has more effect than cycling, since the latter involves no impact.
23 April 2017
Emergency admissions for children under 4 rose by 28% in the last decade, between 2005-7 to 2015-16, with admissions amongst babies aged under one having increased by 30%, compared to a rise of 20% amongst the population as a whole, according to research by the Nuffield Trust and Health Foundation based on the official hospital episode statistics. The researchers say that the reasons for the increase are complex but that a proportion of the admissions could have been avoided by prevention or care in community settings.
(24/04/17) Press release: http://www.qualitywatch.org.uk/news/press-release-new-research-reveals-rise-emergency-hospital-admissions-young-children
(24/04/17) Link to the report: http://www.qualitywatch.org.uk/cyp
22 April 2017
More smokers and obese patients may face delays before having surgery, it is suggested, after a letter from NHS England in one area (Yorkshire and the Humber) supported Rotherham CCG’s policy of such delays for knee or hip surgery. It suggested that many other CCGs could be developing such plans, which “is something we would encourage.” The schemes would typically require some demonstration of having quit smoking or reduced weight or else face delays of 6-12 months in accessing surgery.
21 April 2017
A cut in the proportion of sugary drinks sold in hospital shops has been agreed by WH Smith, Marks & Spencer, Subway, Greggs and others. NHS England has asked retailers with outlets in hospitals to cut sales to less than 10% by next April, or face the threat of a total ban on selling sugary drinks. Progress is also being made on cutting price promotions and advertising of foods high in fat, sugar and salt. NHS England is now trying to get hospitals to stock more healthy sandwiches and confectionery.
Press release: https://www.england.nhs.uk/2017/04/nhs-and-leading-suppliers-join-forces-to-cut-sugary-drinks/
An increasing number of cases of the ‘superbug’ CPE have been reported in recent years, according to a report from the Bureau of Investigative Journalism. The number of confirmed cases of the bug, carbapenemase-producing Enterobacteriaceae (CPE) rose from 3 to nearly 2,000 in the twelve years to 2015. According to responses to freedom of information requests, since 2009 at least 81 people infected with CPE have died at 66 NHS trusts in England, although it may have been a complicating factor rather than the cause of death. The research revealed that many trusts did not have the data, which experts said could be a hindrance in tackling the problem.
The number of people on mixed sexed wards has increased in recent years, from 2,655 in 2014-15, to 5,309 in 2015-16 and 7,771 in 2016-17 according to the latest figures.
A £1.2bn cycling and walking strategy for the next five years has been published by the Department of Transport.
£56m A&E capital funding, out of £100m announced in the budget, has been allocated to 70 NHS trusts, the Department of Health has announced. The funding is to be used to help meet the 95% four hour target.
The latest ONS wellbeing statistics show no major changes in the last year. Self-reported anxiety has improved slightly in Northern Ireland but got slightly worse in England.
20 April 2017
Child victims of sexual abuse within the family are being let down by the system, often being left to report the abuse themselves rather than signs being picked up by the authorities and with delays in investigations and in receiving help, according to a report from the Children’s Commissioner for England. Children are waiting 100 days longer than adults for sexual abuse investigations to go to court.
Press release. http://www.childrenscommissioner.gov.uk/news/new-research-shows-victims-child-sexual-abuse-within-families-face-differential-access-support
Link to the reports: http://www.childrenscommissioner.gov.uk/publications/preventing-child-sexual-abuse
Carbon dioxide in the atmosphere has reached 410 parts per million according to data recorded at the Mauna Loa Observatory in Hawaii. This is the highest level for about three million years. The 410 figure does not have any particular scientific significance but indicates another record milestone (round number) reached. The 400ppm level was reached in 2013. The figure was about 280ppm at the start of the industrial revolution and 315ppm when continuous measures started being taken in 1958.
The police are increasingly dealing with problems that other services, such as mental health, cannot adequately manage, Her Majesty’s chief inspector of constabulary, Sir Tom Winsor, says in his annual report on the state of policing. Rather than being the service of last resort, he says the police, particularly where people with mental health problems need urgent help, are increasingly being used as the service of first resort.
A petition to reverse a data sharing policy between the NHS and the Home Office has been launched by medical charity Doctors of the World, Liberty and the National Aids Trust. They argue that the memorandum of understanding agreed between the Home Office and NHS Digital in January makes vulnerable people scared of seeking needed healthcare. The Home Office uses the data to locate, arrest and deport visa overstayers and undocumented migrants. As well as the impacts on the individuals, there could also be implications for public health, if, for instance, infectious diseases were not dealt with.
Cycling to work was associated with a reduction in mortality, including a reduced incidence of cancer by 45%, heart disease by 46% and death by any cause by 41%, in research from the University of Glasgow on 264,337 UK commuters over five years published in the British Medical Journal. Of those studied, 2,340 died, of whom 3,748 had been diagnosed with cancer and 1,110 had heart problems. There were also benefits from walking, if over 6 miles a week, but it was thought there were more from cycling as people were travelling further and exercising harder.
19 April 2017
UK teenagers had a below average score for life satisfaction, in an OECD survey of 540,000 students in 48 countries. The UK average score was 7 compared to the overall average of 7.3, on a 10 point scale. The UK was in 38th place for life satisfaction. 24% from the UK said they were victims of an act of bullying at least a few times a month with 15% saying they were made fun of and 5% that they were hit or pushed. The UK students were competitive in school, with 90% saying they wanted to be the best in whatever they did, compared to 65% across all the countries. 72% said they felt anxious before a test, even if well prepared, the third highest country in the survey.
69% of people who experienced housing worries in the last five years said their mental health was affected, in an online survey by ComRes for Shelter, with a representative sample of 3,509 adults across England, of whom 1,050 had experienced housing problems. The most common problems were: stress, 64%, anxiety, 60%, sleep problems, 55% and depression, 48%. Shelter said that if the results were replicated across England, a million people would have sought medical help for mental health issues. Overall, 21% of adults had experienced issues including long term stress, anxiety and depression due to a housing problem over the last five years. One in six respondents (17%) said housing worries had affected their physical health.
Slight improvements in race equality in the NHS are reported in the second Workforce Race Equality Standard annual report published by the NHS Equality and Diversity Council. However, BME staff are still significantly more likely to experience discrimination at work than others, even though the proportion who had personally experienced discrimination fell from 15% in 2014 to 14% in 2015. More nurses and midwives are progressing to senior roles and there is greater BME representation at ‘very senior management’ and executive board level.
(20/04/17) (£) London has the worst performance despite highest BME workforce: https://www.hsj.co.uk/7017423.article
Press release: https://www.england.nhs.uk/2017/04/report-sets-out-progress-on-race-equality-standards-for-all-nhs-trusts-in-england/
(20/04/17) Link to the report and data: https://www.england.nhs.uk/publication/workforce-race-equality-standard-data-reporting-march-2017/
18 April 2017
A general election is to be held on 8th June, following an announcement by Prime Minister Theresa May on 18th April and a vote in the House of Commons on 19th April. Potential areas of impact on the health service deriving from promises made by the parties and decisions at the ballot box include: the extent of spending on health in the next few years and whether previous Tory plans will be kept; the position of staff from other parts of the EU post-Brexit; delays in making changes and savings identified in STPs and elsewhere, such as reconfiguring services given uncertainty and political sensitivity; the possibility of a new health secretary and changed policies (such as on seven day working); and progress towards social care reform which could be delayed or disrupted. The Local Government Finance Bill will not be passed before the election, a minister has told the commons, meaning that 100% business rates retention will be delayed.
(20/04/17) (£) https://www.lgcplus.com/7017436.article
The first sugar tax in the US led to a fall in sales of sugary soft drinks by 9.6%, while sales in surrounding areas with no tax rose by 6.9%, according to research published in PLOS Medicine. The 10% tax was introduced in March 2015 in Berkeley, California. Sales of bottled water increased by 15.6% after the introduction of the tax. Average grocery bills remained the same.
More than 100,000 patients a year are having to wait more than two weeks to see a cancer specialist, according to an analysis of cancer waiting time figures in 2016 by the House of Commons library for shadow health secretary John Ashworth. 25,153 people had to wait more than the designated 62 days to start their treatment. The analysis also found that 25 of 157 NHS and independent providers did not meet the 93% target of cancer referrals being seen by a specialist within two weeks and 86 of 155 providers missed the target of 85% of those diagnosed with cancer starting treatment within 62 days.
Spending on NHS mental health patients treated in private hospitals has increased by 42% in five years, in 40 out of 81 mental health authorities across the UK that responded to a BBC freedom of information request, from £71m in 2012-13 to a projected £101m in 2016-17. The number of patients treated privately increased over that period from 1,842 to 3,323.
An NHS productivity growth timeline has been updated by the Centre for Health Economics, York University. The update includes growth for 2013-14 and 2014-15 and looks at 10 year growth trends since 2004-5. It says that the rate of productivity growth since 2004-5 compares favourably with that of the economy as a whole, having outpaced it since 2008-9 as the economy has stagnated and the health service has coped with increased demand.
17 April 2017
Rejections for the PIP (personal independence payment) benefit have increased recently, according to figures obtained by Angela Eagle, former work and pensions secretary. There were 83,000 people scoring zero points for both components of the assessment in just six months between April and October 2016, compared to 93,000 in the full 12 months previously.
The use of ECT (electroconvulsive therapy) to treat serious mental health problems has increased in recent years according to information obtained by the Guardian through freedom of information requests with comparable data received from 44 NHS trusts. Over four years, there was an increase of 11% in the number of treatments carried out, from 20,400 to 22,600 in 2015-16. There was a more modest increase in the number of patients receiving ECT, to over 2,200, suggesting that more treatments per person were being given. The newspaper noted that the exercise revealed a lack of properly collected data about the procedure.
Background information about ECT: https://www.theguardian.com/society/2017/apr/17/what-is-ect-and-how-does-it-work
16 April 2017
Prince Harry, speaking out about his mental health problems, has been praised by mental health professionals. He talked about bottling up grief following the death of his mother, but then having to deal with it when it resurfaced years later.
15 April 2017
Problem gamblers are significantly less happy than others, according to research based on an analysis of 10,000 adult gamblers presented to the Royal Economic Society’s annual conference. Subjective scores of happiness on a 10 point scale produced an average of 6.25 for the gamblers compared to 7.95 for others. If this was judged in terms of the additional income that would be required to bridge the difference, the cost would be equivalent to about £30bn a year. About 0.7% of adults, or about a third of a million people, are classified as problem gamblers.
The number of NHS managers has increased by 18%, or 4,650 posts, from 26,051 in April 2013 to 30,724 at the end of 2016, according to figures from NHS Digital. In the light of falls in the number of GPs, the BMA criticised the government for failing to achieve their objective of reducing back-office posts and increasing the number on the front line.
14 April 2017
Schools are struggling to find support for the increasing number of mental health problems amongst children, according to a survey by the National Association of Schoolmasters Union of Women Teachers (NASUWT) of 2,051 teachers and leaders. 98% of respondents said they had come into contact with pupils they believed were suffering mental health problems, including: 91% of anxiety or panic attacks; 79% depression; 64% self-harm; and 49% earing disorders and OCD. The largest number of teachers, 58%, had experienced these issues amongst pupils aged 15-16, 35% amongst those aged 7-11, 18% between 4-11 and 7.2% in children under 4. While 54% felt fairly confident they would recognise the signs of a mental health problem, only 24% were very or fairly confident they could get timely support from experts such as CAMHS and 46% said they had never received any training on children’s mental health.
Press release: https://www.nasuwt.org.uk/article-listing/schools-need-support-mental-health-upsurge-pupils.html
Many hospitals are struggling to fill rotas, the Guardian reports. The paper says it has received examples of hospitals desperate to get doctors to work extra shifts from ‘dozens’ of hospitals.
The number of obese and overweight children in Amsterdam has fallen by 12% between 2012 and 2015, following a concerted effort to tackle the problem. Initiatives include allowing only water or milk in schools, and not fruit juice, subsidised sports centre membership, restricting fast food sponsorship at sporting events and promoting good sleep patterns.
Prescription of antidepressants is highest in deprived seaside towns, according to analysis of NHS data by Exasol, a database analysis company. The areas with the highest number of prescriptions out of the 326 district council areas in England were Blackpool, Sunderland and East Lindsey (which includes Skegness). The number of prescriptions has risen sevenfold in the last 25 years.
13 April 2017
Extensive pressure on the health service continued in February, according to the combined performance indicators for England. A&E attendances rose by 3.1%, emergency admissions by 2.9% and ambulance calls receiving a face-to-face response by 6.4%. There was a 17% increase in the number of beds not available to other patients because of delayed discharges. Only 87.6% of patients were dealt with within the 4 hour A&E target. For elective care, targets were met for 7 of the 8 cancer standards but not for referral to treatment within 18 weeks, diagnostic tests or the 62 day wait from urgent GP referral to treatment for cancer. A&E four hour waits increased nearly five fold in five years, from 40,791 between December 2011 and February 2012, to 195,764 in the same months in 2016-17. The total number of emergency admissions to English NHS hospitals went up from 1.3m in the winter of 2011/12 to 1.44m in the winter of 2016-17. 1,877 patients had to wait more than 12 hours before being admitted, compared to 375 the previous winter. There was also a record number of days lost to delayed discharges between December to February, rising from 471,780 days in 2015-16 to 577,195 days in 2016-17.
The data in charts: http://www.qualitywatch.org.uk/latest-data/combined-performance-summary-february-2017-0
A quarter of young women in the UK report some mental health problems according to the latest overview by the ONS of existing statistics on the wellbeing of people aged 16-24. There appear to be a mix of changes, some positive and some negative. The proportion of young people reporting symptoms of anxiety or depression increased from 18% in 2009-10 to 21% in 2013-14 with a greater proportion of young women than young men reporting this. The proportion of young people saying they find it difficult to get by financially fell from 15% in 2009-10 to 7% in 2014-15, but the proportion living in households at risk of poverty increased from 19% in 2008 to 25% in 2015. Overall satisfaction with health has improved with the gap between men and women narrowing.
A direct link between nurse staffing levels and mortality has been found, in the first research of its kind in this country. It found that in the first five days of hospitalisation, for each day with staffing below what is typically required, the risk of death increased by 3%. The use of temporary nurses also increased the risk of death. The research, from the University of Southampton, was based on data from 32 general medical and surgical wards in a large NHS hospital in England between 2012 and 2015. It was presented at a Royal College of Nursing conference earlier this month and is due to be published later this year.
(18/04/17) (Rgn) https://www.nursingtimes.net/news/research-and-innovation/link-found-between-low-nurse-staffing-and-patient-death-risk/7017344.article
12 April 2017
An extra 1,500 clinical pharmacists are to be located in GP surgeries by 2020-21, with £100m support from NHS England. This extends a current pilot which started in July 2015, as a result of which 490 clinical pharmacists are working across 650 GP practices.
Press release: https://www.england.nhs.uk/2017/04/up-to-six-million-people-set-to-benefit-from-more-clinical-pharmacists-in-gp-surgeries/
A tenth of mental health inpatients are not seen within a week of discharge as NICE guidelines say they should be, according to information obtained by Mind from freedom of information requests. This amounts to at least 11,000 people a year, who are therefore at greater risk of returning to hospital or suicide. Information was received from 54 of 56 mental health trusts in England and one of seven health boards in Wales.
51,000 disabled people have had specially adapted vehicles taken away from them since the PIP (personal independence payment) scheme was introduced in 2013. Of that 51,000, more than 3,000 have since rejoined the scheme after the original refusal was overturned. A DWP spokeswoman said that there were now 70,000 more people on the Motability scheme than in 2010.
Two in five GPs in the south-west of England are planning to quit and seven in ten are planning changes such as reducing their hours that would mean less contact with patients, according to research from the University of Exeter, published in the BMJ Open. It was a based on a survey sent to 3,370 GPs across the region, to which 2,248 replied, a response rate of 67%. Over half, 54%, of respondents reported low morale.
Feature and comment: https://www.theguardian.com/society/2017/apr/12/gp-recruitment-crisis-overwork-low-morale
Theresa May has admitted the extent of the air pollution problem, blaming diesel vehicles as a major cause. She was responding to a letter from 220 doctors that warned that time is running out to deal with the UK’s ‘toxic air scandal’. She said it was the fourth biggest public health risk after cancer, obesity and heart disease and said it disproportionately affects some of the most vulnerable in society.
Bone health could be being harmed by young people cutting dairy products from their diet, the National Osteoporosis Society has warned. In a survey of 2,000 adults, including 239 under the age of 25, it found that a fifth of 18-25 year olds had cut out or significantly reduced dairy products from their diet. It was not known why they were cutting out diary. Having enough calcium and vitamin D before the age of 25 is important for strong bone development, although they can be obtained from foods other than diary.
Seven digital exemplars for mental health have been named by NHS England, which will be providing £35m in support, to be matched by a further £35m from the seven trusts. The money is to be used for a variety of schemes, including sharing patient records, supporting self-care and remote access to psychological therapies.
Green space produced a calming, as well as other, effects on people aged over 65 in research in which eight people wore a portable EEG head-set while walking between busy and green urban spaces. There were changing levels of ‘excitement’, ‘engagement’ and ‘frustration’. They were part of a wider sample of 95 people over the age of 65 who were studied. The study was published in the International Journal of Environmental Research and Public Health.
11 April 2017
The number of social care staff leaving their roles has increased in each of the last four years, with 339k having left in 2015-16, 60% of whom left the adult social care sector altogether, out of a total workforce of 1.3m according to data gathered by Skills for Care and analysis by the BBC. There was an estimated shortage of 84k care workers with about 1 in 20 posts vacant. The turnover rate is 27%, which is twice the rate of other professions. A letter from the Chair of the UK Homecare Association to the Prime Minister says that the social care system has started to collapse. The Department of Health said that 88k apprentices had started last year.
The £2bn extra for adult social care won’t stop the need for council cuts, the head of the Association of Directors of Adult Social Services’ resource network, John Jackson, has said. Government funding for local authorities has been cut by 37% in real terms between 2010 and 2015 with £5.5bn saved from social care budgets over the six years and another £1bn to be found this year. So although the additional money promised in the budget will reduce the pressure for savings, it will not eliminate it.
Essex County Council is being taken to judicial review for the fees it pays for care homes by Care England, the body representing adult care providers. The fees paid are said to be so low as to be unsustainable. Care England said it believed the council’s actions were a breach of its responsibilities under the Care Act 2014.
The Secretary of State for Education is the person best placed to drive improvement of social work practice of children and family social workers, the school’s minister, Lord Nash, has said. He said that in the absence of a professional body and with nearly a quarter of councils rated ‘inadequate’, “it is critical that the Secretary of State is able to bring forward improvement activity that she believes will help raise the standard of social work practice by making clear what standards are expected of children and family social workers and assessing social workers against those improvement standards”.
Tobacco companies have been refused permission to appeal against plain packaging laws by the Supreme Court, meaning that the regulations will come into force as planned on 20th May. The attempt by the companies was being made after a failure of a similar attempt in the court of appeal in November.
Care homes’ quality varies considerably across regions and local authority areas, according to an analysis of CQC inspection reports by the charity Independent Age, which classified homes scoring in the lowest two of four categories – ‘requires improvement’ and ‘inadequate’ – as ‘poor performers’. It found that the North West was the worst performing region with the south west the best. Five local authorities have more than half of homes rated as ‘requires improvement’ or ‘inadequate’: Stockport, Salford, Tameside, Manchester and Kensington and Chelsea.
Press release: https://www.independentage.org/news-media/press-releases/best-and-worst-areas-for-care-home-quality-england-revealed-new-research
10 April 2017
NHS Improvement is said to be trying to borrow £10bn from hedge funds and investment companies, according to a report in The Times. It would need Treasury approval to go ahead. The money would go towards investing in infrastructure and specialist care in GP surgeries.
Interest in hosting the European Medicines Agency has been expressed by 21 other EU countries, according to Reuters. The regulatory agency is preparing to leave its London headquarters following Brexit.
09 April 2017
Tobacco companies are trying to flout plain packaging regulations according to an industry insider. The range of techniques includes putting price stickers on the cellephane wrapping, using particular varnishes and finishes on the packs, using particular terminology to denote different strengths of cigarettes (which is banned) and putting two 10 cigarette packets into a 20-size pack. They also built up large stocks before the ban came into force, as products manufactured before the ban could still be sold.
The more time that 10-15 year olds spend on social networks, the less satisfied they are with other aspects of their lives except friendships, according to research from the University of Sheffield, to be presented at the Royal Economic Society annual conference. It was based on data from the UK Household Longitudinal Study between 2010 and 2014. Spending an hour a day on social networks affected happiness with the rest of life three times as much as being in a single parent household and was larger than the effect of playing truant.
07 April 2017
The NHS could have a shortage of 40,000 nurses by 2026, post-Brexit, on a worst case scenario, according to modelling by DH seen by the HSJ. Even without a reduction in the number of nurses from the rest of the EU, and other parts of the world, the supply of nursing staff will only just meet the lower estimated level of demand, creating a risk if there is an increase in demand.
Nine out of ten (87%) of vaping shops are selling their products to non-smokers, which is against the industry’s voluntary code of conduct, according to an investigation by the Royal Society of Public Health into 100 of the 1,700 specialist vaping shops in England, Scotland and Wales. Just under half did not investigate whether the shoppers had smoked before and of those that did, three quarters still encouraged non-smokers to start vaping.
The UK purchases almost four times more packaged than fresh food, according to data on 54 countries analysed by Euromonitor. It found 85% of the countries purchasing more calories from processed than fresh food. In 28 of the countries, including the UK, more calories were bought in the form of alcohol than soft drinks.
Applications to study nursing at university from over 25’s have fallen by 23% in the last year according to figures from UCAS. The Royal College of Nursing said the figures should be a cause of great concern, having repeatedly warned that ending bursaries would reduce nursing degree applications.
Ambulances were diverted from busy A&E’s nearly twice as often this year as in the same period in the previous three years according to a study by the Nuffield Trust. There were 478 redirects in the three months from December to February compared to an average of 249 in the previous three years.
Falls amongst the over 60’s are the most common cause of major trauma in UK hospitals, constituting a third of all life-threatening cases, according to a report by the Trauma Audit and Research Network. Of 15,972 life threatening traumas in 2014, 6,829 were from falling from a height of less than 2 metres and 5,383 of those were among patients aged over 60. There were 4,466 cases resulting from road collisions.
A record number of GP practices closed last year according to NHS England data obtained by Pulse magazine. Of the 92 practices which closed, 58 did so completely and 34 merged with other surgeries. It meant that 265,000 patients had to change their practice last year.
Hospital parking is ‘unreasonably stressful’, the RAC has said. It made freedom of information requests to 206 hospital trusts in England and of the 160 responses, 125 charged for car parking. Of those, 40 did not have payment on exit, meaning people would need to guess how long they would be at the hospital. A similar number had pay on exit at some, but not all car parks and 36 had pay on exit at all their car parks. Payment by credit or debit card was available in 41 trusts at all their car parks and 31 at some of the sites.
06 April 2017
Fewer than half of people with learning disabilities are receiving the annual health check that it is recommended they have, although the number is increasing (from 43% in 2014-15 to 46% in 2015-16), according to figures from NHS Digital. Women with learning disabilities have a life expectancy 18 years less than the national average and for men it is 14 years.
Key facts and data: http://www.content.digital.nhs.uk/catalogue/PUB23781
Interactive report: https://app.powerbi.com/view?r=eyJrIjoiYTY2ZGM0ZGQtZGY0My00ZmFiLTljNTctYmNhMzA2OGJlYjczIiwidCI6IjgwN2YyZjMwLWNhOGMtNDE5Zi1hMTc5LTVjNGZjN2E0YmY2YiIsImMiOjN9
Funding and resources to support the Five Year Forward View next steps in 2017-19 are set out in a document from NHS England.
New immigration skills charges will have a detrimental effect on NHS finances, it is claimed by the BMA and RCN. There will be a £1,000 annual charge for certain categories of skilled workers from outside the European Economic Area. There were over 6,000 applications for such workers, for doctors and nurses in 2015.
Problems with online prescriptions affecting patient safety have been noted by the CQC in its latest inspection results on four online services. Problems included making prescriptions too quickly without the proper checks, poor recording of medical histories and lack of communications with the patient’s GP.
A quarter of diabetes patients report rationing of the test strips used to monitor blood glucose levels, in a survey carried out by Diabetes UK. More than half (52%) of those who said they had problems, had Type 1 diabetes. When restrictions on people’s prescriptions for the strips were challenged, the previous arrangements were frequently reinstated.
Press release: https://www.diabetes.org.uk/About_us/News/Testing-times-for-many-living-with-diabetes/
Sir Bruce Keogh, NHS England Medical Director, is to leave his position at the end of the year to become Chairman of Birmingham Women’s and Children’s NHS Foundation Trust. He has been in his current (or equivalent) position for ten years.
Free condoms should be provided to reduce STIs, NICE is recommending in new guidance on condom distribution schemes.
Press release: https://www.nice.org.uk/news/article/councils-and-sexual-health-services-should-consider-providing-free-condoms-to-reduce-stis-says-nice
Statutory guidance on patient and public participation in commissioning health and care has been published by NHS England. The guidance is for CCGs and NHS England
The latest ONS report on national wellbeing shows some improvements, with 15 indicators having improved over the previous year, 18 having stayed the same and two deteriorated.
05 April 2017
The long-term sustainability of the NHS and adult social care is under threat, according to the House of Lords Select Committee on the Long Term Sustainability of the NHS. It said that cuts to public health will mean more people becoming ill, putting further strain on the NHS. They also urged citizens to do more to live healthily and suggested that the NHS Constitution should be redrafted to include more personal responsibilities. The Committee also said the lack of a comprehensive workforce plan was the biggest internal threat to the sustainability of the NHS. It said there was a ‘prevailing culture of short termism’ and recommended the establishment of a new body, the ‘Office for Health and Care Sustainability’ which would look 15-20 years ahead on a rolling basis. It also said that social care should be funded centrally and that the current GP model was no longer fit for purpose.
(06/04/17) GP leaders respond to criticisms: http://www.onmedica.com/NewsArticle.aspx?id=bf54f456-f12f-4754-a8b8-c221f1728c43
Press release: http://www.parliament.uk/business/committees/committees-a-z/lords-select/nhs-sustainability-committee/news-parliament-2015/nhs-sustainability-under-threat/
Six out of seven councils cut adult social care spending per adult between 2009-10 and 2015-16, with an average fall of 11% per adult resident in England, according to an analysis by the IFS funded by the Health Foundation. A tenth of councils had made cuts of more than 25%. There was a big variation in social care spending from £325 per adult resident in the lowest spending tenth of councils to £445 in the highest tenth with only a small proportion of the difference explained by the official assessment of social care needs (though this had not been updated for two years). The number of people receiving care fell by 25% between 2009-10 and 2013-14.
Press release: https://www.ifs.org.uk/publications/9123
The report: https://www.ifs.org.uk/publications/9122
There are a third fewer designated Sure Start children’s centres since 2010 in England, that is 1,240 fewer, according to figures from Labour. The Government said that some centres had merged for greater efficiency.
A report on how social science can contribute to improving public health has been produced by the Campaign for Social Science. It suggests that understanding the social and economic factors of ill health and how to change habits and behaviour could make a major contribution to health care improvement.
Press release: https://campaignforsocialscience.org.uk/news/common-sense-flaw-led-major-public-health-failures-campaign-says/
The report: https://campaignforsocialscience.org.uk/healthofpeople/
04 April 2017
More than 2,000 schools and nurseries with 50,000 children are within 150m of roads with damaging levels of air pollution, according to an investigation by the Guardian and Greenpeace.
Interactive map: https://www.theguardian.com/environment/2017/apr/04/check-whether-your-childs-school-is-exposed-to-illegal-levels-of-air-pollution
Nearly a million households (3%) in the UK are unable to cover the cost of two or more essential bills, according to the IPPR, which calls this ‘Income Crisis’. Nearly two thirds (64%) of such households have at least one adult in work and 53% contain children.
A new programme of relationship support for unemployed families has been announced by the DWP. Children whose parents are in conflict are less likely to do well in school and in later life. The new £30m programme aims to help parents resolve conflict, using new and existing services. It is part of the next stage of the ‘Troubled Families’ programme. Initiatives were also announced to help people with drug and alcohol problems.
Press release: https://www.gov.uk/government/news/new-support-to-help-workless-families-and-improve-childrens-lives
The CQC has rated most (82%) of GP practices as either ‘good’ or ‘outstanding’ in the latest batch of 131 inspection reports that have been published. Of the 131, 5 were ‘outstanding’, 103 were ‘good’, 11 ‘requires improvement’ and 7 ‘inadequate’ and 5 were focussed inspections that were not rated.
Press release: http://www.cqc.org.uk/content/cqc-inspectors-highlight-outstanding-and-good-care-reports-are-published-131-more-gp
The Licensing Act is fundamentally flawed and should be radically overhauled, including abolishing local authority licensing committees with the function taken over by planning committees, according to a report by the House of Lords Select Committee on the LIcensing Act. The Committee also said that minimum pricing for alcohol should be introduced across the UK if it proves a success in Scotland. The LGA said that abolishing licensing committees would be “unnecessary and ill-advised.”
Press release and links to the report: https://www.parliament.uk/business/committees/committees-a-z/lords-select/licensing-act-2003/news-parliament-2015/licensing-act-report-published/
The Health Select Committee is to investigate STPs (sustainability and transformation plans), including governance, policy and what is needed to support their implementation.
03 April 2017
Disabled people are being left behind and their “life chances remain very poor”, according to a comprehensive report from the Equality and Human Rights Commission, ‘Being Disabled in Britain: A journey less equal.’ Food poverty affected 18.4% of disabled people aged 16-64 compared to 7.5% of non-disabled people. The report said that obtaining adequate healthcare was a challenge for many disabled people. Negative attitudes towards disabled people remain prominent with mental health conditions and learning disability particularly likely to be stigmatised. There is a persistent and widening disability pay gap and welfare reforms are significantly affecting the already low living standards of disabled people.
Press release: https://www.equalityhumanrights.com/en/our-work/news/disability-progress-%E2%80%98littered-missed-opportunities-and-failures%E2%80%99
Links to the report: https://www.equalityhumanrights.com/en/disability-report-being-disabled-britain
The Daily Mail claims to identify £7.6bn of waste in the NHS where savings could be made. It includes £2bn in procurement of basic items such as loo rolls; £1.23bn for fees and compensation in negligence cases; £1bn for running costs, such as electricity; £1bn for unjustified price increases for medicines; £1bn ignoring NICE guidelines on treatments shown to work; and £432m on management consultants.
02 April 2017
The richest will receive 80% of the benefits from tax and welfare changes coming into effect this week, according to analysis by the Resolution Foundation. It finds that income tax cuts of £2bn and cuts to welfare of £1bn will result in a transfer from low and middle to higher income households. The welfare savings are expected to grow from £1bn a year in 2017-18 to £12bn a year by 2020 as more and more households are affected.
Press release: http://www.resolutionfoundation.org/media/press-releases/poorest-third-of-households-will-be-worse-off-from-tax-and-benefit-changes-starting-this-week-despite-a-1bn-giveaway/
Welfare changes coming into effect on 6th April will push a quarter of a million children into poverty and substantially reduce payments to bereaved families. More than 600,000 families are to be hit by child welfare cuts. In most cases, child tax credits will not be able to be claimed for third and subsequent children. Payments to widowed parents will now only last for 18 months rather than until the youngest child leaves full time education as previously. Theresa May defended the changes to bereavement payments as being fair to the taxpayer. There is also to be a freeze to working age benefits. The Government has argued that limiting benefits to two children will act as a ‘behaviour change’ incentive to persuade poorer families to have fewer children.
(04/04/17) Analysis and comment: https://www.theguardian.com/society/2017/apr/04/ministers-not-helping-jams-struggling-families
(03/04/17) Comment: https://www.theguardian.com/commentisfree/2017/apr/03/theresa-may-blue-passports-children-poverty-cuts-uk
Labour has challenged the legality of the decision to deliberately miss the 18 week target for non-urgent operations, which Simon Stevens announced as part of the Five Year Forward View refresh. Jon Ashworth, Shadow Health Secretary, wrote to Jeremy Hunt saying the Government and NHS England were acting unlawfully in accepting that the target would be missed, as it was not just a political promise, but a legal duty set out in the NHS Constitution.