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2014 Q2 April-June

Health and Wellbeing Policy Update: April – June 2014

30th June 2014

Over a quarter of visits to A&E are because patients couldn’t get an appointment with their GP according to research from Imperial College published in the British Journal of General Practice, which found that 1.7% of those in the GP patient survey for 2012-13 did this. 

The Mail says that is has found a quarter of GP surgeries close for at least one afternoon a week: 

Briefing on how access to GPs and primary care affects demand for other services, from the Nuffield Trust, “Meeting need or fuelling unnecessary demand? Understanding the impact of improved access to primary care.” 

A majority of people would be prepared to pay more tax to maintain the current level of NHS care and services, with 57% agreeing and 41% disagreeing, in a ComRes survey for the Independent. 

Councils face a funding gap of £5.8bn between 2014-16, which will to more cuts in services, the LGA says.

PHE Bulletin 

28th June 2014

GPs who fail to spot cancer symptoms are to be named and shamed says Jeremy Hunt. 

Senior Tories urge Cameron to increase spending on the NHS, to prevent its collapse.  They include Stephen Dorrell, Sarah Wollaston and Paul Burstow. 

Article by the King’s Fund with recommendations on how to deal with the funding crisis:


(29th June) 

27th June 2014

‘Net promoter scores’ for hip and knee replacements beat iphones and Sky respectively, according to research based on feedback from more than 6,000 people between 2007-11 on whether they would recommend the NHS services to friends and family. 

Guidance to local authorities on health scrutiny is published by DH.

NHS News: Issue 63 

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26th June 2014

Sugar should only make up 5% of our calories according to a report by the Scientific Advisory Committee on Nutrition.  PHE is now inviting comments on its paper on the topic before final guidance is issued in March 2015. 

How do we know if we’re eating too much sugar: 

PHE press release: 

Consultation document: ‘Sugar Reduction: responding to the challenge’ – 

SACN report: 

(27th June) 

A consultation on standardised packaging for tobacco products is published by the Government, running until 7th August.

22% of people with diabetes in hospital will have had a largely avoidable hypoglycaemic episode, and access to specialist staff is ‘inadequate’, according to an audit by HSCIC with Diabetes UK.

People over 65 account for 17% of the population but 54% of hospital bed days, with over 85s representing 2% of the population but 18% of hospital bed days, according to a report from HSIC on the health and care of over 65s, which also notes that over 70% of them are overweight. 

(27th June)

The Government publishes its child poverty strategy. 

Consultation on what level the 2020 ‘persistent child poverty’ target should be set at. 

The Government publishes its response to the Liverpool Care Pathway Review, in a report called ‘One Chance to Get it Right’.  Dying patients should have individual care plans and be supported to eat and drink for as long as they want.

A consultation on protecting people’s personal health and care data is published by DH, with responses due by 8th August. 

Drastic action is needed to stop the spread of Ebola, which has killed nearly 400 people in West Africa in the latest outbreak, according to the WHO, which says it is in danger of spreading further, internationally. 

PHE annual report and accounts. 

An introductory guide on the NHS, designed for those working and training in the NHS but useful for others as well, is published by NHS England. 

25th June 2014

GPs are under increasing pressure with a real terms reduction in their budgets of £450m over the past three years and increasing demands, which is leading to longer waits for appointments, stress and doctors leaving the profession, according to various speeches to the BMA annual representative meeting.

A ‘national conversation on health inequalities’ is being supported by a series of documents published by Public Health England, including a toolkit, research and guidance.

This year’s £10m Longitude prize is to be given for solutions to antibiotic resistance.

(27th June) 

The OECD has published wellbeing indicators showing a large north-south divide within the UK. 

Parents should replace juice and fizzy drinks with water at mealtimes, public health scientists are recommending.  It is also suggested that obese people should be recommended to diet every few years to gradually lose weight. 

A report on the funding of local government from the NAO looks at the used of targeted grants in the context of greater local autonomy.

A new interactive map of mortality statistics from the ONS shows variations across the country.

24th June 2014

The BMA is to lobby for a permanent ban on selling cigarettes to anyone born after 2000, after a motion was passed at its annual representative conference. 

Sir Robert Francis is to lead a review on the treatment of whistleblowers in the NHS.  The enquiry is due to report by November.

(Free registration required) 

Patients could be shown safety videos on entering hospital, as part of a safety campaign. 

Only 12% of hospital finance directors think they will meet their financial targets for 2015-16, according to the 129 who replied, as part of a survey by the Healthcare Financial Management Association of 188 finance directors in NHS organisations.

Hospitals with low numbers of serious safety incidents are to receive poor scores on a new index of their reporting culture. It is said that one in five hospitals are not taking patient safety seriously enough.  However, the new measure has been criticised because of the inherent ambiguity – they could be reporting fewer incidents because they are actually safer.

(Free registration required) 

Sign up to safety campaign:

Sign up to safety website: 

Background info and access to the data: 

23rd June 2014

The BMA promises a fight with the Government in the run up to the general election, over negative press briefings, limited funding, fragmentation of services and prioritising the tendering of services to private companies, unless the Government changes its approach.

The proportion of diabetes patients being given all 8 recommended annual health checks varies widely between different parts of the country with less then 20% receiving them in some areas and 78% in others, according to Diabetes UK.

More investment in the ‘wider public health workforce’ is needed to tackle health inequalities, according to a report from the Royal Society for Public Health. 

Plans to relax the licensing laws, which will allow community groups to sell small quantities of alcohol, such as a glass of wine in the interval of an amateur performance, have been criticised by the BMA and LGA as being a step in the wrong direction for reducing alcohol consumption overall. 

Doctors in training are generally happy with the support and education they receive, though there are still some areas requiring improvement, according to a large scale survey by the General Medical Council. 

A report on child protection and statutory mental health services for vulnerable children and young people is published by the Centre for Social Justice. 

A consultation on a code of practice on the confidentiality of health and adult social care information is published by HSCIC with responses due by 18th August. 

PHE publish resources on preventing accidents to children and young people, for local authorities.  The number of such accidents is falling.  

Children, Families and Maternity e-bulletin 

22nd June 2014

A tax on sugar has been proposed by Action on Sugar as part of a seven point plan to reduce its consumption so as to produce health benefits.

21st June 2014

The LGA has called on the EU to ban misleading labels on food, such as emphasising low fat content while still having high sugar or salt. 

Budgets of child and adolescent mental health services have been frozen or cut by 77% of CCGs between 2013-14 and 2014-15, and by 60% of local authorities since 2010-11, according to information obtained from foi requests by the charity YoungMinds. 

20th June 2014

Outsourcing child protection services to profit making companies is not to go ahead after all, following widespread criticism, although the work may still be contracted to charities and not-for-profit organisations. 

Disabled children are more likely to be bullied, with primary school children with special educational needs twice as likely to be bullied as others, according to research by London University’s Institute for Education.

(19th June),+study+finds&sitesectionid=27&sitesectiontitle=News 

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

20th June 2014

Sick and disabled people have suffered considerable stress from the implementation of personal independent payments, which replaced the disability living allowance, according to a report by the Public Accounts Committee which was critical of both the Government and Atos.  By October 2013 the Government had only made 16% of the decisions it had expected to make.  Some claimants had to wait 6 months for their claims to be decided.

Official mortality statistics can be two and a half years out of date, due largely to the 10% or so where the cause has to be determined at an inquest, such as suicides, accidents and drug related deaths, and this can have a detrimental effect on public health research, an open letter to David Cameron from doctors, charities and scientists says. 

Call for evidence on the work capability assessment. 

Monitor’s annual plan for 2014-15 is published. 

19th June 2014

The number of people living in poverty has doubled from 14% to 33% since the 1980s, where it is defined as going without three or more basic necessities such as adequate food, clothing or heating, according to research by the Poverty and Social Exclusion Project, led by the University of Bristol and funded by the ESRC. 

There have been large, long term increases in the rates of liver and skin cancer, with the rates of liver cancer having risen by 70% for men and 60% for women in 10 years, and those for skin cancer by 78% for men and 48% for women, according to figures from ONS.  The most common forms of cancer are breast cancer for women and prostate cancer for men, followed by lung and colorectal for both. 

“The Condition of Britain: Strategies for social renewal”, recommending a wider spread of power, greater public participation and a strengthening of shared institutions, is published by the IPPR.

The Royal College of GPs launches an enquiry into the role of GPs and how it will need to change with an ageing population and funding challenges, to be led by Mike Farrar, former NHS Confederation CE.

New guidance for local authorities on improving young people’s oral health is published by PHE.

Bulletin for CCGs: Issue 61 

18th June 2014

The NHS could face a funding gap of £2bn next year the BBC has been told. 

The number of 16-29 year olds admitted to hospital with Crohn’s disease has increased from 5,000 to over 19,000 between 2003/4 and last year, according to figures from the HSCIC. 

Former GP Sarah Wollaston MP is to be the new chair of the House of Commons Health Select Committee, replacing Stephen Dorrell. 

Blog including background on the select committee system: 

The Royal College of GPs is urging doctors to use less jargon and speak more slowly to help patients understand them better.

The NHS should be less hostile to competition, a report by the right wing think tank Reform, and co-authored by Paul Corrigan a former Blair adviser, has recommended.  It also says that in 10 years 50% of NHS services might have been transferred to private companies or charities.

The National Mental Health Dementia and Neurology Intelligence Networks, goes live, starting with 4 profiling tools to help commissioners, decision makers and other health professionals to better identify needs. 

(19th June)

17th June 2014

The NHS is the best in the world, as assessed by a panel of experts from the Washington based Commonwealth fund, examining a range of characteristics.  It came top in 8 out of 11 measures.  However it scored only 10th in terms of keeping people alive. 

(16th June)

The number of district nurses has fallen by 47% in the 10 years from 2003, from 12,620 to 6,656.  They are under increasing pressure, with 75% saying they do not finish all their tasks after a home visit, according to a survey of 2,438 community based nurses in England, carried out for the RCN by the nation nursing research unit at King’s College London and the Employment Research Unit.  DH said it was looking at what it could do to increase the number of district nurses.

(Commentary) Pay issues in nurse recruitment:

Only 25% of people trust the Government with the NHS according to a comres poll of over 2,000 people for Unison. 

A woman with a ‘do not resuscitate’ order who died had her rights violated, the Court of Appeal in England has ruled.  It said there should be a presumption in favour of patient involvement on decisions which could deprive the patient of life-saving treatment. 

(18th June) 

Significant lapses in confidentiality in protecting patient confidentiality, found during an audit have led the HSCIC to introduce spot checks. 

(18th June)

The benefits, risks and progress in sharing patient records between primary and secondary care are explored in a report from Imperial College for the Sowerby Trust. 

NHS Trusts are to receive a premium of 25% on the tariff for treating patients from the EU, Jeremy Hunt has said, in a drive to recoup £500m a year from oversees patients.  They currently receive no extra for money for reporting someone as an EU visitor.

Sexual health statistics are published by PHE showing that the risk of sexually transmitted infection is greatest for young adults and gay men.  The number of STIs fell overall, but increased by 8% amongst the over 65s. 

A report on how to support people with long term conditions on a sustainable basis is published by the College of Medicine. 

PHE’s new knowledge and information strategy

16th June 2014

Guidance for teachers on how mental health problems can affect behaviour, is published by DoE. 

The Department of Health’s Corporate Plan 2014-15 is published. 

15th June 2014

The troubled families programme has identified more families in need than the scheme is funding; councils have ‘turned around’ 33% of those identified; but even in those many problems remain such as crime being committed and in 60% of the turned around families there are adults still on unemployment benefits, according to information obtained by Labour using foi’s with data from 133 of the 152 participating councils. 

14th June 2014

The number of GPs has fallen from 70 per 100,000 in 2009/10 to 66.5 now according to figures compiled by the House of Commons Library.  This follows news last week of continuing falls in the number of GP training places being taken up. 

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

14th June 2014

The Government’s four hour A&E target was not met again, for the whole of May and the beginning of June. 

13th June 2014

Every patient should have a named doctor in charge of them according to new guidance from the Academy of Royal Colleges, which had been requested by the Secretary of State for Health, and which will be assessed in CQC inspections.

There is no clear evidence that smaller hospitals, with fewer than 700 beds, have any worse clinical results than larger hospitals, although they may be starting to face greater financial challenges, according to a report from Monitor. 

The Government’s target of having 3,250 new GPs a year by 2016 is under threat with the number of training places filled this year, at 87%, being lower than last year and with some big regional variations. 

55 year olds with vitamin D deficiency are twice as likely to die prematurely according to research from the San Diego School of Medicine based on blood drawn from 567,000 people from 14 countries, followed up again 9 years later. 

12th June 2014

Delayed discharges from hospital have cost £562m since 2010, due to cuts in social care, according to analysis by Age UK 

Those discharging patients from hospital will have to check they have a warm home to go back to under draft NICE guidance.  The consultation runs until 25th July. 

Suicides in Europe and North America increased during the recession according to analysis of data from 24 European countries, the US and Canada, by researchers from Oxford University and the London School of Hygiene and Tropical Medicine.  After declines of suicides in Europe to 2007, there was an increase of 6.5% by 2009.  However, some countries such as Sweden, Finland and Austria saw no increase. 

Child mortality in the UK has gone from one of the best in Europe to one of the worst, between the 1970s and today, according to analysis by University College London, based on data from the WHO world mortality database and published in the Lancet. 

The number of people waiting for NHS treatment has reached 3 million for the first time in six years in another illustration of the growing demands on the service. 

The arrangements for costing ‘payment by results’ were ‘materially inaccurate’ in a third of acute trusts audited.  The selection of the trusts for audit drew on 30 identified as at risk, 10 at low risk and 10 at random.  Only 12% of the trusts had good quality costing across all services. 

79% of 330ml cans of fizzy drinks contain more than 4 teaspoons of sugar, and many have more sugar than Coke or Pepsi, according to an analysis of 232 drinks by the campaign group Action on Sugar. 

(11th June) Coke introduces lower sugar version, but still contains 4 teaspoons of sugar

(11th June) 

The Government publishes its response to the House of Commons Select Committee report on Public Health England.

PHE publishes its business plan for the coming year.

Short film using the voices of patients and staff to bring to life the priorities in the NHS England business plan. 

11th June 2014

The Government is to introduce a new criminal offence of wilful neglect for reckless or deliberate behaviour towards patients, with punishment of up to five years in prison or a fine of up to £5,000.  It is to be introduced through an amendment to the criminal justice and courts bill. 

One in five cancer patients waited over three months after noticing symptoms before seeing their GP according to a survey of 2,371 patients by King’s College London.  The numbers varied for different symptoms, with 35% waiting more than three months following rectal bleeding, 17% after finding a lump and 9% after finding blood in their urine. 

A ‘blood in pee’ campaign has been effective, boosting urological cancer diagnoses by a fifth, and is due to be repeated in the autumn. 

55% of children who have been bullied become depressed as adults according to a Europe-wide poll. 

Frequent callers to 111 are to be given priority appointments with GPs under new service specifications that will require CCGs to ensure that providers put the necessary systems in place. 

A statutory code of practice on special educational needs and disability (SEND) is published by the Government. 

‘It’s Time to Stop Top Down Reform in the NHS’, publication from the King’s Fund. 

Evaluation of children’s centres in England, research published by DoE.

A report on how unemployment affects men’s health is published by the Work Foundation.

10th June 2014

The Government is being urged to act quickly on plain cigarette packaging in a letter from 600 clinicians and public health leaders to the BMJ.  DH says a consultation on it is to be published shortly. 

The Government’s response to consultation on the Mental Capacity Act 2005 includes its ‘system-wide programme of work’.

NHS News: Issue 61.  (Includes: a new seven day working self-assessment tool; and a report on open data in health and social care).

9th June 2014

Autism costs the UK economy £32bn a year, more than any other medical condition and more than the cost of cancer, strokes and heart disease combined according to a US-UK study co-authored by the LSE, and based on a review of the existing literature.  The high cost, from services and lost employment, is because it is a life-long condition.  Relatively little is spent on autism research.

The proportion of people at risk of diabetes (with ‘prediabetes’) has tripled in eight years, from 12% to 35% between 2003-11 according to a study by the University of Florida and University of Leicester, based on data from the Health Survey for England and including analysis of blood samples from 20,000 people. 

(10th June)

(10th June) 

(10th June)

There has been a 54% increase in the number of food bank meals served in 2013 according to a report by Oxfam, Church Action on Poverty and the Trussell Trust.  Much of the increased demand comes from rising food prices and falling disposable incomes of the poorest 20%.  The Trussell Trust said it is helping feed 300,000 children, which it called a national disgrace.  A Government spokesman is quoted as saying: “It’s simply not possible to draw conclusions from these unverified figures from disparate sources.”

There are calls for an enquiry into PFI deals as the Northumbria NHS Trust buys out a hospital from such a deal, saving £67m. 

The financial strategy and inadequate focus on care by Southern Cross lay behind the deaths of 19 people at the Orchid View care home in West Sussex, a serious case review has concluded.

The statutory child poverty targets are now virtually unattainable according to the Social Mobility and Child Poverty Commission.  Part of the problem is in-work poverty, and the likelihood of the needed increase in working hours of families in poverty being met was implausible.

A document setting out the functions of the local public health system in England is published by the UK’s Faculty of Public Health. 

Primary Care Commissioning Newsletter: Issue 12.  (Mainly quite technical, but includes a link to the paper on “Emerging findings on a future strategy for commissioning general practice services”, i.e. how CCGs might co-commission GPs.) 

8th June 2014

Labour accuses the Government of failing to honour its pledges to act on the mid-Staffordshire scandal in not introducing a bill to regulate health and social care professionals. 

The NHS is failing disabled and seriously ill teenagers by providing reduced levels of support when they turn 18, according to a CQC report.  The review based on 180 young people or their parents found that the transition was un-coordinated and could cause stress and anxiety.

(9th June)

Lung cancer patients over 75 are five times less likely to be given life extending surgery, with England and Wales having the worst five year survival rate for this age group in Europe, according to Macmillan Cancer Support. 

University GP practices will be amongst those whose existence is threatened by the withdrawal over the next seven years of the Minimum Practice Income Guarantee (which will also hit some rural and inner city practices) campaigners are warning. 

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

6th June 2014

Thousands of people could lose their eligibility to care under draft guidelines for implementation of the Care Act, now open to consultation, according to campaigners.  All councils will have to provide support at a minimum of the ‘substantial’ level (which 130 out of 152 already do) from April 2015, but it is argued that the definitions used are too restrictive and don’t promote a preventive agenda.  The consultation is open until 15th August.

(News release): 

(The consultation):

Eleven factsheets on Part 1 of the Care Act are published. 

Junior doctors spend two thirds of their time accessing or updating patient notes and two thirds of trusts retrospectively type up paper notes for inputting to an electronic system, according to research by the HSCIC based on 16 trusts.  The research is aimed at reducing the ‘burdens of bureaucracy’.

Mental health services can better manage risk by involving service users in risk management according to a briefing paper from the Centre for Mental Health.

The experience of partnership working to tackle local issues in 25 areas is explored in a publication, ‘Local Vision: The Revolution will be Improvised.’ 

‘What is the evidence on the economic impacts of integrated care?’, report from WHO European Observatory on Health Systems and Policies.

Updated briefing on General Practice in England from the House of Commons Library. 

5th June 2014

The Government is to introduce guidance on a requirement to share patient records between health and social organisations, Normal Lamb told the NHS Confederation conference. 

Labour says the NHS will have to be ‘reset’ after the next election with more support in the home and downgraded local hospitals. 

Labour says it would scrap competition requirements for CCGs, including S.75 of the 2012 Health and Social Care Act that requires CCGs to put services out to tender. 

Andy Burnham says GPs’ independent contractor status may have to change, with generalist doctors working across the boundaries of primary and secondary care. 

Simon Stevens says the NHS should become a world leader in personalised medicine, making use of patients’ individual genetic information.  He identifies three fundamental shifts in medicine: a coming revolution in biomedicine; data for quality and proactive care; and a bigger role for patients in managing their own health and care.  An element of funding could be based on patient feedback.

(4th June) 

(4th June)

Local Government Financial Statistics 2014 published.  [Not just financial statistics – also provides useful summaries of local government history, functions and structure.]

Bulletin for CCGs: Issue 60 

Later Life Newsletter: 56 

4th June 2014

The three main parties must find ways to deal with the looming NHS funding crisis, say 71 NHS leaders, mainly from NHS Trusts, in a letter to the Guardian.

People in deprived areas tend to find it harder to get an appointment with their GP than people in other areas, according to a survey by the Royal College of GPs. 

The top three in demand professions in 2022 will all be in health and social care according to a report by IPPR. 

Robert Francis is joining the Board of the CQC as a non-executive director.

(Free registration required): 

Patient and family-centred care toolkit published by the King’s Fund, offering a step-by-step guide to improving processes of care and patient-staff interactions. 

‘Where Next for Childcare?’, reviewing the last 10 year’s of childcare policy is published by the Family and Childcare Trust. 

3rd June 2014

The LGA is arguing for a larger Better Care Fund guaranteed for five years, arguing that it will take time for the changes to work through, and more certainty is required.  They note that localities have gone beyond the minimum £3.8bn to actually pool £5.4bn. 

Law to protect elderly from abuse to be left out of the Queen’s Speech. 

New framework for the inspection of children’s services is published by Ofsted. 

There could be babies with 3 parents in 2 years after further safety checks, after the Human Fertilisation and Embryology Authority said it found no evidence the practice was unsafe, but called for more evidence.  The technique could be used to stop women miscarrying.  The Government is considering changing the regulations. 

(4th June) 

(5th June)

Some hospital inspectors say their workload is intolerable with concerns about the system, according to leaked internal documents.

Too many centenarians are dying in hospital, with more, better quality primary and community care needed for them, according to a study of the place and case of death of nearly 36,000 people over 100 in England between 2001 and 2010, by King’s College, London.  It is suggested they are surviving ‘lifestyle diseases’ but then succumb to infectious ones.  

(4th June) ‘Centenarians are outliving diseases of old age’:

(4th June) 

NHS News: Issue 60

2nd June 2014

Labour is intending to increase spending on the NHS significantly if it wins the election, according to the Independent.  It is not yet clear how it would be paid for, but one option is a ring fenced increase in NI.

Frank Field proposes a 1p increase in NI contributions to pay for extra spending on the NHS: 

(3rd June) 

(4th June) Comment: 

People dying from cancer are 20% less likely to have their care needs assessed than those dying from other causes, according to a study by the Nuffield Trust

(3rd June):

18% of junior doctors said that their decision to section a mental health patient had been influenced by the need to find them a bed, according to a survey by the Royal College of Psychiatry of 576 trainees working in psychiatry.  It was suggested that mental health services are approaching a tipping point.

Welfare reform is a significant cause in the rise in demand for food banks, and DWP is in denial about it, according to a report from the Scottish Parliament’s welfare reform committee. 

Many major food companies have sidestepped their ‘Responsibility Deal’ pledges, by reducing sugar in lesser rather than their main brands, it is claimed. 

A bill to allow doctors to try new techniques or unapproved drugs on dying patients, rather than sticking to standard approaches for fear of litigation, which was to be introduced to the Lords on 5th June, has received overwhelming backing in large scale public consultation involving 18,000 people.

60% of community nurses believe they do not have the staff or skills to deliver the care their patients need and 70% said morale ranges from ‘quite poor’ to ‘extremely poor’, according to a survey of over 1,000 community nurses by the Queen’s Nursing Institute, published in a report ‘2020 Vision – Five Years On’. 

(Free registration required) 

Monitor is asking hospital trusts to review their financial plans for next year, because it believes many are too optimistic. 

Report on the employment prospects of young people with autistic spectrum disorders in Wales is published by the Welsh Government. 

Updated list of Directors of Public Health in England–2

1st June 2014

Death rates following surgery internationally are higher in the afternoons, at weekends and peak in February according to analysis of data from 72 research projects covering 55 million people by researchers from Japan, although the reasons for the differences are not explained. 

A new book suggests that antibiotics may be a cause of increasing obesity and a range of other conditions including Type 1 diabetes, asthma and food allergies.  It is suggested that antibiotics in the food chain affect the ‘microbiome’ (the population of bacteria that live in us and are essential for our survival) and our immunity. 

(3rd June) 

31st May 2014

The LGA is urging major food companies to sign up to the voluntary front of pack labelling system, which uses a traffic light system to show how much fat, salt, sugars, saturates and calories the product contains. 

(Blog, 3rd June) 

Children under two can be encouraged to eat vegetables if offered them 5-10 times according to a study on 332 children aged between 4 and 38 months from the UK, France and Germany.  They also found the children were not more likely to eat them if they were sweetened. 

30th May 2014

Cancer waiting time figures published, including the first breach of a cancer waiting time since 2009, with the proportion of urgent cancer referrals seen within 62 days falling to 84.4%, just below the 85% target.

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

30th May 2014

NHSE CE Simon Stevens has said there should be more local services and less centralisation in the NHS, in comments to the Daily Telegraph. 

An interactive map of health and wellbeing board priorities across England has been published by the LGA. 

NHS managers have been cleared by a court of failing to help a whistleblowing GP, but more support for whistleblowers should be provided in future under new rules. 

29th May 2014

The UK has the third highest levels of obese and overweight people in Western Europe, according to the Global Burden of Disease study published in the Lancet.  About 2.1bn people, or 30% of the world’s population, are thought to be overweight or obese and although the rate of increase has slowed in some countries, it has not reversed in any. 

There were over a million alcohol related hospital admissions last year, with over £3m spent on drugs for alcohol dependence, but there was a decrease between 2005-12 in the proportion of people who said they had drunk alcohol for five or more days in the preceding week, all according to Statistics on Alcohol – England, 2014, from HSCIC. 

Improvements in the treatment of high blood pressure have saved thousands of lives and are expected to reduce deaths by 50,000 over the next 8 years according to a study by researchers from Imperial College published in the Lancet.

(30th May) 

(30th May) 

A scheme where seven Scottish GP practices provide non-medical advice on financial, emotional and environmental matters, such as debt, social isolation or fuel poverty, is to be extended from 2015 to 2018.  Results will be compared to other areas to see if it is worth extending to the whole of Scotland. 

50 researchers and public health specialists are urging the WHO to resist controlling e-cigarettes [continuing a developing debate which has been going on for some months about their safety or otherwise.] 

Helpful blog summarising the issues: 

Drugs and prostitution are to be included in the national accounts from September, to bring us in line with European Union rules.  [Assuming this isn’t a spoof, it surely only adds to Robert Kennedy’s assertion that GPD ‘measures everything except that which is worthwhile’ and strengthens the argument for using other measures of wellbeing.]

Reflections on 10 years of foundation trusts from the Foundation Trust Network. 

Consultation on digital engagement guidelines for health and wellbeing boards from the LGA.  The consultation closes on 2nd July. 

NHS News: Issue 59.  NHS News is to be renamed ‘Informed’ from 3rd June. 

‘Municipal Futures’, a collection of essays about the kind of councils likely to be needed in the future, is published by LGIU.

28th May 2014

Prescription of anti-depressants increased during the recession of 2008-12, accelerating a long term trend, according to research by the Nuffield Trust and the Health Foundation as part of their Quality Watch programme.  Prescribing levels were associated with higher employment and worse housing and were not explained by levels of depression.

Cllr David Sparks is to succeed Cllr Sir Merrick Cockell as Chairman of the Local Government Association, following the change in number of councillors after the local elections. 

Complaints about social care to the local government ombudsman have increased by 130% since 2009, to 2,456 complaints in 2013, according to a report by the LGO on the 2013 figures.  This could be because of easier reporting rather than an increase in the problems. 


The goal to end child poverty by 2020 is no longer credible, and should be reconsidered by politicians, according to a new report from Save the Children, which predicts that the number of young people living in poverty could rise from 3.5m to 5m by 2020.  The biggest impacts on child poverty have come from rising food prices and childcare costs, flat wages and cuts to benefits. 

NICE recommends that people aiming to lose weight should make gradual, long-term changes to diet and physical activity, with a 3% weight loss target being valuable, even if more would be better.  GPs should identify people who would benefit from weight loss programmes, and a national database of such programmes should be set up, to identify those which are most effective. 

PHE recommends that local authorities should contact parents of overweight children and advise on how they can lose weight. 

The number of people accepting the offer of a health check has risen by 9% in the last year according to figures from PHE.  Out of 15m people eligible for the checks, 2.8m were offered them of which 49%, or 1.3m, accepted the offer.  Responsibility for the checks passed from the NHS to local authorities in April 2013. 

Older people doing at least 25 minutes exercise a day needed fewer prescriptions and were less likely to be admitted to hospital in an emergency, according to data on 213 people with an average age of 78, by researchers from the University of Bristol, and published in the journal PLOS ONE.  The research used accelerometers to measure activity and medical records for the following four years.  The third most active of the sample were at half the risk of emergency hospital admissions as the lowest third. 

Interesting articles, in advance of a BBC2 programme, on how the tobacco industry fights attempts to reduce the take-up of smoking [similar articles, by the same author]

27th May 2014

PHE Bulletin

26th May 2014

There is concern that a scheme to share information on violent incidents between hospitals and the police is not being rolled out as promised.  Partnerships acting on the data were able to reduce violence dramatically when it was initiated in Cardiff twenty years ago.  A review of take-up is to be undertaken in the summer.

25th May 2014

Less than 10% of people with learning disabilities in hospital will have been moved to community settings, by the target date of 1st June, set following the Winterbourne View scandal.

Patients are being asked to support a campaign to reverse cuts to GP services, with posters being sent to GP practices by the Royal College of GPs and others. 

(28th May)

24th May 2014

New approaches are needed to dealing with anti-biotic resistant bacteria, including redesigning hospital wards to be more like those in the Victorian era, according to a number of experts including the Chief Medical Officer, Dame Sally Davies.  It is estimated that there are 5,000 deaths a year from antibiotic resistant bacteria. 

(26th May)

23rd May 2014

Many mental illnesses can reduce life expectancy by more than smoking according to a review of previous research by Oxford University, funded by the Wellcome Trust. 

Consultation on Government proposals to increase the waiting period before entitlement for certain benefits from 3 to 7 days.  It is estimated that this will mean those seeking Job Seeker’s Allowance will lose on average £40 and those seeking Employment Support Allowance, £50. 

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

23rd May 2014

Consultation on a strategic framework for improving the health and wellbeing of men who have sex with men, and another on whole system commissioning for sexual and reproductive health and HIV, are published by PHE, with responses due by 6th and 12th June.

22nd May 2014

People are not overusing A&E, with only 15% of people attending A&E who could have been helped in the community instead, according to research based on an assessment of 3,000 patients over 24 hours in 12 A&E Departments, by consultancy Candesic on behalf of the College of Emergency Medicine.  NHS England said last year that the figure was 25%, but in response to this study, noted that it was within the 10-45% range of previous estimates.  It is not being suggested that the current proposals for major and minor A&E units with GPs on-site is wrong.

The large number of people being discharged from hospital in the middle of the night has continued, despite the practice being recognised as causing problems.  Figures obtained by Sky News through foi requests from 72 of England’s 160 NHS trusts, show around 152,000 people discharged between 11pm and 6am in both 2011-12 and 2013-14.

The Antibiotic Resistance Coalition, including civil society organisations from a range of sectors and from six continents, is launched during the 67th World Health Assembly.  The Coalition urged that a number of steps be taken globally to tackle the problem. 

GP leaders warn of the pressures on GPs and of the risk that surgeries might have to close.  Dr Chaan Nagpaul, Chair of the BMA GP committee says that there is no meaningful structure to protect 98 surgeries at risk from the withdrawal of the Minimum Practice Income Guarantee (MPIG).  Another report says that extending surgery opening hours may not be the best way to improve access to GPs. 

(19th May)

GPs rejected a motion to charge for appointments, but approved one that said general practice is unsustainable in its current format, at the BMA annual local medical committee conference.

Tesco has said it will stop selling sweets and chocolates at checkouts in all its stores by the end of the year, after a survey of customers found a majority supporting this.  Lidl and the Co-op have already done this. 

Bulletin for CCGS: Issue 59

21st May 2014

There are not enough NHS BME managers, according to NHS England Chief Executive Simon Stevens.  He also hinted that he may oppose hospital centralisation, noting the importance of giving weight to communities’ preference for access over specialisation.

A pilot scheme to help GPs deal with long term conditions is being launched by NHS England in partnership with the King’s Fund, the Health Foundation and five CCGs.  It will make use of a patient activation assessment tool, about which the King’s Fund recently published a report. 

A third of first time mothers suffer some depressive symptoms at birth and in the early years of the child’s life, with the peak when the child is age 4, according to Australian research based on the experiences of 1,507 women from six hospitals in Melbourne.  (The depressive symptoms could be short lived and not necessarily post-natal depression).

A third of 15 year old girls say they have self-harmed in the last year, three times the number a decade ago, according to a WHO report, the Health Behaviour in School Aged Children (HBSC), due to be published in the autumn. 

There has been a 10% reduction in opiate and crack use since 2004-05 and fewer people are entering treatment for dependency, according to a report from Liverpool John Moores University funded by PHE, HO and DH.

A third of young girls believe exercise is socially unacceptable in making you hot and sweaty, according to a survey of 2,000 school children aged 8-16, carried out by health club operator Virgin Active. 

Weight loss at any age, and even if it is temporary, has cardiovascular benefits, according to research on 1,273 British men and women, followed since their birth in 1946, published in the Lancet.  

The Government welcomes CQC commitments to improve regulatory enforcement. 

Advice on mental health patients’ rights to choose where they have their first outpatient appointment has been published by NHS England. 

A survey of NHS managers and clinicians on culture, leadership and compassion, based on around 2,000 responses, is published by the King’s Fund.  It is published alongside a report, ‘Developing Collective Leadership for Health Care’.  Managers were found to have more positive views of the culture than clinicians.

(Free registration required) 

20th May 2014

Action to reduce dementia should include attention to physical activity, tobacco, alcohol use and diet as well as other known risk factors, according to the Blackfriars Consensus Statement, signed by 26 national organisations and 32 dementia and public health specialists.  There is now evidence that these factors affect dementia but this knowledge needs to be communicated more widely and more research is needed.  Dementia is estimated to cost the UK economy £23bn a year. 

The United Nations warns of the increased number of synthetic drugs, in its World Drug Report. 

Deaths from overdoses are twice as high in the UK as the European average, at 38 per million compared to 17 per million.

(27th May) 

(27th May) 

Monitor, the CQC and TDA have agreed a common leadership framework for use in making judgements on NHS providers. 

Information on repeated use of detentions and short term orders under the Mental Health Act is published by HSIC. 

NHS News: Issue 58 

19th May 2014

The food industry should be regulated in the same way that tobacco is, according to two international campaigning groups, Consumers International and the World Obesity Federation.  That could include regulation of content and information on packaging.

Patients and the public are being invited to contribute to a code for nurses, being developing by the Nursing and Midwifery Council, covering conduct, performance and ethics.

Information on how well hospitals deal with stroke is being made available online as part of the Royal College of Physician’s ‘Sentinel Stroke National Audit programme’. 

18th May 2014

The Children’s Commissioner suggests that increasing mental health problems in young people are linked to budget cuts and restructuring of health and social care, in written evidence to the Commons Health Select Committee enquiry on child and adolescent mental health. 

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

18th May 2014

Only a quarter of children with mental health difficulties are getting the services they need according to an internal NHS England presentation seen by the Observer.  It is said to paint a picture of a service in crisis. 

16th May 2014

There has been criticism of Government proposals to privatise child protection and other children’s social services, including a letter to the Guardian from 37 senior social services academics. 

Children’s mental health has been getting worse, exacerbated by computer use, with increased screen time raising the risk of mental health problems, according to evidence by PHE to the Commons Health Select Committee enquiry on child and adolescent mental health.  The report says that 750,000 teenagers believe they have nothing to live for.

28% of 16 year olds in Northern Ireland said they had experienced serious personal, emotional or mental health problems in the last year, and 13% had self-harmed at some time, according to a survey of 1,367 sixteen year olds by ARK on behalf of Queens and the University of Belfast. 

Health Education England is to launch a campaign to encourage nurses who have left the NHS to return. 

Overweight people tend to have friends who are also overweight because of being rejected by slimmer people, with younger people more likely to discriminate against them. 

 ‘Supporting People to Manage their Health’, report from the King’s Fund, including how to conceptualise and measure ‘patient activation’. 

Blog – and some interesting comments:

15th May 2014

Only a fifth of hospitals were able to offer palliative care seven days a week, despite this having been recommended by NICE ten years ago, according to a study by the Royal College of Physicians which investigated 6,580 deaths in 149 hospitals last May. Doctors and nurses talked with dying patients about their condition in only 48% of cases and palliative care training was mandatory for nurses in only 28% of trusts.  A survey of bereaved relatives found that 76% felt adequately supported in the final two days of life, while 24% did not. 

The Care Act receives Royal Assent.  The Act places a limit on how much people will have to pay for their care costs and puts a duty on councils to provide preventive services to support people’s health. 

A survey of NHS qualified nurse supply and demand has been undertaken by NHS Employers on behalf of Health Education England. 

‘Looking forward to Later Life’ report from Community Links.,2GC8E,FQODL,8X9GE,1 

New requirements on schools to ensure children with medical conditions have full access to education, will be hard to implement according to head teachers, because of the timescale of the reform, the reliance on teachers volunteering to take on tasks and limited access to further support. 

Mental health trusts are to receive additional funding for physical health checks of mentally ill patients, designed to reduce the 15 year life expectancy gap between them and the rest of the population, NHS England has said.

‘Spreading Improvement Ideas’, report from the Health Foundation based on a scan of empirical literature on how to spread new ideas and ways of working for improvement and innovation. 

A report on empowering patients to play a more active role in their care, drawing on 100 case studies from round the world, has been published by the All Party Parliamentary Group on Global Health. 

(20th May) 

Life expectancy globally is increasing, a new set of figures from the WHO, the World Health Statistics 2014, show.

(16th May)

‘A Councillor’s Guide to the Health System in England’ is published by the LGA. 

A guide on the commissioning process for those involvement in health improvement has been published by the Royal Society for Public Health. 

A guide on ethical commissioning for GPs has been published by the BMA. 

14th May 2014

The UK is still eating too much saturated fat, sugar and salt and not enough vegetables, fruit, oily fish and fibre, according to the latest National Survey of Diet and Nutrition. 

Depression is the biggest cause of illness and disability amongst adolescents world wide according to a WHO report. 

The second wave of the integrated digital care fund, providing £240m over the next two years, has opened for applications.  NHS Trusts and now local authorities can apply for funding to digitize and integrate patient information across health and social care. This is the second wave of a £500m programme. 

Wexham Park Hospital is said to be the first to use robots to sort prescriptions which are sent by pneumatic tube to doctors. 

(Note: The Heatherwood and Wexham Park Hospitals NHS Foundation Trust were put in special measures at the beginning of May:

It is to merge with nearby Frimley Park NHS Foundation Trust: 

Integrated funds were being used to compensate for spending cuts rather than promote integration according to an analysis by the MHP Health consultancy based on foi requests. 

NHS News: Issue 57

13th May 2014

Councils should provide vitamin D supplements to the 20% of adults at risk of insufficient intake via diet or sunshine, NICE has suggested.  Doctors’ leaders have said more emphasis should be given to obtaining the vitamin from diet or exposure to sunshine.

Healthy women with straightforward pregnancies should be encouraged to give birth in midwife-led units rather than traditional doctor-led labour wards, NICE is proposing.  The proposals were welcomed by the Royal College of Obstetricians and Gynaecologists, subject to further support being accessible if needed.

Report from JRF on informal, everyday support, based on detailed examples of people helping each other, in Glasgow. [Significant because of the large impact of ‘social capital’ on physical and mental health (e.g. loneliness being as significant a risk factor as obesity), and how, with greater understanding, public bodies can at least not undermine, even if they don’t promote, such behaviour.] 

(16th May) 

12th May 2014

Labour promises that people will be able to get a GP appointment within 48 hours, or 24 hours if it is urgent, and the right to book appointments more than 48 hours ahead.  It is to be paid for by the consequent reduction in A&E admissions and by cutting down on competition in the NHS.

Average alcohol consumption in the UK is approaching twice the global average, at the equivalent of 11.6 litres of pure alcohol a year compared to the global average of 6.2 litres according to a report from the World Health Organisation.  Alcohol is estimated to cause 3.3 million deaths a year worldwide.–and-the-uk-doesnt-even-make-the-top-10-9357860.html

The cap on residential care costs will help relatively few people according to a report by the Institute and Faculty of Actuaries.

22% of women feel anxious all or most of the time according to a study by the Mental Health Foundation, ‘Living with Anxiety’, published at the start of Mental Health Awareness week and based on a YouGov survey of 2,330 people.  Only 5% of respondents said they never felt anxious. 

Only a fifth of people have discussed their end of life wishes and only a third had written a will, according to a survey of 2,000 people by the Dying Matters coalition of care organisations. 

The number of people diagnosed with coeliac disease has increased fourfold between 1990 and 2011, from 5 to 19 people per 100,000 according to a study by Coeliac UK, but it estimates that 75% of people remain undiagnosed. 

Briefing on promoting mental health amongst BME children and young people published by Better Health. 

The CQC and Local Government Ombudsman have agreed to transfer relevant social care complaints directly to each other rather than advising people to contact the other organisation themselves. 

DH Corporate Plan 2013-14, Quarter 3 performance 

Report on the mental health of people with learning disabilities, from the Foundation for People with Learning Disabilities. 

Later Life Newsletter: 55 

11th May 2014

Three in five councils will have exhausted efficiency savings by next year and will have to make even more severe cuts to services like leisure, children’s centres, libraries and potholes, according to a report by the LGA, ‘Under Pressure’. 

Cuts in rehabilitation services for people with brain injuries are affecting thousands according to the charity Headway.  More than half of 500 people surveyed had lost access to rehabilitation and support services. 

10th May 2014

A guide to help those with bowel disease find an appropriate specialist, said to be the first of its type, is to be launched on the website of the Association of Coloproctology of Great Britain and Ireland. 

The ‘choose and book’ system for outpatient appointments is to be scrapped and replaced by a new e-referral scheme by 2016. 

(12th May) 

9th May 2014

NICE to suggest that a nurse-to-patient ratio of 1:8 is the minimum necessary for safety, with fewer patients per nurse in many cases.

(10th May) 

(13th May) 

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

9th May 2014

About half of patients with heart failure aren’t treated on specialist wards and have a worst prospect of success as a result, according to an audit of 44,000 admissions for acute heart failure in England and Wales.  The death rate while in hospital for such patients is 7% on a cardiology ward, 11% on a general medical ward and 14% on other wards. 

A BMA online petition calling for the repeal of the Health and Social Care Act has been signed by 3,000 people. 

The roll out of will only happen when it is ready and won’t be subject to ‘artificial deadlines’, according to Tim Kelsey, the National Director for Patients and Information at NHS England. 

(2nd May) 

An ‘alliance contract’ between primary and secondary care has been agreed in Leicestershire, aiming to move 40% of dermatology and 30% of ophthalmology patients out of secondary care.  It is thought that this is the first such operational alliance contract between primary and secondary care. 

8th May 2014

Pharmaceutical companies don’t have sufficient financial incentive to develop new antibiotics according to the Royal Pharmaceutical Society, saying that as they can cure infections in weeks, the volume of sales is low. 

79% of people think the NHS should be protected from spending cuts, while only 21% think the same about social services, according to a survey conducted by Ipsos MORI that asked which two or three areas should be protected from cuts.  The NHS was also the thing that made most people proud to be British. 

Councils should be freed of the requirement to appoint a Director of Children’s Services, SOLACE have said. 

The Government’s response to Sustain’s campaign on improving food in hospitals and schools, sets out the various approaches being taken to improve food across various government departments. 

NHS News: Issue 56

Bulletin for CCGs: Issue 58. 

Includes the launch of a new series of case studies:

GP and Practice Team Bulletin: May 2014 

7th May 2014

The launch of the £3.8bn Better Care Fund is said to have been delayed because of Cabinet Office concerns about its viability and evidence for success.  A review reportedly found a lack of financial credibility in the local plans produced so far, which are designed to reduce acute spending by improving health and community care.  It is also suggested that NHS funds are being used to replace local authority cuts.

Commentary from Richard Vize: 

Commentary from Simon Parker, NLGN: 

Matthew Taylor’s blog on why such spend to save schemes often fail: 

(8th May) Letter from Jeremy Hunt and Eric Pickles says they have made great progress on the project and the schemes are due to start in April 2015:

About a quarter of deaths could be prevented with better health care and healthier lifestyles, according to an analysis by ONS.  However ONS advise caution in interpreting the results because of the difficulties of determining which deaths are preventable and advances in healthcare and policy not being reflected in mortality figures in the short term. 

Avoidable deaths higher in Wales than England:–2012.html 

Dementia care by relatives is costing up to £1.6bn a year to the English economy as around 50,000 leave work to care for relatives, according to a report from the Centre for Economics and Business Research.  The Alzheimer’s Society is launching a new campaign, ‘Dementia Friends’, alongside PHE.

Satisfaction with the NHS remains at about 60%, following a fall in 2010 from its previous high of 70% according to the British Social Attitudes Survey 2013 conducted by NatCen social research and published by the King’s Fund. 

A report arguing for greater integration of healthcare through the use of mutuals, and more preventative activity, is published by ResPublica: “Power to the People: the mutual future of our National Health Service.” 

Briefing on the changes needed to next year’s NHS pricing and payment system, from the Foundation Trust Network.

6th May 2014

Many of the 1,200 deaths a year from asthma are preventable according to a report from the Royal College of Physicians.  An analysis of 195 cases found preventable factors in over 70% of cases, including preventable action by the sufferers themselves (such as more use of preventive inhalers, knowing when to seek help and not smoking). 

The NHS Confederation launches the ‘2015 Challenge’, working with a group of national representative organisations, to highlight the scale and nature of the challenges facing the NHS and to initiate debate on solutions with professionals, politicians and the public. 

The number of mental health patients having to travel out of their area has more than doubled in the two years from 2011-12, from just over 1,300 to just over 3,000 according to a joint investigation between BBC News and the online journal Community Care. 

The physical health needs of people with mental health problems or intellectual disabilities are not being properly addressed according to a report from the BMA. 

A conference of GP representatives is to discuss charging for services, at the Local Medical Committees’ conference on 22-23 May.  Other motions cover whether CCGs should commission primary care, the roll out of and whether GPs should be available from 8am to 8pm seven days a week. 

75% of doctors struck off between 2008 and 2013 were trained overseas, while about a third of doctors overall were trained overseas, according to figures from the General Medical Council.

Discussion on the early intervention message from US psychiatrist Bruce Perry, which has been receiving attention across the parties, suggesting some of the arguments may be overplayed and misinterpreted. 

An alternative view from US philosopher John Bruer, that the effect of early years is important but not irrevocable:

A guide on ‘special measures’ for NHS Trusts, drawn up by the CQC, Monitor and the Trust Development Authority, has been published. 

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

3rd May 2014

Loneliness amongst over 65s has increased from 7% to 10% in the last year according to a random sample of 2,000 over 65 year olds commissioned by Age UK. 

2nd May 2014

The UK has one of the highest death rates for children under five in Western Europe, according to US research from the University of Washington in Seattle, analysing data from 188 countries and published in the Lancet.  Although the situation in the UK has been improving over many years, this slowed down between 2010 and 2013. 

(3rd May) Comment and analysis: 

There has been an overall decline in alcohol related deaths between 2011 and 2012 but with increases in some, particularly deprived areas. 

60% of people struggling with suicidal thoughts receive no help and there is little evidence of what help works, according to a review by Glasgow and Harvard academics on the factors that increase risk or prevention of suicide.

All NHS staff are to be able to receive specialist dementia training by 2018, as set out in DH’s mandate to Health Education England. 

Bristol’s CCG is being taken to Judicial Review over whether they sufficiently consulted on their commissioning budget, the first such legal challenge of a CCG.

Cognitive tests, which may help spot early signs of dementia in the future, are to be given to a third of a million volunteers, who are already signed up to the UK Biobank to which they have given DNA samples.  Funded by the Medical Research Council, this is said to be the world’s biggest test of cognitive function. 

Volunteers in the UK Biobank are also being invited to have their brain, heart and other vital organs scanned:

Macmillan Cancer Support criticise cancer support compared to other European countries, saying that patients are diagnosed too, late, shown a lack of compassion in treatment and do not get the dignified death they would like.,warnsnewreport.aspx

Public health consultants and specialist staff survey results are published by the Centre for Workforce Intelligence. 

1st May 2014

CCGs are being invited to suggest how they could co-commission primary care in partnership with NHS England, Simon Stevens has said.  He says he wants to give CCGs greater influence over how NHS funds are invested locally.

(30th April) Blog on issues raised by Simon Stevens in appearing before the Health Select Committee:

(15th May) commentary in King’s Fund blog: 

There is a 14 year gap in the number of lives without disability that people have in the South East compared to Manchester and Liverpool, according to figures from the ONS. 

The NHS is running out of money according to the King’s Fund, in a report ‘The NHS Productivity Challenge’ which looks at the attempts of six trusts to address this. 

There should be financial incentives to encourage healthy behaviours, such as tax rebates for giving up smoking, staying slim and not drinking, according to a think tank, 20/20 Health. 

2,000 more children die per year than in Sweden, because of wealth inequality and a lack of targeted action on child mortality, according to a report from The Royal College of Paediatrics and Child Health and the National Children’s Bureau.

DCLG is reviewing and updating the indices of multiple deprivation and is keen to hear users’ views. 

‘Who Cares’ report from NESTA on informal care for older people, with a focus on the role of entrepreneurs and technology. 

Evaluation of the Welsh ‘Invest to Save’ fund. 

The ‘Social Services and Well-being Act (Wales) 2014’ receives Royal Assent.  It is described as the biggest transformation of social services in Wales in 60 years and as promoting independence, early intervention and prevention.  It includes the requirement on local authorities to promote social enterprises, co-operatives, user-led services and the voluntary sector in the provision of care. 

30th April 2014

Resistance to antibiotics poses a major global threat according to a new report from the WHO, based on data from 114 countries.  It warns of a post-antibiotic era with many deaths from diseases which are currently treatable.  25,000 people a year die in Europe from infections resistant to drugs of the last resort.

The Scottish Government’s attempt to introduce a minimum price for alcohol has been referred to the European Court of Justice, after a long legal battle by the whisky industry, because it raises issues of European law on free trade and rights to set price controls. 

A meta-analysis of research on young people’s attitudes towards obesity shows that they are more concerned with the social, than health effects, and particularly the bullying, stigma and discrimination that comes from it, with potential lessons for how this is tackled. 

A review of the evidence on access to primary care by vulnerable groups, including vulnerable migrants, gypsies and travellers, people who are homeless and sex workers, has been published, alongside examples of good practice. 

First annual report by the Children and Young People’s Health Outcomes Forum, with responses to consultation. 

PHE Bulletin 

Following BBC Panarama’s exposure of the Old Deanery care home, a comment article on how widespread the problem is: 

29th April 2014

Over two thirds (68%) of inpatients with learning disabilities had been given anti-psychotic drugs in the previous 28 days, and 93% of these had been given them on a regular basis, even though they are only supposed to be used as required.  This is according to further analysis of an earlier census by HSCIC. 

Pfizer begin talks on a takeover of AstraZeneca, Britain’s second largest pharmaceutical company.

(30th April) the proposed takeover could be a threat to the UK’s science base:

(2nd May) AstraZeneca rejects the offer: 

Cancer survival rates improve so that half of those diagnosed with cancer can expect to live another ten years, according to the Cancer Survival Group funded by Cancer Research UK.  However, survival rates are still lower than many other European countries.  There are big differences between different types of cancers, with the 10 year survival rate being just 1% for pancreatic cancer but 98% for testicular cancer.

More needs to be done to combat loneliness in old age, with half of over 85 year olds feeling lonely at some time according to a report by CentreForum.  In addition to the direct unhappiness causes, there are significant knock on costs for health. 

A framework of principles for addressing comorbidities is published by DH.  This short (7pp) document sets out high level principles for action across the health and care system for dealing with co-morbidities particularly from increased life expectancy and from intense exposure to risk factors such as smoking, obesity alcohol and physical inactivity. 

The food a mother eats while pregnant can affect their child’s genes, and so their long term health, although it is currently unclear what the effects will be. 

Public health in local government, one year on: publication from the LGA. 

28th April 2014

The majority of people using e-cigarettes are doing so to stop or cut down on smoking accord to ASH (Action on Smoking and Health).  About 2 million people are thought to be using e-cigarettes but only 0.1% were previously non-smokers.  The numbers using them have tripled since 2010.  The research is based on a survey of 12,000 people.

Not enough has been done to tackle obesity in the last year, according to the annual ‘Weigh-In’ report from the Academy of Medical Royal Colleges which makes recommendations on such things as food advertising, taxes on sugary drinks and school meals. 

A potential GP shortage is possible in the next few years, as the number of training places is not sufficiently increased.  The number of places for this August will increase by 80 places to 2,896, but this compares to DH’s target of 3,250 places by August 2015.  There was also a 15% fall in first round applicants this year compared to last. 

A quarter of a billion fewer units of alcohol have been sold as a result of the responsibility deal according to a new DH Report.  This is in the context of 52bn units of alcohol ‘cleared for sale’ in 2011. 

The Parliamentary and Health Service Ombudsman should be modernised, to give it powers to initiate its own investigations and to allow direct access by citizens according to a report by the Public Administration Select Committee.

A tool to help local authorities assess the financial benefits of weight management programmes has been published by PHE. 

‘Living well for longer’ from DH outlines action being taken to reduce premature avoidable mortality.  It focuses on cancer, stroke, heart disease, lung disease and liver diseases. 

PHE has published data on end of life care for each CCG for the first time.  Over 170 indicators provide information on cause and place of death for each CCG in England.

NHS News: Issue 54 

27th April 2014

Greater competition could be forced on the NHS with American private healthcare companies able to sue CCGs for restriction of trade, under the proposed Transatlantic Trade and Investment Partnership, according to Labour.  Andy Burnham says the NHS should be exempted from the treaty.  The Government says it “strongly believes these fears are misplaced.”  However its statement doesn’t seem to directly contradict the charges (e.g. saying that doctors will remain in charge of deciding who should provide services in the best interests of their patients). 

The high level of still births and baby deaths during or shortly after birth have been criticised by the President of the Royal College of Obstetricians and Gynaecologists.  The number of stillbirths, about 4,000 a year is the third highest of 35 high income countries. 

One in three employees struggle at work because of depression, stress or burn-out according to the Depression Alliance charity.  The research comes alongside a report from a coalition of organisations which launched an initiative last year to target depression at work. 

(28th April) 

Only 7.5% of crimes committed by people with mental ill health were related to their illness, according to a US study conducted with former defendants of a mental health court in Minneapolis. 

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

25th April 2014

£1.2bn over two years is being spent by NHS Trusts to implement improvements following the Francis and Keogh reports, according to the Foundation Trust Network, with much of this not covered by external funding. 

A health atlas of diseases and environment factors impacting on health has been published by Imperial College.  The atlas maps factors at census ward level.  The researchers emphasise that the correlation of factors does not prove causation.  It is also noted that environmental factors are responsible for only 5-10% of health problems with most of the rest a result of lifestyle factors.

24th April 2014

New ‘collective solutions’ to caring for elderly people will be required, as the number of older people needing care outstrips the number of adult children able to provide it, by 2017, according to a new report by the IPPR, ‘The Generation Strain’.  It proposes a number of solutions which are more about partnerships with families and communities than traditional service delivery.

The Human Rights Act is to apply to people receiving state funded care in their own homes, via an amendment to the Care Bill. 

The Department of Health was too involved with operational issues contrary to the intentions of the 2012 Health and Social Care Act according to a survey of stakeholders undertaken by Ipsos MORI last summer.  [Whilst this is a view that has emerged from more informal feedback, particularly from NHS England, this report is significant in being based on independent research involving in depth interviews with 107 stakeholders.] 

Factors affecting children’s happiness are explored in a research report, ‘Predicting Wellbeing’, based on more than 12,000 children in the Millenium cohort study, by NatCen Social Research funded by the Department of Health.  Family composition, such being in a single parent family, did not affect the happiness of seven year olds, but the nature of the relationships did.

Link to report, pdf: 

Southwark Circle, a mutual support scheme for people over 50, is to close following the ending of government funding and a failure to find alternative sustainable sources.  Other circles in London and Suffolk are also closing, but ones in Nottingham and Rochdale will continue. 

DH input and impact indicators for March 2014 (showing such things as life expectancy, lives lost from causes amenable to healthcare and patient experience. 

International compendium of statistics on population from ONS including on life expectancy (leading to news stories about how Japanese women’s diets can aid longevity).

(25th April)

23rd April 2014

A reduction in binge drinking may be a factor in reduced serious injury according to a Cardiff University study based on returns from 117 emergency departments, minor injury units and walk in centres.  Part of the reason for reduced alcohol consumption might be higher prices, but could be a range of other factors as well. 

(21st April) the possible role of lead in violent crime:

The programme is to be trialled in 100-500 GP practices before being rolled out more widely later in the year. 

Alcohol can be carcinogenic, so objection to an advertisement illustrating that has been dismissed by the Advertising Standards Authority.  The objections came from the British Beer and Pub Association and the Campaign for Real Ale, amongst others. 

NHS News: Issue 53 

22nd April 2014

Acute Kidney Injury causes between 15,000 and 45,000 deaths a year, much of it avoidable, and at a cost to the NHS of £1bn annually, according to a study by Insight Health Economics commissioned by NHS Improving Quality.  Dehydration is one of the main causes of the condition.

Guidance from WHO on addressing health inequities arising from alcohol, unintended injuries, overweight and obesity and tobacco. 

21st April 2014

The incidence of skin cancer has increased by five times over 40 years, from 3 in every 100,000 in the 1970’s to 17 per 100,000 in the latest figures.  The numbers are expected to continue rising.  It is thought the increase is at least partly due to the rise in foreign holidays and greater use of sun beds.

18th April 2014

Doctors trained overseas tend to be less competent than those trained here according to research by UCL, Cambridge and Durham universities published in the BMJ.  The researchers recommend that there should be a higher pass mark in the test allowing foreign trained doctors to practise in Britain.  However 27% of doctors qualified outside the European economic area and it is suggested that a harder test would lead to a shortage of doctors.

(17th Apriil)

Children subjected to frequent bullying were nearly twice as likely to suffer from depression at the age of 45 according to a study of 8,000 children born in 1958, according to researchers from King’s College London.

17th April 2014

NHS waiting lists are at their longest for six years, and more than 10% have been waiting for more than 18 weeks for the first time in three years, according to official figures. 

The Government proposes further outsourcing of children’s services, including child protection. 

The Decent Homes programme saved the NHS £392m between 2001 and 2010, by reducing accidents and illnesses.

(Free registration required) 

Findings on the links between air pollution and cardiovascular disease from a government committee. 

Bulletin for CCGs: Issue 57 

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

17th April 2014

NICE issues quality standards to try and reduce infections for hospital patients.  It is said that infections cause 5,000 deaths a year and contribute to others.

The Government suggests pensioners should be told how long they are likely to live, to help them financially plan their retirement. 

The changeover day for junior doctors taking on new positions should be staggered to reduce death rates over this period according to a report from the Academy of Medical Royal Colleges.  Currently junior doctors mostly start new positions on the first Wednesday in August.

16th April 2014

NHS England is conducting pilots trying different ways of involving GPs in the 111 service. 

Over 600 religious leaders have called on the three main parties to take action on hunger, asking them to tackle the causes of food poverty such as low wages, rising food prices and welfare arrangements.  The Trussell Trust said that it provided more than 900,000 people with food parcels in 2013-14.  It said that the main reason people came to food banks was because of welfare changes, cuts and delays, including sanctioning of payments.

The NHS has the fewest number of beds per population than any of 23 European countries except Sweden, and is stretched to breaking point, according to an OECD study.  The Government said more people are being treated in the community with less need to stay over night.  However the Foundation Trust Network said that the figures suggest hospitals are operating near full capacity.

Latest statistics on life expectancy from ONS, show increases in life expectancy, decreases in difference between the sexes and large geographical variations.

Report on ‘Pay, Conditions in Care Quality in Residential, Nursing and Domiciliary Services’ from the Joseph Rowntree Foundation, shows the importance of making staff feel valued, the need to address care work’s low status and the importance of employee retention for quality of care.

15th April 2014

80% of NHS Trust finance directors are very or fairly pessimistic about the state of the health and care economy over the next year according to the King’s Fund’s Quarterly Monitoring Report.

14th April 2014

Overwork amongst nurses meant that two thirds felt they could not spend enough time with patients, according to a Unison survey of almost 3,000 nurses. 


Public services, including health and local government, need to get better at handling complaints, according to the Commons Public Administration Committee.

NHS News: Issue 52 

Later Life Newsletter 54

13th April 2014

The Government is to make £50m available to increase access to GPs, including personalised care for the elderly and appointments in the evenings and at weekends.  This will cover about 1,147, or about 1 in 10, GP practices. The funding is for one year.  [For context, the total budget for GPs is about £8.5bn, so this represents about 0.5% of that].

(Press release, 14th April)

(Policy paper, 52pp): 

(14th April) Experts say there may be conflicts between greater access and continuity of care: 

(16th April) Useful commentary from Richard Murray of the King’s Fund.  Suggests there is some good content but ‘little operationally new’ and it would have been more useful before the CCGs had to submit their strategic plans:

11th April 2014

NHS England consults on mental health indicators for CCGs’ Quality Premium payments.  Responses requested by 2nd May. 

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

11th April 2014

None of the countries of the UK is consistently ahead or behind the others according to a report, ‘The four health systems of the UK: how do they compare’, published by the Nuffield Trust and the Health Foundation.  The report is based on analysis of about 20 indicators over the last two decades.

10th April 2014

Tamiflu does not stop the spread of flu or prevent complications and only slightly reduces the period of symptoms from 7 days to 6.3 days in adults and 5.8 days in children, according to a review of the evidence by the Cochrane Collaboration.  £473m has been spent stockpiling the drug to protect against epidemics.  Roche and some scientists have criticised the review. [This story is perhaps more significant in what it says about access to trial data as in any judgement on this particular drug.  As Ben Goldacre comments, while it took Roche 4 or 5 years to release all the data, they should be thanked for finally doing so and encouraged to continue in this vein.] 

Ben Goldacre comment:

A High Court Judge has dismissed claims that GPs’ exams were discriminatory and unlawful but has still said that the Royal College of GPs needs to change its assessment systems as ethnic minority medical graduates were put at a disadvantage by the current system. 

Wales has the worst waiting times for diagnostic tests in the UK, with 42% of people having to wait more than six weeks, compared with 1.8% in England and 3.8% in Scotland.

A shift in focus in how mental health is dealt with could save the NHS over £50m a year, with cuts likely to cost millions of pounds in the long term, according to a report by Rethink Mental Illness with the London School of Economics.

Air pollution shortens life expectancy by six months, according to a report providing estimates of mortality associated with air pollution by local authority area published by Public Health England (PHE). 

The publication: 

A list of DH arms length bodies with basic contact details, board members and executive teams is published.

9th April 2014

NICE recommends needle exchanges for people injecting steroids and other performance enhancing drugs, including for under 18s, to protect against the spread of HIV and other infections.  NICE estimate that about 60,000 people injected anabolic steroids last year.

CQC consults on its new approach to regulating, inspecting and rating care services.

Interview with David Behan, providing useful summary of progress with CQC: 

The priorities for children’s services should be schools, childcare and a streamlined inspection system, according to the new president of the ADCS, Alan Wood. 

There is no evidence that homeopathy is any more effective than placebos according to a review of the evidence by Australia’s National Health and Medical Research Council.  They could find no good quality, well designed studies with enough participants to meaningfully demonstrate its effectiveness.

The Social Progress Index is published, ranking countries according to indicators measuring a wide range of factors such as basic human needs, health, access to information and rights. 

(8th April)

(4th April) 

8th April 2014

Lack of physical activity is leading to 37,000 premature deaths a year in England, with less activity than at any time in human history, according to an All Party Parliamentary Commission on Physical Activity.–killing-37000-prematurely-in-england-each-year-9244551.html

An organ in a mammal has been rejuvenated for the first time, using gene manipulation with potential implications for regenerative medicine.  The thymus (which is critical for the immune system) of a mouse was ‘regenerated’ by boosting a particular gene which naturally loses effectiveness as the organ ages.

Consultation on Sections 135 and 136 of the Mental Health Act 1983 in England and Wales under which police have powers to temporarily remove people who appear to be suffering a mental disorder to a place of safety. 

The CQC Inpatient Survey for September 2013 to January 2014 shows improvements in information provision, communication with staff and cleanliness of hospital wards and bathrooms.  Few questions showed a decline but there was nevertheless scope for improvement in some areas.  The survey covered over 62,000 people aged over 16, with a 49% response rate. 

Government response to the Health Select Committee report on public expenditure on health and social care.  [Essentially seems to be saying, ‘thanks very much, but we’re going to carry on doing what we were doing anyway.] 

7th April 2014

People who survive intensive care are three times more likely to experience depression than the public as a whole, according to US research published in the Lancet Respiratory Medicine. 

NHS News: Issue 51

4th April 2014

Guide for local Healthwatch organisations on mental health, published by NSUN Network for Mental Health 

(9th April) 

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

4th April 2014

Nearly 30% of CCGs are putting services out to tender because of new competition rules according to a Health Service Journal survey which received responses from 93 CCGs. 

3rd April 2014

The Government intends to introduce plain packaging for cigarettes following the review by Sir Cyril Chantler.  It is drafting regulations and will consult on the proposals.

Patient charges may be necessary to fund the health service in future according to an interim report from the King’s Fund’s ‘Commission on the Future of Health and Social Care’ in England, chaired by Kate Barker.  This report sets out options, with recommendations to be made in the final report in September.  The report also proposals a single, ring-fenced budget for health and social care. 

(Press release): 

(The publication): 

Blog by Kate Barker: 

Funding of £230m for GPs’ IT systems is announced by NHS England 

The HSCIC publishes a list of bodies to which NHS patient information has been released.

Commissioning in Adult Social Care: briefing from LGIU and Mears, based on a series of roundtables on: market management; monitoring and evaluation; personalisation and co-production; integration; and workforce issues. 

Bulletin for CCGs: Issue 56 

2nd April 2014

DCLG announces £410m funding for councils to aid transformation of services.  £90m is to be distributed immediately and £320m over the next two years through the Transformation Challenge Award, for which bidding has now opened.  The money could be used for such things as integrating health and social care, helping the unemployed back to work or helping children get ready for school.  It includes funding for the Public Services Transformation Network.  However, it appears from the prospectus that of the £320m, only £120m is a grant, with £200m a ‘facility to use capital receipts from asset sales’ [i.e. permission to use the money from selling things off?] 

Prospectus for local authorities: 

The Health Select Committee’s annual review of the GMC found problems with the GP revalidation process, with too many doctors for each individual to assess making it hard to form the necessary professional relationships. 

Changes to EU regulations on clinical trials, to reduce bureaucracy, are welcomed by the NHS Confederation.

Progress by councils with the Troubled Families programme (spreadsheet).

1st April 2014

Simon Stevens draws criticism from unions on his first day by appearing to support more private sector involvement in the NHS, when he talked about ‘the innovation value of new providers’. 

Full text of speech:

Press release:

Less than half of GPs think CCG decisions reflect their views, although they think they can influence CCGs more than they could PCTs, according to a survey in 6 CCG areas by the Nuffield Trust and the King’s Fund. 

People in England with complex health needs have a right to ask for a personal budget from 1st April. 

People in Scotland needing social care now have the right to personal payments if requested as the Self-Directed Support (Scotland) Act comes into force. 

Updated framework giving information about patients’ right to choice about their healthcare is published by DH. 

Guidance to NHS Trusts on publishing staffing information (e.g. number of nurses on a ward) as part of the ‘Hard Truths’ commitment. 

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