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2013 Q2 April-June

Health and Wellbeing Policy Update – April-June 2013

28th June 2013

DH consults on having national levels of eligibility criteria for social care from 2015, rather than letting councils decide the level locally

Consultant mortality data starts to go online.  Unadjusted mortality figures are revised after mistakes and the media are accused of misusing the figures.  Six consultants opting out of the publication are named.

(5th July) 

GP says publication makes no sense as GPs can’t refer to specific individuals: 

(30th June) 

(5th July) Data not robust enough to spot poor performance:

JRF research shows falls in absolute living standards over a sustained period for the first time since the 1930s. 

NHS Direct has cancelled two of its eleven NHS111 contracts.  It has cancelled the contracts in North Essex and Cornwall. 

(2nd July) 

(2nd July)

How to save money: #51 – don’t go overdrawn.  DCLG has been fined £20,000 by the Treasury for its poor financial management.–charged-with-getting-local-council-budgets-under-control–fined-for-217m-unauthorised-overdraft-8678239.html 

27th June 2013

Poor diabetes care is leading to life threatening complications and 40% suffered a medication error according to an audit of care. 

Stress and anxiety are the leading causes of time off work, with a Government analysis of sick notes finding that 35% were linked to stress, anxiety or depression–men-likely-longer-women.html 

The Government’s Work Programme has improved on its first year but is still failing to meet targets for getting people into work.  In particular, only 5.3% of those on incapacity benefit were helped into work, against a minimum performance benchmark of 16.5%

(24th June) The Work Programme is not doing enough to help those furthest from the labour market, according to a Policy Exchange report, Route2Work:

NHS News: Issue 13 

The BMA passes a no-confidence motion in the CQC 

26th June 2013

Spending Review

  • £3.8bn for integrating health and social care.  £3bn of services for the elderly to be jointly commissioned by health and local government.  This includes £2bn transferred from health.  HWBs will determine who gets what.
  • NHS real terms increase of 0.1% up by £2.1bn from £108.3bn to £110.4bn.
  • Local authority grants to be cut further by 10% in 2015-16 from £25.6bn to £23.5bn.  A further 144,000 jobs to go on top of 312,000 in the last two years.
  • Council tax freeze enabled by government grants to be extended for another two years.
  • £3bn capital investment in affordable housing.  However, this is less per year than the current funding and other changes will lead to a funding gap:
  • A welfare cap to be set each year, with the government having to explain if it is going to breach it.
  • Tightening of eligibility for welfare (such as jobseekers having to wait 7 days before being able to claim then signing on weekly instead of fortnightly and lone parents with children as young as 3 having to regularly attend job centres)
  • Community budget pilots to be extended
  • Automatic progression of pay to be ended in the civil service by 2015-16 with an aim to remove it in the NHS, schools, prisons and the police.
  • Public sector pay rises to be limited to an average of 1% in 2015-16.

Link to pdf, ‘Spending Round‘, HM Treasury: 

BBC on health: 

There is no evidence of community-based interventions reducing emergency hospital admission according to a review by the Nuffield Trust of 30 such scchemes. 

Doctors at the BMA annual conference have criticised the financial incentives where hospitals are paid for the number of people place on the Liverpool Care Pathway, seen as a ‘one-way-ticket to death’. 

Death rates from coronary heart disease have more than halved between 1980 and 2009 in almost all European countries according to research from Oxford University.  However cardiovascular disease is still the main cause of death in Europe. 

Summary of NICE guidance for public health domains

25th June 2013

Consultation on proposals to overhaul children’s residential care 

A claim that local government can manage 10% further cuts in 2015-16 on top of the 26% up until then through efficiencies and without affecting front line services, has been made by Grant Shapps, former housing minister and now Conservative Chairman. 

Doctors say that NHS managers should be held to account [see also: MPs criticise how hospital consultants are managed – 2nd July] 

Young people in the UK spend longer unemployed than in other parts of Europe according to a report from the OECD 

24th June 2013

The BMA has passed a vote of no confidence in Jeremy Hunt.  Last year they passed one against Andrew Lansley.  The Health Secretary was criticised for attacking the NHS and front-line staff. 

The Government is to increase spending on the Troubled Families Programme by £200m

Monitor publishes FAQs on integrated care. 

21st June 2013

The Royal College of GPs has published its vision for the next ten years in primary care, including suggesting that GPs should commission out-of-hours care. 

The CQC has published its previously secret report on the Morecambe Bay NHS Foundation Trust  

The BMA and other professional bodies are reviewing their guidance on Do Not Resuscitate (DNR) notices. 

[Weekly update sent out ————————————————————–]

21st June 2013

The extra risk of dying from diabetes has fallen significantly since the 1990s (from twice as likely to one and a half times), thought to be because of earlier diagnosis and better treatment. 

20th June 2013

48% of health and social care ‘consumers’ do not have the confidence that formal complaints are dealt with and 54% of those who had a problem with health and social care in the last three years did nothing to report it, according to a survey from Healthwatch England reported at their [excellent] annual conference. 

56,000 families will have their income cut by an average of £93 a week as a result of the benefit cap, according to the Government’s impact assessment.  89% of the families affected have children.  The assessment claims there will be no impact on health and wellbeing.  The aim of the policy is to reduce benefits to the level of the average take-home pay of working households [but  not the average income of working households allowing for benefits]. 

The perceived quality of end of life care from GPs varies significantly according to the deprivation of the area, with 37% of bereaved relatives in the least deprived areas describing the care as excellent, compared to 30% in the most deprived areas.  There was no such different in hospitals or care homes according to the analysis by the ONS. 

NHS News: Issue 12 

Bulletin for CCGs: Issue 36

19th June 2013

CQC report cover up.  CQC publishes the critical internal report on its oversight of University Hospitals Morecambe Bay NHS Foundation Trust.  

Jeremy Hunt’s statement to Parliament:

(20th June) CQC publish the names of those involved in the cover up – CE Cynthia Bower and two other senior managers:

New voluntary guidance on labelling food, using a simpler ‘traffic light’ system, has been introduced. 

Over 9,000 mentally ill people were detained in police custody in 2011-12, despite official guidance saying this should only be done in exceptional circumstances, according to a joint report from the police, prisons and health service inspectorates. 

An association between eating and signs of potential heart disease can be seen in children as young as 3-5 according to research from Toronto. 

There are big differences in end of life care as a result of arbitrary factors according to a Demos report. 

One in five people suffer anxiety or depression with the highest incidence amongst the 50-54 age range and amongst women, according to figures from the ONS’s Measuring National Wellbeing Programme–2013/index.html 

18th June 2013

The King’s Fund launches a commission on the future of health and social care, due to report in 2014 

17th June 2013

Consultation on plans for emergency care.  There should be a simplified and co-ordinated system of emergency care according to an NHS England review led by Sir Bruce Keogh. 

A new ‘charter’ of 8 standards for NHS patients is launched by the CQC.

The CQC is to monitor death rates in care homes 

HWB report from NHS Confed on ‘Making a Local Difference: state of play and challenges ahead for health and wellbeing boards’. 

A partnership agreement between Monitor and NHS England sets out their strategic intent and commitment to work together 

Pregnant women and new mothers have limited access to specialist mental health services in many parts of the country, with less than half of mental health trusts having such specialist services, according to a report by the NSPCC. 

Britons are consuming an average of 600 calories a day less than 30 years ago, but weigh 30lbs more according to research from the Institute of Fiscal Studies.  More sedentary lifestyles are only part of the cause.–weigh-30lbs-MORE.html 

16th June 2013

Three quarters of councils are commissioning home care on the basis of 15 minute slots according to Unison. 

There are about six times more people being diagnosed with Type 2 diabetes than in the 1990s, largely due to increased obesity, according to research from Cardiff University and the Heart of England NHS Trust in Birmingham. 

15th June 2013

The CQC publishes proposals for hospitals to have two-week long inspections with ratings and the possibility of being put in special measures.  Inspectors will be specialists rather than generalists.  The consultation is open until 12th August. 

Patient views to be at the heart of inspections: 

Half of GPs believe they can no longer guarantee safe care to their patients with 93% saying their work had become more stressful in the last five years, according to a poll by the Royal College of GPs 

14th June 2013

The number of patients going to A&E has hit an all time high, according to official statistics. 

Ofsted consults on child protection inspections.  The consultation lasts until 12 July.

[Weekly update sent out ————————————————————–]

14th June 2013

A smaller proportion of women from deprived areas take up screening for breast cancer 

13th June 2013

(14 June) An extra million people in absolute poverty since the coalition came to power according to new statistics from DWP. 

(13 June 2013) 

DWP press release:

Commentary on LSE blog:

JRF analysis:

Commentary from New Policy Institute:

The Care Minister, Normal Lamb has held ‘crisis talks’ with care providers to try and improve home care for the elderly and disabled. 

CCTV footage reveals poor care: 

NHS England has published a strategy for the development of commissioning support services.  The current Commissioning Support Units (CSUs) will operate within the NHS until 2016, and this strategy looks at how to create the market for commissioning support. 

The number of children and young people admitted to hospital for conditions related to being overweight, rose from 872 to 4,000 between 2000 and 2009.

Government response to House of Commons Health Select Committee report on public expenditure on health and care services 

Consultation on the 2014-15 national tariff from NHS England and Monitor 

The GP patient survey results for 2012-13 have been published by NHS England 

NHS England has accepted that surgeons can legally refuse to provide performance data for the league tables to be published this summer and 4% have so far done so. 

(14 June) Hunt says those surgeons who refuse to provide performance data will be named:

CCGs to pool budgets with the police to ensure integrated commissioning for sexual assault services 

Volunteering for 200 hours a year or more reduced the risk of high blood pressure by 40% amongst over 50 year olds according to American research on 1,164 people. 

A new online handbook on how local authorities can reduce accidents which currently cause around 14,000 deaths a year in the UK, 700,000 emergency hospital admissions in England and cost the UK about £150bn, from RoSPA and PHE, funded by DH. 

NHS News: Issue 11 

12th June 2013

Two thirds of the 150,000 deaths a year of under 75 year olds are preventable according to Public Health England.  A website showing early, preventable deaths by local authority area has been launched by Public Health England.  Jeremy Hunt described the variation as ‘shocking’. 

Jeremy Hunt has suspended the Safe & Sustainable review which was to have ended child heart surgery at Leeds, Leicester and the Royal Brompton in London.

PULSE reveals how new CQC inspections of primary care might operate including speaking to GPs to assess their compassion 

NICE provides hospitals advice on reducing falls and says they should do more.  There were 209,000 falls in the year to September 2012 leading to 90 deaths and 900 serious injuries.

A cancer database recording details of all 350,000 tumours discovered each year is being set up by Public Health England 

Air pollution from coal power stations leads to almost as many deaths as from car accidents in the UK, according to a European study 

Hospitals have spent £2m as part of 50 gagging clauses according to a freedom of information request by a Tory MP 

NHS England has published interim specifications for specialised commissioning 

NHS England has launched the new e-referrals service which is to replace ‘choose and book’.  [I’m not sure what ‘launch’ means as the service won’t be ready for another year] 

11th June 2013

Action to reduce the spread of drug-resistant bacteria is being proposed by the Government to the G8 

Breast cancer screening may not reduce deaths according to new research from Oxford University, contradicting previous research

Total pay has fallen according to research from the TUC 

(13 June) Labour says average weekly pay has fallen by 5.5% since 2010 using figures produced by the House of Commons Library.  FactCheck says the figure is right but you could measure it in other ways to get a lower figure. 

NHS England is piloting the CareConnect service which allows information provision and real time feedback by patients via the web, phones, skype, twitter and apps.  The pilots are starting in London and the North East and are due to be extended to all areas by 2015. 

New Clinical Commissioning Hub from the Royal College of Physicians.  Designed to provide support in commissioning secondary care, it has information that may be relevant to others, such as on the new health structures 

NHS News: Issue 09 

NHS News: Issue 10 

10th June 2013

Three quarters of carers were unprepared for the role and even more were unaware of support available according to a survey of 2,100 British carers commissioned by a range of charities

Performance of NHS Foundation Trusts 2012-13: slides from Monitor 

Personal Independence Payments (PIPs) started to replace Disability Living Allowance (DLA) across England, Scotland and Wales.

Young offenders are receiving poor care, according to a report from a coalition led by the Royal College of Paediatrics and Child Health.

9th June 2013

52 of 193 acute hospital trusts failed to meet at least one of 5 management standards last year, according to analysis of CQC inspection reports by the Daily Telegraph. 

Women in professional jobs had a nearly 70% higher chance of getting breast cancer than other women, according to a study of nearly 4,000 women who were aged 36 in 1975. 

7th June 2013

Healthwatch and Health and Wellbeing Boards.  Report from Healthwatch England. [N.B. This link is directly to the document] 

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7th June 2013

Dozens of councils are on the brink of financial collapse according to the Public Accounts Committee following the NAO saying that 1 in 10 are under high financial stress 

Guidance on estimating health and adaptation costs of climate change from WHO 

Fatal or serious injuries reduced where speed cameras were put up in 96% of the 551 cameras analysed in research commissioned by the RAC.  Overall the incidents fell by 27%.

Blackpool is to roll out a free breakfast scheme to 33 primary schools after pilots suggested (but do not yet prove) that it made children happier and more alert and had the potential to improve attendance and punctuality. 

6th June 2013

The Health Secretary has announced a review of emergency care, focussing on vulnerable older people. 

More on IFS study trailed on 4th June – reductions of child and pensioner poverty at risk from austerity measures 

DH Corporate Plan 2013-14 

DH report on its arms length bodies.  Brief description, three or four priorities and achievements for each of 15 arms length bodies including NHS England, Monitor, CQC, NICE and Public Health England. 

Bulletin for CCGs: Issue 35.  Includes: new interactive version of CCG outcomes tools.  CCG leaders invited to get involved with LGA’s HWB peer challenge programme.  The ‘choose and book’ system is to be upgraded. 

5th June 2013

There is a need for hospital re-organisation with fewer, bigger acute hospitals according to a report from a coalition of the NHS Confederation, the Academy of Royal Colleges and National Voices. 

A quarter of children are forecast to be in relative poverty by the end of the decade and the annual cost is predicted to be £35bn by 2020 (including from increased services to deal with the consequences and loss of taxation) according to a report by an academic commissioned by the Child Poverty Action Group. 

Only 20% of NHS trusts are learning from complaints according to research commissioned by the Health Ombudsman for England. 

4th June 2013

There are increasing waiting times for A&E and cancer referrals and more cases of C-difficile according to reports from the King’s Fund and Monitor. A&E waiting time targets were missed by almost 40% of trusts in January-March.

GPs could take back out-of-hours responsibility for some heavy users of NHS services, Dr. Clare Gerada, chair of the Royal College of GPs has suggested.  The proposal was welcomed by Jeremy Hunt 

The poorest households are to be hit hardest by the coalition’s austerity policies according to the Institute for Fiscal Studies.  The better off have been worse hit up to now. 

3rd June 2013

Waiting times and the availability of care will worsen according to a survey of the Chief Executives and Chairs of 185 NHS commissioners and providers.  62% described the financial situation as very serious or worse.  93% said that only slight or no progress was being made to integrate care. 

There is a risk of growing child poverty amidst continuing inequality according to a report from the International Labour Organisation–en/index.htm 

The Public Administration Select Committee calls for greater public engagement in policy making. 

NHS England is recruiting patient and carer members of the Clinical Reference Groups for various specialised services. 

2nd June 2013

The number of childcare places has been reducing and 250 Sure Start centres are expected to close. 

The number of claims for negligence against the NHS rose by 18.4% last year from 13,517 to 16,006. 

Don’t believe most of what you read here – there aren’t many cures for anything [not really policy, but a useful corrective to all the news stories – some covered here – about the latest health scare or cure] 

1st June 2013

The number of planned operations which were cancelled was the highest in the first few months of this year than since 2004-05 according to official figures.  The A&E crisis is thought to be a cause. 

Rightwing think tanks, The Adam Smith Institute and the Institute of Economic Affairs, have received funding from tobacco companies.  They have argued against plain packaging for cigarettes, which the Government dropped from the last Queen’s Speech.  

31st May 2013

People who have had a general anaesthetic are 35% more likely to develop dementia, according to French research on over 9,000 patients. 

[Weekly update sent out ————————————————————–]

31st May 2013

Monitor is to investigate the closure of walk-in centres to see whether it has had an effect on A&E

Sir Mike Richards has been appointed the first Chief Inspector of Hospitals. 

30th May 2013

The number of ambulances being diverted from full A&Es has risen by 24% in a year (from 287 to 357) according to figures published by Labour 

Comment piece on how the Government’s response to the A&E crisis is undermining CCGs:

Claims by the Conservative chairman Grant Shapps that 878,300 people took themselves off benefits rather than taking a medical test have been challenged by the ONS which said this conflated different figures. 

Local Government Financial Statistics 2013 published (222 pp).  [Mainly finance but also some useful general information about local government history, roles etc.]

NHS News, Issue 08. 

Leading for Outcomes: Integrated Working.  Guidance for managers, team leaders and trainers on moving to a personal, outcomes based approach, from IRISS (the Institute for Research and Innovation in Social Services, a Scottish charity). 

29th May 2013

The risk of dying after planned surgery rises through the week from Monday through to the weekend according to a study from Imperial College based on records from 4.1m elective surgeries.

(28 May) and the risk of death from heart surgey is lowest on a Monday, and highest on a Friday night in January: 

Those with personal budgets for care and support have improved physical and mental health according to a new survey from Think Personal Act Local 

Children’s health improved between 1999-2009 but the gap between richest and poorest widened according to research from University College London.

The Public Administration Select Committee says the Government should do more to ensure its use of statistics presents a fair picture 

NHS England issues guidance to GPs on how patient data can be collected, anonymised and used by commissioners to improve care 

A psychiatrist talking to schizophrenia patients through an avatar matching the voice they heard, helped ease their symptoms, (albeit based on research on only 16 patients). 

(27 May) And in California, a virtual therapist is being developed, initially to identify those with post traumatic stress disorder: 

Insights into Developing Caring Cultures, a review of the experience of the Foundation of Nursing Studies 

28th May 2013

New DH ‘mandate’ to Health Education England says at least half of medical students should become GPs and more should be done to increase awareness of dementia. 

A Conservative early policy consultation document asks for feedback from its members on options including limiting the number of times someone can visit their GP in a year and whether evening and weekend GP appointments are a luxury the country cannot afford. [I generally don’t like criticism of ‘early policy thinking’ because you should have space to think of new things without it being assumed this is now policy.  However this is still a bit worrying, indicating where some people’s minds are going] 

FAQs for elected members on the NHS Health Check which transferred from PCTs to local authorities on 1st April.  Councils are required to plan a programme which will invite all 40-74 years over a 5 year period to a health check. 

A range of non-drug therapies were found to be as effective for depression as taking anti-depressants.  No signifiant difference was found between the therapies, which included cognitive behavioural therapy, psychodynamic therapy and supportive counselling.  The research was based on 198 studies involving more than 15,000 patients. 

27th May 2013

A system of whole person care for the elderly is operated by Dutch district nurses working for a not-for-profit homecare firm. 

25th May 2013

[Secretary of State for Communities and Local Government, Eric Pickles, continues to champion local government and focus on the pressing issues of the moment.  Noting the increasing use of food banks he recognised the unfairness in the implementation of the bedroom tax by-  No, of course he didn’t.  In an official press release he criticised “stupid municipal officialdom” (a town council refused to fly the flag of St George), and instead is striking a blow for modernity and common sense, by flying the flag of Wessex.] 

24th May 2013

DH is putting £650,000 into a project to allow hospital staff to attend group sessions when they can talk about their work related pressures and stresses. Started in the US, it is known as ‘Schwartz Center Rounds’ 

GPs voted against any change which would return responsibility for out of hours care to GPs,  at a BMA conference

Children, Families and Maternity e-bulletin, May 2013.  Includes: revised guidance on safeguarding children and adults and local authority child health profiles. 

[Weekly update sent out ————————————————————–]

24th May 2013

GPs have rejected a motion of no confidence in Jeremy Hunt 

23rd May 2013

Three quarters of senior NHS staff say quality of care is not given sufficient priority, according to a King’s Fund survey of 900 people. 

King’s Fund: ‘Patient Centred Leadership’: 

Dr Laurence Buckman, Chair of the BMA’s GPs Committee, attacks the Health Secretary over his denigration of GPs and blaming them for the A&E crisis 

Jeremy Hunt’s speech: 

King’s Fund response: 

NHS England has announced the designation of 15 new Academic Health Science Networks.  They will aid the adoption and spread of innovation and improvement by sharing evidence and experience. 

Open plan offices make people less healthy, less happy  and they are less productive according to Scandinavian research

22nd May 2013

Spending by the NHS on private services has risen by £3bn to £8.7bn last year, according to a report by the Nuffield Trust and the Institute of Fiscal Studies.

The Government’s fitness-for-work test is unfair to people with mental health issues, a three-judge tribunal has ruled.  The Government has said it intends to appeal and will continue the assessments in the meantime. 

NICE briefing to help local authorities tackle obesity 

Monitor and the CQC sign a memorandum of understanding on how they will work together 

Satisfaction with councils is largely holding steady at 70% according to an LGA poll 

Targets and poor organisational environments to blame for patient neglect‘ according research from the LSE 

Letter from Cabinet Office minister outlining various programmes to support local organisations with innovation, service redesign and the development of new delivery models (including the Commissioning Academy covering both health and local government). 

21st May 2013

King’s Fund says health and social care budgets should merge 

King’s Fund report says restrictions on eligibility for care mean the care cap will be increasingly irrelevant. 

The report: ‘Paying for Social Care: Beyond Dilnot’: 

Sir David Nicholson is to retire as Chief Executive of NHS England in March 2014

The House of Commons Work and Pensions Committee says that “The Work Programme has the potential to work well for relatively mainstream jobseekers but is unlikely to reach the most disadvantaged long-term unemployed people

The NHS Confederation say they see no correlation between A&E four hour performance and the 2004 GP contract

Jeremy Hunt to announce a new rigorous inspection regime of GP practices with a new post of Chief Inspector of GPs 

20th May 2013

Government clarification of roles in the regulation and oversight of NHS Trusts and Foundation Trusts.  This is in response to criticism in the Francis report that there is a lack of clarity in responding to failures in quality of care. This document says that the CQC will assess performance. Trusts and commissioners should rectify problems, but if they persist, Monitor and the NHS Trust Development Authority, not the CQC, will take enforcement action.  If it is impossible to turn the performance around, Monitor or the CQC will be able to place the organisation into special administration. 

The UK Government calls for international action to tackle the problem of antibiotic resistant infections, with a paper to the World Health Assembly 

(21 May) 

6,000 beds have been closed since the coalition came to power (from 110k to 104k) which some argue has meant frail people being discharged early and sometimes having to return to A&E 

Department of Health civil servants are to spend time on the front line with the Permanent Secretary and Directors spending at least a month a year learning about patient experiences. 

Consultation on how Monitor will enforce the Procurement, Patient Choice and Competition regulations.  (Runs until 15 July) 

Hypothetical case studies: 

Half of parents who drive their children to school live less than a mile away according to a YouGov poll of 1,000 parents commissioned by the charity ‘Living Streets’. 

A Which survey of 122 pharmacies found 43% of chemists gave advice rated as unsatisfactory. 

DH’s post-legislative assessment on whether the Health and Social Care Act 2008 met its objective.  [That’s the 2008 Act, not last year’s] 

19th May 2013

The CQC have criticised private company Harmoni, which provides out of hours GP services in North London.  It is reported that Harmoni won the contract on price rather than quality. 

The DWP will have to reveal at which organisations unemployed people are working for nothing, as a condition for receiving benefits, following a tribunal decision on a freedom of information request. 

18th May 2013

The number of people applying for emergency handouts (‘discretionary housing payments’) rose from 5,700 in April last year to more than 25,000 this April, thought to be as a result of cuts to welfare payments including the bedroom tax.  A Government spokesman is quoted as attributing the increase to publicity from councils about the availability of discretionary housing payments.

It is suggested that at least part of the current problems with A&E may be caused by a greater number of referrals by NHS Direct, which is being wound down to make way for the new NHS111 service. 

17th May 2013

A new Chief Social Worker for adults has been appointed: Lyn Romeo who is Assistant Director of Adult Social Care and Joint Commissioning in Camden 

The Government has announced a £260m technology fund for hospitals to improve patient safety, for instance by increasing access to patient records to reduce prescribing errors

Experts say it may not be enough for laggard trusts: 

(22 May) the £260m fund announced by NHS England:

Briefings on the Care Bill


House of Lords library: 

London Councils: 

(21 May) Nuffield Trust: 

The Government has been accused of scaremongering over ‘health tourism’ when claiming the cost to the health service was £200m a year, while official figures show that only £11m of bills from foreign patients has been written off in the last year 

Migrants tend to use the NHS less than natives.  Those who use it most are Poles, but they prefer not to as they think their health system is better:

(21 May) £74m owed by foreigners to the NHS over 10 years: 

BUPA has been approved to be able to access sensitive medical records. 

An integrated care pilot led to  increases in the diagnosis of dementia and of diabetes testing 

Depressed women are more likely to have a stroke according to an Australian study of over 10,500 women between the ages of 47 and 52.  Those with depression were 2.4 times more likely to have a stroke, but the chances of having a stroke were quite low, being 1.5% of the total or just over 2% for those with depression. 

NHS News: Issue 

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17th May 2013

The number of under 40s with Type 2 diabetes has increased by about 270% in 20 years 

16th May 2013

Child obesity is higher in deprived than better off areas according to a report published by Public Health England. 

Retirement is harmful to mental and physical health according to a study by the Institute of Economic Affairs. 

Austerity may increase child poverty according to a report from the BMA 

Nearly a quarter of a million children in England and Wales are caring for a relative according to new figures from ONS—detailed-characteristics-for-england-and-wales–march-2011.html

Labour plans to give councils and new regional bodies a greater say in welfare spending 

The Government promises more choice in public services, responding to a review by David Boyle 

A series of publications on health equity (website commissioned by the EU) 

The LGA criticise new Ofsted inspection framework for schools, saying they have little influence over many schools now. 

Men with more upper body strength are found to have more right wing political views.  [Hmm]. 

15th May 2013

The College of Emergency Medicine have called for an overhaul of accident and emergency with primary care doctors available to deal with 15-30% of routine cases. This is based on a survey of conditions at 131 of the 248 A&Es in the UK.  It also suggests doubling the number of A&E consultants.  The Foundations Trust Network said that the emergency system may collapse next winter without urgent changes to funding.  Jeremy Hunt in part blamed the problems on Labour’s renegotiation of the GPs’ contract.  [That was in 2004.  Nine years ago.  These problems are happening now.  In 2013.  Still, it does sometimes take time for problems to work their way through.] 

NHS Confed response: 

GPs not to blame for pressure on A&E.  Say GPs. 

Fact Check from Channel 4: 

Adult social care choice framework is published: 

The OECD says the Government’s austerity measures have increased inequality and impacted on the poor and young 

Children and young people’s health outcomes forum recommendations 

Learning from LINks, resources for Healthwatch, from Regional Voices.  There are publications on: leadership and governance; engagement; representation; and influence. 

New research suggests that part of the reason women live longer than men is because their immune systems age more slowly 

Recessions can hurt but austerity kills‘: discussion and interview with David Stuckler, author of ‘The body economic: why austerity kills’.  Countries have varied in how they have responded to austerity with some approaches leading to reduced access to healthcare and increased disease and suicides.  Others have avoided this. 

14th May 2013

The Government has announced its intention to achieve joined up health and social care by 2018.  They have asked NHS England to come up with a system preventing people being passed around between hospitals and community services.  There could be fines on providers if patients have to retell their stories to different professionals.

(13 May):

What co-ordinated care looks like – a vision of integrated care, from National Voices, developed following consultation with care users and seen from their perspective:

Does integrated care deliver the benefits promised? Research by Rand for DH on 16 integrated care pilots 

The King’s Fund view on progress in implementing the Health and Social Care Act 2012, in a submission to the Health Select Committee 

The UK’s economic wellbeing has fallen from 5th to 12th place out of 30 countries over six years according to analysis by the ONS. 

A survey of 1,000 whistleblowers found 60% received no response, 19% were disciplined or demoted and a further 15% dismissed.  The survey was carried out by charity Public Concern at Work. 

Labour has said that the proposed £72k social care cap is a con-trick, as it doesn’t include ‘hotel costs’, is limited to council care rates, and it would take twice as long as the average stay in a care home to have an effect.  [N.B. this has already been pointed out by other commentators but may be significant because there has previously been all party consensus on this]. 

Bulletin for CCGs: Issue 34 

13th May 2013

NHS England and Monitor have published a joint discussion paper asking for views on NHS payment systems.  It is suggested that the current payment by results system is not sufficiently patient focussed, is not always based on good quality information and may be a barrier to integrated care.  Any new system would probably come into effect from 2015/16.  The consultation runs till 19th July.

Vulnerable elderly people are to have a personal NHS worker to co-ordinate their health and care needs.  Better access to GP surgeries is to be part of a plan to better manage the health of vulnerable elderly patients according to Jeremy Hunt. 

The non-executive director’s guide to hospital data, part two: 

12th May 2013

In a poll of 2,000 nurses, 40% said there were not enough staff for a safe level of care on their last shift.  The Safe Staffing Alliance of senior nurses says that ratios of 8 patients per registered nurse and above put patients at risk. 

The Royal College of Midwives is now backing NHS guidelines, which they had previously opposed, which recommended that pregnant women should be asked to take breath tests to prove if they smoke.  [Seems a bit odd to me.  The women already know if they smoke, the tests are voluntary so what do they add?  Is it just to pressure women to admit that they smoke?] 

The British Psychological Society attacks the biomedical model of mental illness suggesting that psychiatric diagnoses such as schizophrenia are not useful.  This comes in advance of the publication of ‘DSM-5’, (Diagnostic and Statistical Manual) the American dictionary of mental disorders. It has led to a backlash from psychiatrists. 

11th May 2013

The RCGPs propose that carers should be routinely screened for depression and mental health problems 

10th May 2013

Hospitals giving inaccurate data on death rates will be subject to unlimited fines. 

Assessment of savings from abolition of the Audit Commission and publication of the report (previously only a summary was published) on the options for transferring the Audit Commission’s in-house practice to the private sector. It estimates savings of £128m p.a. on a net present value basis.  [It would be interesting to see this methodology applied to the current increasing inspection in Health.  It’s a long and complex document, but as far as I can see it doesn’t seem to allow for any value from inspection, so cutting it is pure savings.  But I may have got that wrong]. 

NHS News: Issue 06 

Chief Nursing Officer bulletin for May (useful roundup of news, from the nursing perspective) 

Allied Health Professionals bulletin (ditto) 

[Weekly update sent out ————————————————————–]

10th May 2013

Care Bill published 

A series of 16 fact sheets on the bill: 

Briefing on key changes in the Bill from Carers UK: 

Figures show the extent to which NHS111 performance dipped in March 

9th May 2013

The LGA warns of cuts to services if funding is reduced further.  It says local government is already dealing with a 33% cut in funding in real terms from central government and argues against further cuts.  The BBC reports the Government as saying, “The LGA’s shrill and alarmist claims lack credibility …” 

LGA spending round submission: 

NHS England announce plans to strengthen performance in urgent and emergency care 

(10th May) 

Progress report on DH structural reform plan (whether they’ve achieved their objectives) 

Data has been released on the first four hospitals in the Keogh review of 14 hospitals with higher than expected mortality rates 

There have been more than 750 ‘never’ events in the last 4 years; events which should never happen, such as objects left inside patients after operations and removal of the wrong body parts.  However this represents a risk of 1 in 20,000 of such an event happening to any given individual 

The new No.10 health advisor, Nick Seddon, has previously advocated health cuts, charging for health and the organisation of healthcare outside of government by insurance companies and other organisations. 

Iain Duncan Smith is criticised by the UK Statistics Authority for wrongly claiming that the benefits cap had already led to 8,000 people moving into employment 

(25 April) Background: 

Report on online medical records from the Medical Protection Society based on the views of doctors and public, suggests that “the current rhetoric does not reflect what is practical …” and that the public may have unrealistic expectations. 

Information pack for local authorities to help HWBs which have to assess needs for pharmaceutical services in their areas. 

NHS News: Issue 5 

Dashboard of performance by acute trusts, produced by private company, Methods Analytics, based on public data 

8th May 2013

Adult social care budgets have been cut by 20% (£2.7bn) since 2010 while demand has risen by 3% a year because of demographic changes such as people living longer, according to a survey by ADASS (the Association of Directors of Adult Social Services) 

Queen’s Speech: social care legislation.  A duty of candour is to apply to care homes.

Queen’s Speech.  Proposals to restrict access to healthcare for people from abroad. 

(9 May) Migrants bring more benefits than costs and are important for growth: 

Queen’s Speech. Proposals omitted for minimum alcohol pricing and cigarette plain packaging.  Jeremy Hunt says the proposals have not been abandoned but no decision on them has been made yet: 

Bill announced in the Queen’s speech to finally abolish the Audit Commission and strengthen the legal status to the Local Government code of practice on publicity. 

LGA criticises inadequate consultation on changes to publicity code of practice: 

NHS ‘Safety Thermometer’ data for April 2012 – April 2013.  Provides data on four sorts of harm to patients: pressure ulcers, falls, urinary tract infections in patients with a catheter and new venous thromboembolisms (VTEs). 

Public health outcomes framework (PHOF) data update.  Also links to a tool allowing comparison of HWB areas’ data against regional and national averages. [Looks good]. 

Statement of Government policy on adult safeguarding: 

A programme for screening the whole adult population for diabetes is under consideration by the UK National Screening Committee, with a decision expected in the autumn. 

NHS England is planning a relaunch of the ‘choose and book’ system, but without any fundamental changes to the service 

7th May 2013

One in four children are projected to be in relative poverty by 2020, a rise of 6%, according to the Institute for Fiscal Studies 

The health and wellbeing of mothers and their children lag behind many other European countries according to a report from Save the Children 

An interim assurance framework for CCGs has been published by NHS England, with the final version due in the autumn, following consultation.  A large part of the assessment is to be based on information made public by CCGs, to be summarised in a ‘balanced scorecard’. 

The Community Budgets / Total Place pilots are not delivering savings according to evidence given to the Public Accounts Committee, and Manchester is to end its pilot 

There has been a dramatic rise in the number of people surviving heart attacks in the last four decades according to the British Heart Foundation. 

There are wide variations in the proportion of people suffering asthma attacks being admitted to hospital in different parts of the country, according to Asthma UK 

NHS England has produced dedicated webpages for each of the 74 specialised services Clinical Reference Groups which provide advice on these centrally commissioned specialised services 

4th May 2013

The CQC is to be given powers to monitor care providers’ finances to spot potential failures, the Government has announced.

Response to consultation on ‘market oversight’: 

The Government is accused of giving in to lobbyists after proposals prescribing plain cigarette packaging are left out of the Queen’s Speech. 

People who smoke and have and high cholesterol tend to have poorer cognitive function (memory, planning and reasoning) according to a Dutch study of almost 3,800 people.  [It does not say if this was allowing for other factors that might be responsible for the correlation.] 

3rd May 2013

A workforce strategy for public health is published 

A ‘Guide to the Healthcare System in England’ is published by DH (36pp) 

[Weekly update sent out ————————————————————–]

3rd May 2013

Children face no added risk of death from emergency admissions outside normal hours according to new research. 

2nd May 2013

There is a wide variety in maternity care across England according to research from the Royal College of Obstetricians and Gynaecologists based on 11 indicators routinely collected by hospitals.–WONT-able-local-hospital-fares.html 

And 2 in 3 new mothers feel let down by the NHS according to a report from the National Federation of Women’s Institutes and National Childbirth Trust 

Many carers are struggling alone without advice or support, with consequent effects on health, family and finances according to a report based on a survey of 3,000 carers from Carers UK 

Half of a cohort of 430 doctors who qualified in 2006 report staffing shortages in their workplaces with high levels of stress according to a BMA report. 

There is to be a fundamental review of GPs’ contracts this year, the Chair of NHS England has told Pulse 

Report on survival rates from different forms of cancer, from Public Health England

Scientists identify a part of the brain that affects ageing–paving-way-turn-clock.html

1st May 2013

The NHS 111 service rollout is to be reviewed by NHS England

The Government has not sufficiently protected people from air pollution and could be subject to European fines, following a supreme court ruling.  Air pollution is said to cause 29,000 early deaths a year in the UK. 

The CQC is making 3 out of 4 of its senior executives redundant following criticism of its performance 

More than half of stroke survivors experience depression but 79% said they had received no advice on how to deal with the emotional consequences according to a Stroke Association survey of 2,700 people.  The mental effect then has knock-on physical effects. 

Shelter says that renting adversely affects children’s wellbeing 

30th April 2013

Guidance on commissioning for for children’s health has been produced by a number of the Royal Colleges 

New vaccination programme announced, including for Shingles for people over 70. 

Press release: 

People identifying themselves as black are the least happy ethnic group according to ONS figures on wellbeing by ethnicity.

29th April 2013

Health Ombudsman’s report criticises NHS complaints system,-says-ombudsman 

Austerity is harming health, including increasing suicides by 10,000 across Europe and North America according to research from Oxford and Stanford Universities published in a book this week,. 

GPs fear they could lose £200m funding next year 

Detailed definitions published for ASCOF (Adult Social Care Outcomes Framework) 

Report showing transfers and redundancies of staff in the move to the new health system. 

Bulletin for CCGs, Issue 33 

28th April 2013

Middle class women tend to get quicker care for breast cancer according to a study of nearly 21,000 women by Leicester University. 

Public Health England publishes its priorities for 2013-14 

[Weekly update sent out ————————————————————–]

26th April 2013

Caldicott reveiw reports and says patients should be given access to medical records.  Dame Fiona Caldicott is to chair an independent panel to oversee the implementation of her review’s recommendations on information governance in health and social care.  The Government is to formally respond to the review in the summer.

The review: 

25th April 2013

Jeremy Hunt says there is extra pressure on A&E because of the 2004 change in GP contracts which removed the requirement to provide an out of hours service.  He wants a rethink of primary care. 

Steve Field said GPs should never have given up this responsibility.  Other GPs disagree.  Strongly. 

RCGP Chair Dr Clare Gerada challenges Jeremy Hunt. 

Online profiles for care homes and other care services as part of the NHS Choices web site is launched 

Press release: 

A report suggests GPs have an untapped potential to improve the health and wellbeing of local people, but their role in prevention may be hindered by the transfer of public health from the NHS.  Report by the Nuffield Trust, commissioned by the National Association of Primary Care

NHS News: Issue 4 

24th April 2013

The attempt to stop the new S75 regulations on competition become law have failed in the House of Lords.

‘Let’s Get Moving’ care pathway: lessons from a pilot where GPs signpost people to healthy activities 

Government announces a review of social work education 

The number of people using food banks tripled last year, to 350,000 according to the Trussell Trust. 

Summary of changes to secondary legislation as a result of the Health and Social Care Act, for Local Authorities (8pp) 

23rd April 2013

20% of GP practices (1,545) are non-compliant with at least one of CQC’s 16 standards, with infection control and premises the most common issues. 

Nurses are being put off whistleblowing, with 64% of nurses have raised concerns (about issues such as unsafe staffing (48%) or patient safety (24%)) but 24% said they were discouraged by managers or colleagues from taking further action, according to an RCN commissioned survey by ICM of 8,262 nurses. 

NHS Employers response: 

Britain should spend £1bn a year to increase cycling by ten times, according to the All Party Parliamentary Group on Cycling.  They suggest funding should come from health, education and business as well as transport, because of the widespread benefits. 

Reflections on a decade of NHS commissioning: interviews with 20 leading figures, from NHS Confederation: ‘Ambition, Challenge, Transition’. 

More cases are being picked up by the NHS Health Check Programme than had originally expected with implications for better health but bigger workloads.  Experts are now expecting 158,000 cases to be found, compared to the original DH prediction of 20,000. 

NHS England is to examine the feasibility of letting some patients stay and be treated in hotels, to ease the problem of bed blocking. 

(24th April) Telegraph suggests relatives may be required to provide some care: 

Computer models are outperforming doctors in their assessment of how patients will respond to cancer treatment and are likely to be increasingly used in future

Three publications to help voluntary and community sector involvement with Healthwatch, from Regional Voices 

22nd April 2013

Three out of four nursing managers said staffing levels fell below unsafe levels at least once a month, according to an RCN survey of 2,086 ward sisters and community team leaders.,_says_rcn 

Labour is setting up an independent commission on how to integrate health and social care spending.  It is to be chaired by Sir John Oldham. 

Labour says it will seek to protect NHS spending but rules out massive spending increases:

Briefing for councillors on school health services (2pp) from DH and LGA 

People living in greener urban areas report higher life satisfaction and less mental stress according to a study of 5,000 UK households between 1991 and 2008, conducted by Exeter University 

Women who have their first child before 19 are a third more likely to be overweight, after controlling for factors such as race, education and background, according to US research 

‘Quality Governance’: guidance from Monitor for Board members to help them judge whether their organisation is working effectively to improve patient care 

What to expect from your doctor; a guide for patients, from the General Medical Council 

21st April 2013

Nurses are spending 17% of their time on paperwork and clerical tasks according to a poll of 6,387 members of the Royal College of Nursing working in the NHS, commissioned by the RCN.  It is reported that 81% of nurses said having to complete non-essential paperwork was preventing them providing care.  [However one of the examples given is ‘ordering supplies’ which doesn’t sound non-essential to me. Maybe it should be done by clerical staff – but then they’d be back-room bureaucrats and would have to be got rid of.]–nurses-spend-FIFTH-time-paperwork.html 

NHS Confed response:

[Weekly update sent out ————————————————————–]

19th April 2013

A study by the WHO on the changing governments’ role in health in 12 countries. 

NHS News: Issue 03 

18th April 2013

CQC launches its strategy for 2013-16, saying that it is making radical changes to how it inspects and regulates health and social care. 

CQC to use feedback from Facebook and Twitter to help make judgements: 

NHS England is to appeal against the High Court ruling on changes to children’s heart surgery in England and Wales. The case was taken to the High Court by campaigners trying to save keep operations at Leeds General Infirmary.

17th April 2013

The House of Commons Health Select Committee has confirmed that it is to investigate emergency services and emergency care 

A new body to promote the development of health and social care records using common standards has been launched.  The Professional Records Standards Body is backed by nearly all the royal medical colleges  

Only 61 GP practices offer patients full online access to their patient records, although the Government has said this should be available to everyone by 2015. 

The NHS in numbers from the Nuffield Trust, and supporting blog: 

DH have announced 21 voluntary sector organisations that will be part of the Health and Care Voluntary Sector Strategic Partner Programme, through which voluntary bodies can influence national policy. 

16th April 2013

Fifty NHS trusts targeted in first wave of new inspections.  The inspections are to last for four weeks and the teams will include doctors, nurses and managers seconded from high performing trusts. 

(25 June, 2010) The Government is committed to ‘shunning the bureaucratic levers of the past’  as it instructs inspectorates to stop costly top-down reports: comprehensive area assessments: 

Experience of inpatients in NHS hospitals in 2012 published by CQC, based on a survey of 64,500 patients.  It finds that overall care has improved, but there are still areas of concern, with a quarter of people saying the Doctors talk is if they weren’t there. 

A DH toolkit to help NHS managers and the public understand how the patient experience measure is made up.–3 

Jeremy Hunt says the rise in admissions to A&E is in part due to the ‘disastrous GP contract’ negotiated by the previous government which led to the decline in availability of out of hours services.  Dr Laurence Buckman, GPC chair said this revealed a ‘superficial analysis based on no evidence.’

(Blog, 19 April) 

There has been a 5% annual fall in emergency admissions for asthma sufferers since the ban on smoking in public places came into force in 2007 according to research from the University of Bath which looked at data on over 500,000 admissions. 

And more than 2 million people may be unaware they are at risk according to Asthma UK 

A hospital is making money by selling a moisturiser, the first such money making scheme by an NHS trust 

15th April 2013

The public may be prepared to accept more change to the NHS than generally assumed according to a two day deliberative exercise with 80 people conducted by Ipsos-Mori and the King’s Fund.    

Prof Malcolm Grant, Chairman of NHS England has said the government might have to consider charging for services to meet rising future demands. 

(17 April) 

NHS England publishes implementation plans for ‘Compassion in Practice‘, a three year strategy for nursing, midwifery and care staff 

Public Health England has updated its marketing plan for 2013-14 

Mid-Staffordshire is to be the first NHS foundation trust to be put into administration 

A number of claims by Government ministers about people’s behaviour in response to welfare changes are not warranted by the statistics used and are misleading: 

The TUC has asked the UK Statistics Authority to investigate the Work and Pensions Secretary for misusing official statistics:

(18 April) In depth analysis of the figures, and policy, behind the benefits cap:

Nearly half of people with Parkinson’s face regular discrimination (such as being mistaken for being drunk) according to a survey of 2,000 people by Parkinson’s UK. 

A very clear demolition of the arguments for the benefit cap – including that currently an out of work family is never better off than one in work: 

14th April 2013

The friends and families test has been criticised by the public and professionals who think it should be rethought, according to a government commissioned review by Ipsos-Mori. 

12th April 2013

The impact of CQUIN has been limited with the costs possibly outweighing the benefits according to a DH commissioned report.  The report on the Commissioning for Quality and Innovation Framework (CQUIN), by Nottingham University Business School and Manchester University, says that the quality incentive scheme has failed to engage clinicians or encourage innovation. 

[Weekly update sent out ————————————————————–]

12th April 2013

The NHS health check programme is at risk of failure as many areas have not established schemes and people are not turning up. 

Statistics on latest monthly hospital activity events–71 

Statistics on the use of the new 111 service in 18 sites up to February 2013.–2 

11th April 2013

A King’s Fund report says government reforms to resource allocation risk creating a more complex and fragmented system which puts attempts at integration at risk. 

The Government’s welfare reforms will take £19bn out of the economy and hit the poorest communities hardest, such as older industrial areas, a number of seaside towns and some London boroughs, with the worst hit local authority areas losing 4 times as much as the least worst hit, according to a report from Sheffield Hallam University.  

The House of Commons Health Select Committee is to launch an inquiry into NHS emergency care in the light of the impact of failures with the new 111 service. 

Local Healthwatch Organisation directions 

NHS News: Issue 02 

10th April 2013

Children’s wellbeing is below average of a number of developed countries but has risen from last place in 2007 to 16th out of 29 according to a Unicef report which combines a range of factors.

The health of today’s adults is poorer than earlier generations, according to a study in the Netherlands, of 4 cohorts born over 16 years.  The prevalence of being overweight, of obesity and high blood pressure increased with age, but was more prevalent in more recently born generations. The youngest cohort studied reached given obesity levels 15 years earlier than the oldest cohort. 

NHS diagnostics waiting times and activity data for February 2013. 

DCLG consultation on removing councillors’ access to the Local Government Pension Scheme 

9th April 2013

Cuba’s national weight loss of 5.5kg per person was followed by a reduction in deaths from diabetes and heart disease according to a study reported in the BMJ.  The weight loss was a result of US sanctions and the loss of Soviet support after the collapse of the Soviet Union.

Projections of household numbers and types from 2011 to 2021 are published by DCLG 

NESTA’s People Powered Health initiative published

(11th April) 

8th April 2013

NHS England publishes a three year business plan, ‘Putting Patients First’, which, it says, puts patients at the heart of improving care. 

(9th April) financial incentives will depend on the friends and family test 

Jeremy Hunt indicates he will consult on a further revision of the NHS Constitution later in the year with a view to giving greater prominence to putting patients first. 

5th April 2013

Report on children’s wellbeing, from ONS suggests they are mostly happy:

but body image knocks confidence for girls: 

DH progress against equality objectives (a five page table in pdf). 

NHS News: Issue 01 

[Weekly update sent out ————————————————————–]

5th April 2013

Brisk walking provides more health benefits than running for the same expenditure of energy, though both improve health. 

4th April 2013

Labour is to table a motion in the House of Lords to prevent the Section 75 regulations on competition in the NHS from coming into force: 

NHS Direct is to be paid £8.4m to cover the delay in the rollout of the new 111 service 

NHS England publishes an agreed set of clinical access policies for specialised services, on which it had previously consulted 

NHS England has published 14 interim generic policies relating to its direct commissioning role including specialised services, primary care, screening, military and offender health. 

The family nurse partnership programme, offering help and support to disadvantaged new parents, is to be extended.

DCLG is to move in with the Home Office using spare office space in 2 Marsham Street, from mid 2014 

3rd April 2013

Satisfaction with the NHS seems to have stabilised, at 61% after a fall from 70% in 2010 to 58% in 2011 (the latest small rise is not statistically significant).  Satisfaction with social care was 30%.  This is based on a sample of all adults rather than those who have used the services. 

The Government needs to listen to, and assist, councils with welfare reforms says the DCLG committee of MPs. 

Memorandum of understanding between the CQC and the Public Health England. 

Public Health England now has a new website 

2nd April 2013

The target for seeing 95% of A&E patients within 4 hours has not been met for the last 9 weeks, slightly worse than last year, according to official figures.

Guidance on ‘Working with Communities, Developing Communities’ for CCGs has been published by the Royal College of General Practitioners Centre for Commissioning 

A 5 year Antimicrobial Resistance Strategy, addressing the risks of antibiotic resistance raised by the Chief Medical Officer, is in development and expected to be published by the summer 

Rates of bowel cancer have risen by over a quarter in men over the last 35 years but only 6% in women. 

1st April 2013

‘The Day Britain Changes: welfare reforms and coalition cuts take effect‘ – [a useful summary of a range of policies coming into effect at the start of the financial year] 

Labour says the health reforms have cost £3.45bn, with over £1bn spent on redundancy payments,2013-04-01

(4th April) 

Monitor is consulting on safeguarding choice and preventing anti-competitive behaviour.  The consultation is open until 25th June. 

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