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2014 Q3 July-September

Health and Wellbeing Policy Update: July – September 2014

19th September 2014

NHS trusts were over £450m in deficit in the first three months of this financial year, with 86 of 147 foundation trusts being in the red with a combined deficit of £167m and 33 of 65 non-foundation trusts being in the red with a total of £300m according to figures from Monitor and the Trust Development Agency.  

News release:–3

Official (‘experimental’) benefit and unemployment statistics for people on the DCLG’s ‘troubled families programme’, are published by DWP.

18th September 2014

Alcohol related liver problems are highest in the North West and North East, according to a regional map of emergency hospital admissions due to alcohol related liver disease in England produced by HSCIC.  Liver disease kills around 11,000 people a year, and the numbers are rising. 

Too many patients are not sufficiently involved in planning their care, with 23% saying they had not agreed with someone from mental health services what care they should receive, according to a survey by the CQC of more than 13,500 people who use mental health services in England.  66% rated their overall experience of mental health services as 7 or above on a 0-10 scale. 

CQC press release: 

CQC report on the survey: 

78% of people would like more help to treat themselves independently, according to a survey of 2,600 people with ongoing physical or mental health conditions in the social network HealthUnlocked, published in a report by IPPR.  57% said that being able to phone a doctor would reduce visits to the GP or hospital. 

Press release:

The report:

Norman Lamb says patients should be allowed to spend their personal health budgets on luxury goods if it improves their experience of the health service and wellbeing, it is reported in Pulse magazine.  But Dr Chaand Nagpaul, Chair of the BMA GP Committee, said such spending should be subject to the same controls and restrictions as other NHS budgets. 

DH publishes a progress report on premature deaths of people with learning disabilities. 

NICE is not taking forward proposals for more value based assessments taking account of societal benefits of treatments after public consultation found no agreement on the way forward. 

A number of business chiefs have called for a rise in the minimum wage. 

A new ‘MyNHS’ website, providing data for patients goes live.  The website is a joint project between DH, NHS England, PHE, CQC and HSCIC. 

The website: 

CCG outcome indicator set is published by HSCIC, on quality of services commissioned and health outcomes, for CCGs and HWBs. 

A useful set of infographic slides on public health and return on investment from the King’s Fund and the LGA [best viewed through the link to Slideshare – watching on the King’s Fund site missed half the slides at time of viewing]. 

17th September 2014

Poorer women tend to receive worse care in pregnancy and were significantly less likely to have seen a health professional according to a study based on 5,000 responses in the 2010 National Maternity Survey. 

61% of the 700k people referred for talking therapies were seen in the target 28 days, but with large variations around the country, between 3% and 96% in different CCG areas, according to figures from HSCIC. 

Unemployment has fallen to the lowest level since 2008 and is now 6.2%¸ according to figures from ONS.  There are now 967k unemployed on the ‘claimant count’ measure but 2.02m on the ‘labour force survey’ measure. 

Waistlines in the US have grown by an inch between 1999 and 2012 while BMI changed little.  The reason for the difference isn’t known. 

Healthy lifestyle factors like smoking and obesity influence the chances of getting dementia, although many people don’t realise it, according to the World Alzheimer’s Report 2104, from Alzheimer’s Disease International.

Simon Stevens says we need to get serious about obesity or it will bankrupt the NHS. 

PHE publishes its global health strategy, covering how it will contribute to public health in other countries and protect health in England from international threats. 

16th September 2014

Simon Stevens has said Labour’s proposed blanket ban on competitive procurement would not be legal, under existing UK and EU legislation, in a letter to Andy Burnham. 

People with mental health problems are having to wait too long for treatment and are getting worse during the wait, with 41% having to wait more than three months according to a survey of 2,000 people by the ‘We Need to Talk’ coalition.

Sugar consumption should be cut to 3% of energy intake since dental problems cost between 5% and 10% of health expenditure in industrialised countries according to a report in BMC Public Health.  NHS Choices suggests that on its own the study is not robust enough to lead to policy changes.

More money is not enough to save the NHS, the Health Foundation argues in a new report, ‘More Than Money: closing the NHS quality gap.’  The report says money is needed for a transformation fund to move to co-ordinated care, care outside hospitals and a greater role for patients.

Press release:

The report: 

A series of evidence reports and briefings on health inequalities, and what can be done to tackle them through the social determinants of health, at a local level, has been commissioned by PHE and produced by the Institute of Health Equity at UCL. 

NHS England publishes its first Annual Review. 

(18th September) 

15th September 2014

NHS finances are worsening with a majority of trusts ending the April-June quarter in deficit, which collectively totalled nearly £500m, according to figures due out later in the week from Monitor and the TDA. 

NHS England is to consult on the future of children’s heart surgery following a series of controversial proposals over a number of years.  Rather than proposing that some centres close while others remain, the new approach sets standards in 13 areas that the units must meet to remain open.  The consultation runs until 8th December.

Half of 31,000 heart attack patients missed key aspects of care even though that meant a 46% higher chance of dying within a month, according to research from the University of Leeds published in the European Heart Journal: Acute Cardiovascular Care.  The researchers looked at whether the patients received all 9 recommended steps of care.


The ADCS has criticised proposals for multi-agency inspections of children services, as the inspectorate have not agreed a common framework and would produce separate inspection results. 

The Government is consulting on whether health and social care providers should be required to display their ratings from the CQC.  The King’s Fund warned that this could be misleading as the overall score of, say a large trust, might be quite different from the particular service being used.

Walking or cycling to work makes people calmer and happier and bus or trains are better for wellbeing than driving, according to research on 18,000 people by the University of East Anglia Norwich Medical School. 

Nearly two thirds of research used in NICE guidelines for GPs was of ‘uncertain relevance’ to primary care according to a literature review from Norwich Medical School. 

A report on health inequalities between the north and the rest of England, ‘Due North’, is published by CLES (the Centre for Local Economic Strategies).

14th September 2014

More councils are only providing social care for those whose needs are assessed as critical or substantial, (rather than low or moderate) with the proportion having risen from 72% in 2010-11 to 90% now, the Association of Directors of Adult Social Services has said. 

The Office for Budget Responsibility should be required to monitor and forecast levels of poverty as part of a comprehensive, cross-party, long term strategy to sustainably reduce it, the Joseph Rowntree Foundation says in a publication, ‘A UK Without Poverty’. 

JRF press release: 

The publication: 

13th September 2014

Exempting health from the Transatlantic Trade and Investment Partnership would be against the interest of British pharmaceutical and medical firms, which face trade barriers in the US, Government minister Earl Howe has said. 

12th September 2014

An inhaler which delivers nicotine has been licensed as a medicine, the first of this sort of product so to have been in the UK.  The device could be provided on prescription to help people stop smoking, but there is some concern because it is financially supported by British American Tobacco (meaning NHS funds could subsidise a tobacco company). 

The Government publishes its response to the report on antimicrobial resistance from the House of Commons Science and Technology Committee. 

The Government publishes its response to the Health Select Committee report on long term conditions. 

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

12th September 2014

NHS England’s 25 Local Area Teams could be reduced by between a quarter and a half as part of a restructure the body is currently considering, according to Pulse magazine. 

A report on scrutiny and accountability for local government spending is published by the Public Accounts Committee.

The Government response to the Health Select Committee’s report on long term conditions is published. 

11th September 2014

There is an unfair allocation of resources for local health commissioning, with progress towards rectifying it too slow, the NAO has said.  The report looks at funding arrangements for CCGs, NHSE Local Area Teams and local authorities, which previously all went to PCTs.  19 of the 20 CCGs with the tightest financial position are receiving less than they ought.

The key issues in health and social care that the political parties should address have been set out in ‘The 2015 Challenge Manifesto’ from a coalition of 21 bodies. 

Making people feel bad about their weight does not help them to lose it according to research from University College London published in Obesity.  The study of 3,000 UK adults over four years found that the 5% who suffered ‘weight discrimination’ gained 0.95kg while those who did not lost an average of 0.71kg.

PHE consult on ‘Everybody Active, Every Day’, a publication providing evidence and proposals for why and how people can be encouraged to be more active through central and local action.  The consultation ends on 25th September. 

Patient Reported Outcome Measures covering hip and knee replacement, varicose vein and groin hernia, for 2013-14 are published by HSCIC. 

Bulletin for CCGs: Issue 67

10th September 2014

Dementia costs the UK £26bn a year, made up of £5.8bn social care paid by individuals, unpaid care by relatives and others worth £11.6bn, health costs of £4.3bn and councils’ social care costs of £4.5bn, according to research by the LSE and King’s College London for the Alzheimer’s Society.  That means the equivalent of over £21,000 a year is paid by dementia patients and their families themselves.

Labour argues against new regulations letting councils outsource children’s safeguarding, but votes for them anyway. 

Informed: Issue 3 

Later Life Newsletter: 58.  August 2014 

Later Life Newsletter: 59.  September 2014

9th September

More should be done to keep people with mental health problems in work, the Chief Medical Officer, Dame Sally Davies has said in her annual report.  Working days lost to mental illness cost the economy £70-100bn a year but 75% of people with diagnosable mental illness get no treatment. 

(10th September) Feature on mental health in the workplace: 

(Press release): 

(The report):

Older people tend to be excluded from drug trials, reducing the evidence available of the effects of drugs and appropriate dosages on older age groups, according to research in the BMJ.  There is also limited evidence on the interaction of different drugs when many people are taking a number of different medicines. 

Older people’s immune systems were more affected by the stress of bereavement than younger people who seemed to be more resilient, in research looking at blood samples and health behaviours of 41 younger and 52 older people, published in the journal Immunity and Ageing. 

(Open access) 

Globally 9 times more people are killed in violence between individuals than in wars according to US research. 

Free bus passes for older people generate £2.87 for every £1.00 spent, in terms of social and economic benefits, so scrapping them would cost the equivalent of £1.7bn a year, according to a cost-benefit analysis by KPMG for Green Journeys.  Benefits include greater social interaction, better access to public services and the ability to provide care, for instance for grand children. 

Public Health funding will remain the same next year at £2.79bn and will be ringfenced the Government has said in announcing allocations to local authorities.  There will also be a pilot, £5m incentive scheme, for reaching one central and one local public health target. 

Consultation on the incentive scheme: 

The CQC announces the first inspections of independent hospitals under its new style of inspections. 

8th September 2014

More than twice as many people under 65 develop early onset dementia than previously thought, at 42,000 according to research from the Alzheimer’s Society, LSE and the Institute of Psychiatry, to be published on 10th September. 


Cancer services have been weakened by the NHS reorganisation and reduced funding, with a reduction in leadership and co-ordination according to a report based on 45 interviews with leading cancer experts and an online survey of 450 other NHS cancer personnel, by the Health Services Management Centre at Birmingham University for Cancer Research UK.

The term ‘pre-diabetes’ is confusing and alarming patients and should be avoided, diabetes charities have said.  It is not a condition recognised by NICE or the WHO and it is suggested that a better term is ‘high risk’.


A virus placed on a door handle spread to 40-60% of other tested surfaces within two hours, but could be fairly easily prevented through hand washing and disinfectant wipes, according to research from the University of Arizona Tuscon. 

(9th September) 

Five minutes walking every hour can help reduce the harmful effects of extended sitting, by preventing the reduction in the arteries’ ability to expand with greater blood flow, according to researchers from Oregon, USA, on 11 healthy men aged 20-35 who had three five minute walks in three hours of sitting.

Monitor publish a tool to help commissioners estimate how a local care economy spends its money by age group, patient group and care settings.

7th September 2014

The CQC is planning to increase its scrutiny of the big chains of care home providers, by scrutinising corporate leadership (although it doesn’t have the power to inspect head-office functions) and looking at other homes in the chain if there is trouble with one, the Chief Inspector of Social Care, Andrea Sutcliffe has said.

Waistlines more than half a person’s height reduce life expectancy, research from City University London suggests, which they say is an easier to use and more reliable formula than BMI.  The research was based on records of more than 300,000 adults over 20 years. 

6th September 2014

About 5,000 people joined the ‘people’s march’ against privatisation of the NHS when it arrived in London following a 300 mile walk from South Tyneside organised by a group of about 30 mothers. 

(7th September)

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

5th September 2014

91.3% of A&E patients were treated within the 4 hour target last week, the lowest level since April 2013. 

About a fifth of child deaths are preventable, according to three papers in The Lancet.  There are striking differences between the death rates of the richest and poorest children.  The NHS Choices website points out that this one-in-five figure is not a new one.

GPs are calling for delays to a scheme which will allow patients to register with GPs outside their home area, which is due to be implemented in October, because detailed guidance on how it should operate is not yet available. 

A private member’s bill to modify the bedroom tax has passed its second reading with Lib-Dem and Labour support with some Tories also voting for it.  It would exempt social housing tenants from having their housing benefit reduced if there wasn’t a reasonable offer of accommodation with the ‘correct’ number of bedrooms, or if there were adaptations or medical reasons for another room.

Informed: Issue 2

4th September 2014

A prospectus for the Integrated and Personalised Commissioning (IPC) programme has been published by NHS England, the LGA, TLAP and ADASS.  The programme will offer technical support and regulatory and financial flexibilities to local authorities and NHS commissioners.

‘Getting Serious About Personalisation in the NHS’ is published by TLAP, to accompany the IPC prospectus.  Provides a very helpful overview of background, explanation and good practice in personalisation. 

The Government publishes its plans for helping disabled people fulfil their potential, in ‘Fulfilling Potential: Making it Happen’. 

Gay people are more likely to report poor experience of GP services, are slightly more likely to say their health is poor and are more likely to have mental health problems, according to research by Cambridge, Harvard and the Rand Corporation on the 2009-10 English general practice survey with over 2 million responses including 27,000 from gay, lesbian and bisexual people.

Rand press release: 

Suicide is a significant cause of death worldwide and is the second leading cause of death amongst 15-29 year olds, but much could be done to prevent it, according to a report from the WHO.

There are calls for NHS staff to be freed to help with the Ebola crisis in Africa. 

3rd September 2014

Social care for the elderly and long term ill should be provided free, ending the ‘illogical’ divide between health and social care, with the commissioning of both services brought together, according to the King’s Fund’s Commission on the Future of Health and Social Care in England, led by Dame Kate Barker.

Care for smoking related diseases is costing councils £600m a year, with further costs for individuals estimated as £450m as well as the non-financial costs of caring, according to analysis by Action on Smoking and Health (ASH). 

Decisions about care and the residential aspect of it should be separated according to the report of a commission led by Demos. 

Build homes for the elderly on NHS land:

Brooks Newmark, the new minister for Civil Society has said he wants to keep charities out of politics, and said they should focus on their core costs (‘sticking to the knitting’, not, as some have interpreted it, ‘sticking to knitting’) in response to a question on the ability of charities to campaign.  He later revised this to say he was referring to keeping them out of party politics rather than campaigning in general. 

Children are spending 26 hours a year being driven to school now, compared to 18 hours in 1995, with the proportion being driven to school having risen from 40% to 46%, according to analysis of Government figures by Sustrans. 

There is little difference between diets in terms of weight loss, with the key being adherence to them, according to Canadian research analysing data from over 7,000 overweight dieters, published in the Journal of the American Medical Association.  Behavioural support and exercise also help weight loss.  However, it didn’t look at other health effects such as the effect on cholesterol.

A report on volunteering, ‘People Helping People: the future of public services’ is published by NESTA. 

2nd September 2014

English hospital admissions for skin cancer have risen by 40% in five years from 88k to 124k between 2007 – 2011 according to figures from Public Health England due to be reported to a conference.  It is suggested that the bulk of these could be avoided by better protection from the sun. However part of the reason for the increase is said to be more referrals by GPs. 

(30th August) Skin cancer rates are rising fastest amongst older men: 

Nearly 12,000 people were wrongly struck off GP registers after there was a 14% error rate in the process used, which removed people from lists if they did not reply to a letter, Pulse Magazine has discovered.  If the same rate applies across the country, there could be 35,000 people who would have to re-register after being removed from lists. 

A double mastectomy for breast cancer does not improve survival chances according to research on nearly 190,000 women in California published in the Journal of the American Medical Association.  Ten years after having both breasts removed 19% of women had died, compared to 17% of those who had had the lump removed followed by radiotherapy.  Double mastectomies are not routinely offered in the UK.

Early research suggests people can be trained to like healthy food, with the results showing in brain scans.  However, while this was a randomised controlled trial, it was just a pilot study on 13 people, so further research would be necessary to confirm the findings.. 

1st September 2014

The Government has no plans to specifically exclude the NHS from the TTIP (Transatlantic Trade and Investment Partnership) being negotiated between the EU and US, the Trade Minister Lord Livingston has said. 

(2nd September) Comment:

A national Child Obesity Action Group should be set up, the Royal College of GPs and 11 other organisations have said in a letter to the Chief Medical Officer.  Other research says obese children are six times at risk of high blood pressure.

The results of a survey of VCS involvement with health and wellbeing boards is published by Regional Voices.

31st August 2014

13 senior psychiatrists from round the word are leading a campaign to have mental health included in new Sustainable Development Goals, which are due to replace the Millennium Development Goals after 2015. 

Early trials of a ‘bionic pancreas’ have been successful in automatically regulating blood sugar levels of Type 1 diabetes sufferers.

29th August 2014

Cancer waiting time targets have been missed for the second quarter in a row. 

Hospitals are to be ranked on the range, quality and nutritional value of their food, allowing patients to use that to choose a hospital.  Standards are to be written into trust contracts. 

Plain cigarette packaging does not boost illegal trade or negatively impact on retailers according to a survey of 2,000 people by the Centre for Behavioural Research in Cancer in Melbourne, published in BMJ Open.  This contradicted tobacco industry funded research which said there had been an increase in illegal trade of 20% after the change in Australia.

40% of women said they were discharged too soon after giving birth in a need to free up beds, in a survey of 500 women by the Royal College of Midwives. 

NHS England is asking for good practice examples of handover communication in discharge of patients from secondary care, in a ‘patient safety alert’. 

Resources to support personalised, co-ordinated care in mental health are published by TLAP and National Voices. 

PHE Bulletin 

28th August 2014

Three quarters of cancer patients with depression are not receiving treatment for the depression, according to researchers from Oxford and Edinburgh universities.  However, in a trial of 500 patients, 62% of those receiving a treatment called Depression Care for People with Cancer cut their depression by half, compared with 17% receiving the usual care.

Those ‘running Britain’ are mainly from a narrow elite, Alan Milburn’s Social Mobility and Child Poverty Commission has identified, with 71% of senior judges, 55% of permanent secretaries and 45% of public body chairs having attended private school.

Statistics on the number of NHS complaints have been published by HSCIC.  Although there were nearly 175k complaints in 2013-14 and 131k in 2007-8, the figures are not comparable because of how they were collected.  Healthwatch England says that in any case most complaints aren’t recorded and suggests there were 500k unreported cases of poor care in the past two years. 

An increased number of complaints about ambulances and patient transport has led the College of Paramedics to call for more investment: 

GPs account for less than 14% of complaints:

England is ranked 30th for children’s wellbeing out of 39 European countries and North America, in a survey by the Children’s Society published in its Good Childhood Report 2014.  36% said their families had been affected ‘a fair amount’ or ‘a great deal’ by the economic crisis which impacted on their wellbeing. 

Data factsheets on obesity and its determinants are published by PHE. 

Bulletin for CCGs: Issue 66

27th August 2014

The number of incidents of self-harm in mental health trusts has risen by 56% in four years according to figures from 29 of England’s 52 mental health trusts in figures obtained by Labour through foi.  However Sir Simon Wessely, President of the Royal College of Psychiatrists thought the increase was because of better reporting following the Francis report, though he agreed there were problems of funding and staffing. 

A fifth of council tax charged to working age benefit claimants was unpaid at the end of 2013-14 and councils struggle to collect council tax now due from low income households, according to foi requests from 140 councils collected by False Economy. 

Nurses and midwives trained outside of Europe are to have a new, faster registration system to assess their eligibility to work, the Nursing and Midwifery Council has said.  The current three months of supervised practice is to be replaced by a computer based exam and tests in simulated clinical scenarios. 

Up to 10,000 deaths a year recorded as from natural causes should have been investigated in an inquest, the Royal College of Pathologists has said. 

Some councils are using an eBay style auctioning system to tender individual care packages. 

The results of this year’s Patient Led Assessments of the Care Environment (PLACE), covering cleanliness, condition of the physical environment, privacy, dignity and wellbeing are published. 

PHE publishes the ‘spend and outcome tool’ (SPOT) for local authorities, to help them analyse spending and outcomes.

26th August 2014

A report on sexual abuse in Rotherham says that about 1,400 children were exploited between 1997 and 2013.  The report by Professor Alexis Jay was commissioned by the Council. 

The WHO has called for the regulation of e-cigarettes, including bans on indoor use, advertising and sales to minors, in a new report.

DH has no plans to ban indoor use of e-cigarettes: 

24th August 2014

The allocation of state subsidies for nurseries and childminders should take account of the qualifications of staff and standard of care, the Resolution Foundation is due to say in a report, which compares approaches in a number of other countries.

23rd August 2014

45% of the 229 children held in secure children homes in 2013-14 were being held for their own protection, rather than because they had committed a crime, an increase from 28% in 2011, according to a report in the Observer.

44% of people are unaware of the link between cancer and being overweight, and two fifths do not know that diet can affect the risk of getting cancer according to a survey of 2,000 people for the World Cancer Research Fund.  It is estimated that 12,000 cancers a year are linked to obesity. 

22nd August 2014

Public health services for under 5s are to be transferred to local authorities from October 2015, although health visitors themselves will continue to be employed by the NHS, DH has confirmed.


The GMC is consulting on tougher sanctions for doctors, which could lead to them being struck off for not apologising for errors, or not improving following mistakes.

Hospital parking should be free for some priority patients and visitors according to new Government guidelines.  Healthwatch England says parking charges are the most common reason for patient complaints. 

(23rd August) 

(23rd August) 

The Government is planning to increase the number of ‘physician associates’ who will be able to free up doctors’ time by taking on simpler medical tasks.  They would be science graduates with two years of intensive training.

A physical activity programme for older people (ProAct65+) was found to reduce falls by 26% and increase exercising by an average of 15 minutes a day, by teaching them tai chi, in a randomised controlled trial involved 1256 patients published in the Health Technology Assessment journal. 

21st August 2014

Obesity in middle age is associated with an increase in dementia, in an analysis from Oxford University of data on 450,000 people between 1999 and 2011.  However the NHS Choices website says that the link isn’t proven and notes that many of the associations are based on small numbers (e.g. only 19 people in their 30’s).

The Government is reported to have decided not to introduce a traffic light rating system for GPs, because of issues such as the variety and complexity of cases dealt with and the risks of perverse incentives.

There is the lowest number of young people who are not in education, employment or training for 9 years the Government has announced.

20th August 2014

Norman Lamb has said that children’s mental health services are dysfunctional and crying out for an overhaul.  He has announced the formation of a task force to recommend changes to the service.

The number of children in care has risen by 12% in four years to just over 68,000 in March 2013, while costs have risen by 4% over the same period with considerable differences between geographical areas, according to a report by the Audit Commission.  The annual cost was £3.4bn in 2012-13. 

(21st August) 

Women who breastfed their babies were 50% less likely to suffer post-natal depression in a study of more than 10,000 mothers published in Maternal and Child Health.  Those who had planned to breastfeed but were unable to were twice as likely to become depressed as those who had simply chosen not to.  The NHS Choices website notes a number of limitations of the research such as that depression was self-reported.

Deaths from cardiovascular disease have been falling across Europe, with a 50% fall in the UK over 10 years, according to analysis by the British Heart Foundation of 10 years’ data on 52 countries. 

US GP practices with 1 to 2 physicians had 33% fewer preventable hospital admissions than those with 10-19 doctors, according to a US study by the Commonwealth Fund. 


‘Informed’: Issue 1, is published by NHS England. 

19th August 2014

45% of doctors admitted prescribing antibiotics despite knowing they would not help and 28% had when they were not sure it would make a difference according to a survey of 1,004 GPs for the Longitude Prize.

Stroke wards with fewer nurses at the weekend led to 1 extra death for every 25 patients, with an 11% chance of dying in a month where the nurse to patient ratio was 3:10 but a 15% chance where the ratio was 1.5:10, according to a study of 56,000 patients across 103 English stroke units over 18 months, published in PLOS Medicine. 

Examples of health service failures are published by the Parliamentary and Health Service Ombudsman, to help providers improve in the future. 

Briefing on the health problems faced by ‘troubled families’ (4 pages). 

Monitor publishes NHS Foundation Trusts accounts data for 2013-14. 

NHS England publishes an update on its Urgent and Emergency Care Review.

18th August 2014

New GP contracts are increasingly to be opened up to private providers, including short term, profit maximising conglomerates, to meet competition requirements, Pulse reports. 

Higher levels of social cohesion were associated with lower levels of heart attack according to an American study of 5,000 over 50 year olds, over 4 years.  However the NHS Choices website points out that there is no association once other factors such as smoking, exercise and BMI are taken into account.

Deaths from the most common cancers have fallen by a third in the last 20 years according to Cancer Research UK. 

17th August 2014

1.3m under fives are living in areas with insufficient childcare according to the Family and Childcare Trust. 

Very high stress at work can increase the risk of getting Type 2 diabetes by 45% according to a study by the Institute of Epidemiology in Munich on 5,337 people aged 29 to 66. 

Addicts of drinks and drugs should have abstinence based treatment paid for by a new ringfenced ‘treatment tax’ on alcohol, the Centre for Social Justice is proposing. 

(pdf) CSJ press release: 

15th August 2014

Post-Winterbourne View goals to move people with learning disabilities out of institutions and into the community are not being met, according to figures published for the last three months showing 358 people admitted to ‘assessment and treatment units’ and only 261 discharged. 

49% of people say they would be prepared to pay more tax to fund the NHS, with 33% saying they wouldn’t and 18% who said they didn’t know, in a representative poll by ComRes.  This is reported as being the highest proportion willing to pay more in a decade. 

Geographical variation in cancer diagnosis is leading to about 6,000 more people a year dying within 12 months compared to the numbers if all areas performed as well as the best according to analysis of ONS figures by Macmillan.  The proportion of newly diagnosed cancer sufferers dying within a year varies from 24% to 38% in different areas.

NHS England is developing a ‘five year forward view’ (5YFV), mainly by using existing research and engagement. 

The Lib-Dems plan to offer a series of benefits to carers, such as free hospital parking in plans for “Carers’ Passports” to be included in their next election manifesto. 

There has been a small increase (0.7%) in members of NHS Foundation Trusts who are patients or members of the public, rising to 1.6m in March 2014 out of 2.2m members overall. 

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

14th August 2014

GP practices rated ‘inadequate’ will be given six months to improve or be placed in special measures, then if they are still judged ‘inadequate’ after a further six months their registration will be cancelled, the CQC says as it rolls out its inspection regime to GPs this autumn. 

The NHS’s 57 mental health trusts have lost 2.3% of their funding in the last two years according to a report by the Health Services Journal based on foi requests. 

Around 12,000 cancers a year are caused by people being overweight according to research based on 5m people in the UK and published in the Lancet.  A link was found with 10 cancers with the strongest associations being with cancer of the womb, gallbladder, kidney, liver and colon. 

The latest PROMS (patient reported outcome measures) data is published, for 2013-14 covering knee replacements; varicose vein surgery; hip replacements; and groin hernia surgery. 

CQC annual report and accounts for 2013-14 are published. 

NHS News: Issue 70 

Bulletin for CCGs: Issue 65 

13th August 2014

Less than a third of Britons with common mental health problems get any treatment at all, the incoming President of the Royal College of Psychiatrists has said in an interview.

Mental health services for children and young people need full reform because of their currently fragmented nature, the LGA has said.  There is also concern about inadequate funding given the large cuts councils are having to make. 

Screening for bowel cancer amongst 55-64 year olds could reduce the number of cancer cases by 20%, according to research which shows that screening is effective in younger age groups than previously thought.  The study, published in the Journal of the American Medical Association was based on 100,000 people with a follow up after 11 years. 

Pharmacies are well placed to provide a much wider range of services, such as blood pressure checks, diabetes screening and public health advice, because of their good reach into the community, particularly deprived areas, a report from Durham University published in the BMJ Open Journal says. 

It is expected that 40% of Americans will get diabetes at some point in their lives, with 90% of those with disease being overweight or obese, and the same is likely to hold true throughout the developed world, according to a study by American researchers published in the Lancet Diabetes and Endocrinology Journal. 

NHS England consults on standards for providing information to patients including the use of Braille and British Sign Language. 

12th August 2014

NHS England is to make funding available to support GP surgeries at risk of closure due to the withdrawal of the minimum practice income guarantee (MPIG).  So far the offer has been made by the London local area team (LAT) but NHS England have told Pulse magazine it will be extended to the rest of the country.  The level of funding is not yet clear, is only for two years and will only go to practices which are losing more than £3 per patient, where none of the doctors earns more than £106,100 and where there is a Index of Multiple Deprivation (IMD) score of more than 35. 

(14th August) 

(13th August) 

Philip Morris International has said it is prepared to sue the government for compensation if it implements plans for plain packaging, saying that it is ‘government-mandated destruction of property’ and is unlawful. 

Treatment for people with diabetes cost over £800m last year, 10% of the drugs budget, according to figures from HSCIC.  This compares with £514m in 2005-06.  According to Diabetes UK, the disease costs the health service £10bn a year in total.

One in ten people don’t have a close friend and 19% feel unloved, according to a survey of 5,778 people by Relate. 

85% of the public want any healthcare professional to have secure access to their GP record, according to a YouGov survey of more than 2,300 people commissioned by the EMIS group. 

11th August 2014

The number of children self-harming has increased by 70% in two years, from about 3,800 to 6,500 ten to fourteen year olds, the vast majority of them girls, according to figures from the HSCIC. 

Briefing on staff, friends and families test from the NHS Confederation. 

Later Life Newsletter: 56 

10th August 2014

Health warnings on bottles of alcoholic drinks should be compulsory according to recommendations from the APPG (All Party Parliamentary Group) on Alcohol Misuse, which also proposes minimum pricing, stricter regulation of marketing and a tighter drink driving limit. 

(11th August)

(11th August)

Labour says ambulance ‘handovers’ at A&E have been lengthening, with a 50% rise in those waiting an hour or more since 2010-11, based on responses to foi requests.  However, NHS England says there was a 30% fall in the number of handovers in the winder of 2013-14 compared with the previous year.

9th August 2014

Infusing stem cells into the brain was effective in helping five stroke victims in research designed to test the safety of the process.  The procedure now needs wider scale testing to see whether it is effective.

PHE recommend not drinking more than two days in a row of the recommended daily amount of alcohol.

8th August 2014

There is insufficiently consistent advice on how best to brush your teeth, according to a study from UCL.

NHS News: Issue 69 

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

8th August 2014

The Cancer Drug Fund has been criticised in the wake of a NICE decision not to fund Roche’s £90,000 cancer drug Kadcyla because it considerably exceeds their value for money criteria.  The Cancer Drug Fund, set up in 2010 is criticised as a means for unfairly bypassing NICE tests and allowing companies to charge more for drugs. 

Further background and analysis:

News items which appears to be against NICE and its decision: 

The cost to English business of dementia is forecast to almost double by 2030 from £1.6bn to £3bn, as people leave work to care for relatives, according to analysis by the Centre for Economic and Business Research commissioned by PHE and the Alzheimer’s Society. 

For information on how to stay healthy, most people would go to their GP (or nurse) with 57% choosing that route, 18% the web (such as Google or Wikipedia), 1% PHE and 1% the local authority, according to a PHE commissioned survey by Ipsos MORI.

7th August 2014

Nine out of ten councils think there is insufficient government funding to properly implement the Care Act, which amongst other things will involve local authorities assessing people’s care costs to see whether they are eligible for the £72,000 cap. 

Labour would depend on savings from integration to meet the shortfall in NHS funding, after Ed Balls ruled out an estates (death) tax or a national insurance increase.

The assumption that integration would save money in the short term is over-optimistic and it is too late for this sort of change to avert the funding crisis coming this year or next, says the Nuffield Trust:

Two thirds of voters in 13 Tory marginals want the NHS excluded from the TTIP (Transatlantic Trade and Investment Partnership) being negotiated between the EU and US, according to a survey by Survation commissioned by Unite.  Len McLuskey called on David Cameron to guarantee that the NHS would be exempt. 

Just 51% of people are aware of their legal right to choose a hospital or clinic for an outpatient appointment, according to a survey of over 2,700 patients by Monitor and NHS England, who said more needs to be done to offer choice.

Briefing from the NHS Confederation on use of data from the voluntary sector in JSNAs. 

6th August 2014

If 50-64 year olds took aspirin every day for 5-10 years, it could save 6,000 lives net a year according to an analysis of about 200 previous studies by Queen Mary University.  Although side effects would kill around 900 people a year, about 7,000 lives would be saved from cancer, mainly of the digestive system.  Because of the side effects, medical advice should be sought before starting such a regime.

Low levels of vitamin D are associated with higher levels of dementia in elderly people according to research analysing blood from 1,659 people over 65 at the time free of dementia.  The results were published in the journal Neurology. 

(7th August)

(7th August) 

Plain packaging could save £500m with greater benefit in more disadvantaged areas according to an assessment by PHE.  [This figure seems to be based on the Australian experience of reduced sales of tobacco by 3.4% in the first year of standardised packaging, so seems to be about cost of cigarettes rather than public health benefit.  It is also not clear whether this is for one year or ongoing.] 

(7th August)

There is uncertainty about how top up fees will work under the Care Act according to research with 13 local authorities by Independent Age.


The right to film and digitally report council meetings has been signed into law by Eric Pickles. 

Policy briefing on the Friends and Families Test from the Picker Institute. 

The NHS safety thermometer report for July 2013 to July 2014 is published by HSCIC. 

Consultation on the NHS outcomes framework.  The consultation is open until 12th September.

5th August 2014

The percentage of patients given antibiotics for coughs and colds has increased from 36% to 51% in the twelve years from 1999 to 2011, according to research from UCL and PHE based on 537 UK GP practices.  The research also found big variation between GP practices, from 32% to 65%.

The centralisation of stroke services in London is estimated to have saved 96 lives a year, according to research from UCL, the University of Manchester, King’s College London and Guy’s and St Thomas’ NHS Foundation Trust, which looked at nearly 259,000 stroke admissions between 2008 and 2012. 

(6th August) 

(6th August) Analysis, with more detail on what made a difference: 

(7th August) Blog with more historical background: 

An A&E closure led to an increase in death rates of 5% in surrounding hospitals research in San Francisco has found.


Deprivation of liberty assessments dealt with by councils are likely to increase from 10,000 last year to 94,000 this, following a supreme court ruling in March which clarified the law on challenging decisions. [Useful background information in the article about these assessments.] 

Cardiovascular disease profiles are published for each CCG, by the PHE’s National Cardiovascular Intelligence Network.

Press release:

The profiles:

An ‘Adult Social Care Efficiency Tool’ is published to help local authorities compare value for money of their services with similar areas, by comparing spending per head, quality of services and access to services for older people and working age people with disabilities. 

There is an association between some saturated fats and reduced Type 2 diabetes according to an analysis of fatty acids in blood samples in a European Commission funded study looking at over 12,000 people who developed the disease from a population of over 340,000 in 8 European countries.  The ‘good’ fats have an odd number of carbon atoms [hope that’s helpful when selecting your foods]. 

(6th August)

(6th August)

4th August 2014

Six of eleven trusts remain in special measures, despite improvements in most of them, a report from CQC, Monitor and the Trust Development Authorities says.

Phone consultations with a GP or practice nurse redistribute but do not reduce overall workload, according to a study by researchers from Exeter University published in the Lancet, which involved 42 practices and nearly 21,000 people seeking a same-day consultation.  Those speaking to a GP by phone were 33% more likely to need care in the following 28 days than ‘standard care’ and those speaking to a nurse were 48% more likely.  The costs of care were similar across all methods [but does that take account of the cost to the patient?] and the quality of care was broadly the same. 


Jeremy Hunt has announced £250m is to be made available to ensure no-one has to wait more than 12 months for hospital treatment unless clinically necessary.  The number waiting for more than twelve months has fallen from 18,000 in 2010 to 574 in May.  However the May figure represents an increase on the previous year so there is a suggestion this is an attempt to reverse that trend, despite the strong pressures on the health service.

Comment piece asks whether this is the Government getting its excuse in first by saying this will lead to a ‘managed breach’ of the 18 week target?

Comparison of data about children and young people across local authorities in England is facilitated by the local authority interactive tool, which has been updated.

3rd August 2014

The number of social work vacancies has increased by 74% in the year to May 2014, from 2,700 to 4,700, with particular problems in finding experienced staff.  There are thought to be a range of reasons including new posts and people moving into agency roles.–and-so-do-workloads-9644673.html

2nd August 2014

More than 1,500 babies a year are born addicted to drugs, according to data obtained by the Daily Mirrror 

1st August 2014

While the number of people in care homes has remained fairly stable between 2001 and 2011, this hides underlying changes, with a smaller proportion of the elderly population in homes, more males so reducing the gender gap and increased age of people in homes.—changes-in-the-older-resident-care-home.html

A patient in London is taking the Secretary of State for Health to court over the potential closure of his surgery due to the withdrawal of minimum income guarantee payments that could lead to 98 closures nationwide. 

(10th August) 

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

1st August 2014

A £300m investment in genome sequencing has been announced by the Government, as part of the ‘100,000 Genomes Project’, sequencing the genomes of about 75,000 patients with cancer and rare diseases to better understand them.  The project runs till 2017 and was initially announced by Jeremy Hunt on 5th July 2013.   The investment includes £78m contract with company Illumina to provide infrastructure and expertise.  There are issues about confidentiality as the anonymised data will be available to commercial companies.

The treatment of whistleblowers in public services has often been shocking according to a report on the topic by the Public Accounts Committee.

Not being able to prescribe the first choice of drug is a problem which has got worse in the last year according to eight out of ten GPs in a survey for GP magazine. 

Scientists have been able to make organs and whole (rodent) bodies transparent, (but only in dead tissue), which could have significant implications for understanding a range of biological processes. 

Healthwatch England publish their Business Plan for 2014-5 and Strategy for 2014-16. 

A report on health literacy, based on a workshop, is published by the Royal College of GPs.

31st July 2014

The health check ‘MOT’ for 40-74 year olds did not lead to more diagnosis of five chronic conditions according to a study comparing 38 GP practices in Warwickshire that implemented the checks with 41 that did not, over a three year period.  However, although the study involved 16,669 checks which identified 1,142 new cases of disease, the sample sizes meant there was limited statistical ability to detect differences and there may be longer term benefits of health checks beyond the three years studied. 

(1st August) 

(1st August)

Many common drugs with anti-cholinergic properties prescribed for elderly people could be causing them physical and mental harm, according to a systematic study based on 46 worldwide studies covering 60,944 patients, due to be published in the journal Age and Ageing next month.

 (1st August) 

80% of the English population, over 40m people, now have electronic Summary Care Records according to NHS England.

Excess weight is the biggest risk factor for Type 2 Diabetes, PHE is saying, apparently for the first time.  Abdominal fat is a more accurate predictor of risk than BMI, with men measuring 40 inches round the middle having five times the risk of having diabetes and women measuring more than 35 inches having three times the risk.

UK border officials are not confident of dealing with an ebola threat according to the leader of the Immigration Service Union, Lucy Moreton. 

Bulletin for CCGs: Issue 64

30th July 2014

The CQC’s hospital inspection regime is more credible, authoritative, rigorous and in-depth than what preceded it according to an evaluation by Manchester Business School and the King’s Fund commissioned by the CQC. 

King’s Fund blog: 

The number of people with diagnosed dementia has increased by 62% in seven years according to provisional figures from HSCIC.  The increase could be due to increased awareness and diagnosis as well as an ageing population. 

The Government’s dementia ‘case finding’ DES has had little impact: 

A fifth of GPs have seen patients with mental health problems come to harm because they couldn’t access appropriate services according to a survey of 500 GPs by Pulse Magazine.  More than 8 out of 10 said they weren’t confident their local community mental health service could cope with its caseload.

The US equivalent of the Family Nurse Partnership was found to reduce mortality for both mothers an infants, reduce crime rates and reduce costs, according to a study of 1,138 mothers and their children over a 20 year period.


Problem drinking was associated with a doubled risk of memory impairment up to two decades later, in an American study of 6,542 fifty to sixty year olds, involving self-assessment of alcohol consumption and testing of mental abilities, over 8 years.

Sandwell Council acted illegally in its council tax policy, in having a two year residency requirement for council tax support, a judge has ruled.  The policy was introduced to discourage incomers from high cost areas in the south east, but the policy was said to harm local people. 

The Government has said they have the expertise and resources to deal with the Ebola virus should any cases emerge in this country.  Over 600 people have died from it in West Africa so far this year. 

(31st July) The extent of the risk in the UK – relatively low as we have the systems to deal with any outbreak:

Simon Stevens has suggested NHS staff might be encouraged to lose weight to set a good example to the rest of the population. 

NHS News: Issue 68 

29th July 2014

More hospitals and youth services should be run as mutuals and taken out of the public sector, says Cabinet Office Minister Francis Maude.  Unions say this risks those services being taken over by private companies in future.  [See also similar comments being made 14th July].

The number of people discharged from English hospitals treated for malnutrition has risen by 84% in five years from 3,633 in 2008-9 to 6,691 in 2012-13 according to figures from the HSCIC. 

Five portions of fruit and veg a day is probably enough, and you don’t need seven after all, according to a meta-analysis of 16 studies covering 833,000 people by Chinese and US researchers, with the results published in the BMA.  (A report on 1st April suggested seven portions reduced mortality more than five).  [Neither study on its own is enough to change guidance and the difference between 5 and 7 is unlikely to affect many people.]

There has been a 150% increase in knee replacements because of obesity in the last four years, from 3,787 operations in 2009-10 to 9,438 in 2012-13.  The proportion of operations due to obesity has risen from one in twenty to one in ten over those four years. 

Jeremy Hunt was wrong to claim that median waiting times to be seen in A&E departments had halved since 2010, Sir Andrew Dilnot, chair of the UK Statistics Authority has said.  In fact it is the mean waiting time that has halved, with the median having fallen from 9 to 8 minutes.  However the more relevant measure is the waiting time until departure rather than first assessment, he says. 

28th July 2014

The number of deaths from hepatitis C has risen from 98 in 1996 to 428 in 2012 according to the PHE annual report on hepatitis C. 

Running for just 51 minutes a week was found to correlate with 30% lower risk of death from all causes and 45% lower risk from heart disease and stroke according to a study from Iowa University of over 55,000 adults over a period of 15 years.  Persistent runners had an average of three years longer lives. 

Guidance from Monitor on complying with integrated care requirements.

27th July 2014

The Lib-Dems are said to be considering an hypothecated tax to fund the NHS which could potentially form part of a coalition agreement with Labour. 

About 15% of children with a healthy BMI had high levels of internal fat, while 10% of children who were overweight according to BMI had healthy levels of fat, according to an unpublished study of 1,000 children which used bio-electrical impedance to measure fat. 

Alcohol related admissions to A&E for under 18s have fallen over four years, while there has been an increase for older age groups, according to information from foi requests obtained by Labour. 

Six second bursts of energetic activity could improve fitness and reduce blood pressure in elderly people according to research from Abertay University in Scotland published in the Journal of the American Geriatrics Society.  The pilot study only involved 12 over 60 year olds so any conclusions can only be very limited but it does suggest further research on exercise in the elderly may be worthwhile, particularly given the high proportion of NHS costs spent on the frail elderly.


26th July 2014

Almost three quarters of people with mobility problems do not have an accessible door into their building, and five million people need a disabled friendly home, according to a report from the charity Leonard Cheshire Disability called Home Truths. 

The LGA has said salt guidelines are not being followed by restaurants and fast food chains with only two companies following guidelines set in March as part of the responsibility deal.

The Behavioural Insights Team (‘Nudge Unit’) should publish more of its results, including unsuccessful ones, to allow better overall assessment of its work, the House of Lords Science and Technology Committee has said in a letter to the Cabinet Office Minister Oliver Letwin. 

25th July 2014

Under new guidance on the Better Care Fund local acute providers will have to comment on projections of non-elective activity.  The guidance also says £300m is to be awarded on performance in reducing emergency admissions with £700m for up front investment in NHS commissioned out-of-hospital services. 

A new occupational health scheme helping those on long term sickness back to work being launched at the end of 2014 is to be provided by Health Management Ltd, owned by Maximus. 

DEFRA produce a ‘balanced scorecard’ on public procurement of food and catering which considers a range of factors including health and nutrition and sustainability in production. 

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

25th July 2014

Men with varying day and night shifts were 42% more likely to develop Type 2 diabetes according to an analysis of 12 studies with data from 226,652 people by Chinese researchers.  For shift workers generally the risk was 9%.  The analysis shows an association, not necessarily causation.

Intrabeam radiotherapy for breast cancer, with a single session during the initial surgery, rather than a series of separate radiotherapy sessions, has been given conditional approval by NICE in draft guidance out for consultation.  It could benefit over 35,000 patients a year.

24th July 2014

The finances of 19 non-foundation NHS trusts are sufficiently concerning to have been referred by the Audit Commission to the Secretary of State, compared with five the year before.  There was concern about financial resilience in 34 (34%) of trusts, up from 26% in the previous year.

The number of adults taking illicit drugs has risen by 230,000 to 2.7m (about 9%) in the last year, according to Home Office statistics from the crime survey of England and Wales. 

There have been big falls in smoking, drinking and drug use among school pupils over ten years, with the numbers having fallen between 2003 and 2013 from 9% to 3% for smoking, 25% to 9% for drinking and 12% to 6% for illegal drug use.  The figures, from HSIC, are based on a survey of 5,187 pupils aged 11-15 in 174 schools in the autumn of 2013.

The Government’s telecare scheme is not sufficiently cost effective, costing nearly £300k per QALY (quality adjusted life year) compared to NICE’s usual threshold of £30k.  It was found to be not statistically better than alternative care, in a randomised control trial of 1,189 people with social care needs in a study led by the LSE and published in the journal Age and Ageing. 

67% of CCGs spend less than 10% of their budgets on mental health although it makes up ‘23% of the service’s overall burden of disease’.  The figures are from 142 of the 211 CCGs following foi requests by the shadow public health minister.

There is evidence of links between improved health staff experience and better care for patients according to a review of the evidence by Sheffield University Management School commissioned by NHS Employers. 

More than two million poorer people will have to pay more council tax because of Government cuts to the benefit system according to figures from Labour obtained through freedom of information requests.

Research on the evidence of the effectiveness of various initiatives to reduce the length of stay in acute hospitals is published by NIHR. 

Annual report of the Office of the Children’s Commissioner.

23rd July 2014

A range of causes and solutions to A&E delays are revealed in a Quality Watch report from the Nuffield Trust and Health Foundation.  Solutions include more investment, redesign within hospitals and changes to services outside hospitals.  The research is based on data from 41m A&E attendances between 2010 and 2013.

Press release:

Link to the report: 

The public most trust GPs and the NHS with their data, with 49% and 36% respectively scoring 8-10 on a 10 point scale.  The police scored 28%, the banks 14% and the government 13%.  The survey of 2019 adults was commissioned by the Royal Statistical Society.  77% supported sharing data for specific purposes such as patient care, 53% agreed that records should be shared with academics and researchers to improve treatment but only 32% thought records should be shared with private companies with 45% opposing. 

A fundamental redesign of the ESA (employment and support allowance) end-to-end process has been called for by the House of Commons Work and Pensions Select Committee, which found that the eligibility tests for disabled people and those with long term conditions were often inaccurate and didn’t help claimants back to work.

(16th July)

(24th July) focus on one section of the report, the ‘Mandatory Consideration’ process which ‘can pitch claimants into a Kafka-esque maze’ – [shocking]: 

NHS News: Issue 67

22nd July 2014

65 NHS Trusts ended 2013-4 in deficit, compared with 45 in the previous year, according to the DH annual accounts.  The hospital sector as a whole had a deficit of £107m, the first such deficit since 2005-06.  The amount DH returned to the Treasury for the NHS underspend fell from £2.2bn to £400m. 

Commentary from the King’s Fund:

The Secretary of State’s annual report on NHS England notes much progress but also some areas where more is needed including on financial management, access standards, safe care for those with disabilities and autism and developing parity of esteem between physical and mental health.

NHS England publishes its first annual report and accounts. 

There are problems with the administration of benefits sanctions which tend to affect some vulnerable people hardest according to a DWP commissioned report from Matthew Oakley.  Communications with claimants was often legalistic, unclear and confusing.  The Government has said it will review and change the sanctions process. 

(3rd August) Some examples of people who have suffered from sanctions: 

The Government is considering encouraging junior doctors to voluntarily opt out of the 48 hour week working time directive to undergo training, with separate categories for work and for training, following a report from Prof Norman Williams, former president of the Royal College of Surgeons. 

In addition to other problems, 70% of families in the Troubled Families Programme had a health problem, and 46% had a mental health concern, according to a ‘National Evaluation’ published by DCLG.  However, the covering note says this is presentation of data rather than interpretation and they are unsure whether it is representative of all families going through the programme. 

Sickness rates among NHS workers have fallen to the lowest level in five years and now average 14.8 days a year according to figures from HSCIC. 

NHS England is surveying NHS Trusts on their use of the NHS number with a view to promoting its greater use [some useful background on the NHS number in the EHI article]. 

21st July 2014

The Friends and Families test (FFT) is to be revised following a report reviewing its operation.  The report found that the results are not widely understood and are vulnerable to gaming.  From next April the surveys will have to ask for comments and systems using tokens to vote will not be allowed (as they cannot link to comments).  The FFT is to be extended to GPs from December, mental health and community services from January 2015 and dentists and patient transport services from April 2015.


Guidance on implementing the friends and families test:

Statutory intervention in Doncaster Council is to be ended after an LGA peer review showed improved political and managerial performance.  [Interesting that the LGA’s self-improvement approach is being accepted within the overall national performance framework for local government.]

19th July 2014

The rate of HIV infections in the US has fallen by a third in ten years, giving some hope that the Aids epidemic is slowing.

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

18th July 2014

Around 4.5m more people could be eligible for statins under NICE guidance which confirms recommendations put out to consultation in February.  Currently around 13m people are eligible, around 40% of the population.  There was strong opposition to the proposals from some doctors because of possible side effects, but NICE says these fears are misplaced. 

(Taking a largely negative view of prescribing statins more):

The A&E 4 hour waiting target has been missed for 52 weeks in a row, according to NHS statistics.  NHS England was quoted as saying this was because of the inclusion of walk-in centres which skewed the figures. 

Monitor publish proposals for tariff changes in 2014-15.

A gap in healthy life expectancy of 14 years for women and 13 years for men between different parts of the country is shown in the latest ONS Annual Population Survey.–england/2010-12/stb—healthy-life-expectancy.html

(22nd July) 

Obese women could have a ‘food learning impairment’, according to a study on 153 men and women by Yale School of Medicine, which involved remembering the order of cards with pictures of food or money on them.  The same did not apply to the healthy men, though. 

Foundation Trust monthly bulletin

GP and Practice Team Bulletin: June 2014 (sic)

17th July 2014

The seven research councils and the Wellcome Trust are to work together in tackling antimicrobial resistance, the first time they have combined in this way.  £25m from the three biggest research councils is to be spent on establishing the initiative. 

The unions, including Unite are calling on the Government to exempt the NHS from the TTIP, the Transatlantic Trade and Investment Partnership, so that future Governments will be able to reverse health privatisations. 

41 of 147 NHS Foundation Trusts reported a deficit at the end of the financial year, but there was a surplus overall of £134m according to a Monitor report of their consolidated accounts. 

A quarter of NHS Trusts could end the year in deficit according to a survey of their finance directors as part of the King’s Fund quarterly monitoring report. 

40% of dementia carers suffer from depression according to a systematic review of other studies by University College London.  A course to help carers manage was tested by UCL on 173 carers compared with 90 who carried on as usual and found that those on the course were 7 times less likely to be depressed after two years, meaning the course was cost effective. 


The Policy Exchange proposes limiting child benefit to four children per household.  Previous proposals from the think tank have been adopted in Conservative manifestos.

(24th July) Comment from JRF:

Warwick University researchers suggest there could be a genetic component to national wellbeing differences, finding that Danes (who are consistently the happiest in the world) are more likely to have a gene that boosts levels of serotonin, and that people with Danish ancestry in other parts of the world tend to be happier. 

The Liberal Democrats are now opposing the bedroom tax in its current form, after having previously supported it. 

Pharmacies and other high street specialists should be the first call for many health issues such as smoking cessation, obesity, sexual health advice and alcohol awareness, a report from Pharmacy Voice says.

(16th July)

Bulletin for CCGs: Issue 63 

16th July 2014

A primary care unit in each A&E is one of 13 recommendations in a report from the College of Emergency Medicine, backed by the medical royal colleges.  However the BMA says the shortage of GPs means that staffing such facilities would not be possible without impacting on regular GP services.

Pregnant women and those likely to become pregnant with a history of mental illness should get more mental health support, according to draft guidance from NICE on antenatal and postnatal mental health.


Asked how they would fund the health service, 48% of people supported higher taxes, 21% charges and 19% a reduction in treatments, according to a Guardian/ICM poll. 

The Government is setting up a taskforce to review CAMHS (child and adolescent mental health services) to deal with the preserve incentives which arise from funding by different bodies for varying tiers of severity. 

Taxes on cigarettes and stricter policies on smoking in public reduced suicides by 15% in the US, according to a study using data from 1990 to 2004 and comparing the outcomes in different states, from the Washington University School of Medicine in St Louis. 

(17th July)

NHS News: Issue 66

15th July 2014

Northern, more deprived, areas have been hardest hit by council cuts, with the 10% most deprived areas having had cuts of £228 per person, compared to an average of £45 for the 10% most affluent areas, according to research by Sheffield University’s Sheffield Political Economy Research Institute. 

The system of ‘special measures’ which has been used for failing hospital trusts is to be extended to care homes and GP surgeries. 

(16th July) 

(16th July) 

Increasing hospital staffing numbers should be triggered by a number of ‘red flag’ events, such as lack of patient checks, not providing medications, delays in providing pain relief or fewer than two registered nurses on a shift, NICE is recommending.

57% of those affected by the bedroom tax say they have cut back on household essentials, to afford it, according to DWP commissioned research.  Five months into the scheme, 41% of tenants had paid the full additional amount, 39% had paid some and 20% none.  26% said they had had to borrow money, mainly from family and friends. 

The Government is introducing a law to ban smoking in cars with children in them.

(17th July)

The Welsh Government is to consult on a law banning smoking in cars with children. 

Many CCGs are not following NICE guidance on when patients should have a number of common operations, according to a report by the Royal College of Surgeons, ‘Is Access to Surgery a Postcode Lottery?’  However, NHS Clinical Commissioners said this reflected increasing local decision making.

The label ‘pre-diabetic’ is not helpful, particularly if it leads to people unnecessarily being prescribed drugs when the solution lies in diet and activity, according to health experts writing in the British Medical Journal.

NICE annual report and accounts for 2013-14 are published.

14th July 2014

The Government is to explore options for mutualised ownership of NHS services by doctors and nurses, potentially including a share of ‘profits’, with £1m to be made available to 10 NHS organisations, to investigate options. 

(15th July) 

Patients from outside the European Economic Area are to be charged 150% of the costs of their treatment, as part of proposals to recover more health costs from migrants. Trusts are to be paid 125% of the costs of EEA treatment to encourage reporting, with costs recovered under reciprocal health agreements.  There are to be sanctions for trusts that fail to identify and bill chargeable patients.  Temporary residents of between 6 months and five years will have to pay a surcharge to cover the costs of care. 

30% of Alzheimer’s cases could be prevented through healthier lifestyles, such as exercising more and not smoking, according to research published in the Lancet Neurology.

A report on Cycling Safety from the House of Commons Transport Committee makes 23 recommendations including more spending on cycling and that safe cycling should be an integral part of the design of all new infrastructure projects.

(25th July) 

Monitor’s annual report and accounts are published. 

13th July 2014

There is insufficient training in the care for frail elderly, with some medical undergraduates receiving 55 hours of specialist training over five years, according to research published in Age and Ageing. 

The most common reason for primary school children being admitted to hospital is for multiple teeth extraction, with over 25,000 admitted for that reason in 2013-14, according to research published in the Sunday Times.

12th July 2014

The Government is piloting mental health assessments as part of work capability tests.  The Government says 46% of those receiving Employment and Support Allowance have mental health problems, and they want to reduce the number of such claimants.  The Conservatives are said to be considering making benefits conditional on receiving treatment. Lib Dem minister Normal Lamb said this is not a sensible idea. 

(13th July) 

(14th July)–or-be-stripped-of-payments-9605026.html

11th July 2014

The LGA calls for a fifth of the VAT on junk foods to be given to councils to tackle obesity.  This would be about £1bn of the £5bn raised.  It is estimated that the cost to the NHS of obesity is £5bn a year.  The proposal is part of a report, ‘’Investing in our nation’s future, the first 100 days of the next government.” 

(12th July) 

(15th July)

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

11th July 2014

The NHS would be safeguarded under the Transatlantic Trade and Investment Partnership between the EU and US, with individual states having the power not to open up health services to foreign firms, the EU official negotiating the treaty has told John Healey MP as chair of the APPG on the Treaty.  A future government could reverse previous decisions such as by discontinuing provision by a foreign operator,

NICE is consulting on a recommendation that bariatric surgery for newly diagnosed type 2 diabetes patients be offered for those with a BMI above 30, rather than 35 as at present.  This would make about 800,000 people eligible, though NICE suggest it is only expected to increase the number of operations by tens of thousands.   Diabetes UK said surgery should be a last resort, and treatment needs to include good diet and activity. 

Half of responding health trusts had closed their maternity units at least once in 2013, according to information obtained by the BBC from foi requests from 121 trusts.  Often the closures were only for a few hours. 

A quarter of people have not heard of out-of-hours GP services and a fifth are unaware of 111, according to a National Audit Office survey of 878 people as part of a wider review of out of hours services.  It also found that the numbers using such services had fallen by a third in six years. 

Providers are finding it harder to find GPs to fill rotas:

The law on sharing data between public bodies should be modernised, clarified and simplified according to a report from the Law Commission.

10th July 2014

The NHS in heading towards a funding crisis this year or next, according to analysis by the Nuffield Trust, and in a survey of 78 senior NHS leaders nearly half said they thought it unlikely that universal healthcare would be provided free at the point of delivery in ten years time.  The report is, ‘Into The Red’.


The NHS Confederation proposes 5 or even 10 year settlements:

A report on adult social care is published by the Public Accounts Committee.  It notes increasing demands and reduced funding and says the Government does not know whether the care system can cope with this through efficiencies.  It says it is appalling that 220,000 people working in the care system earn less than the minimum wage and suggests more time is needed for implementation of the Care Act. 

NHS England is to provide an additional 50 children’s mental bed spaces and recruit 10-20 new case managers, after a review of tier 4 child and adolescent mental health services, for which it is now responsible.  The number of such beds has risen from 844 in 1999, to 1128 in 2006 and 1264 in 2014.  It is hoped this will reduce the number of children being accommodated a long distance from their homes. 

(11th July)

(11th July) 

NHS News: Issue 65. (This is to be replaced by a new bulletin called ‘Informed’ from 22nd July) 

Specialised Commissioning Stakeholder Newsletter: Issue 1 

9th July 2014

Draft legislation on the duty of candour and safe staffing levels, as part of 11 new fundamental standards of care, has been published.  The standards could become law by next April, if agreed by Parliament under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

(Free registration required) 

(7th July) Consultation on duty of candour, response: 

(7th July) Government response on consultation on fundamental standards for health and social care providers:

The Government says 53,000 ‘troubled families’ have been ‘turned round’ since the scheme started in April 2012. 

The NHS complaints system can only be improved through culture, not regulation, the NHS Confederation has told the Health Select Committee enquiry into complaints. 

A new resource for doctors to help them care for older patients has been published by the General Medical Council. 

8th July 2014

Simon Stevens offers the possibility of personal budgets to combine health and social care, initially for four high-need groups, in a speech to the LGA annual conference.  The groups are: people with long term conditions; children with complex needs; people with learning disabilities; and people with severe and enduring mental health problems.  He felt integrating at the level of the individual was likely to be more successful than integrating on the provider side.  A prospectus for this new Integrated Personal Commissioning (IPC) programme is to be published at the end of July, inviting expressions of interest from local areas, with a view to it going live from April 2015. 

A blood test which predicts the onset of Alzheimer’s disease within 12 months with 87% accuracy has been developed by an international collaboration led by King’s College London, and could be available within two years.  The test would probably be used alongside other tests.  It would help identify people to be involved in clinical trials of drugs earlier. 

However, the predictive ability falls to no better than chance, when combined with information on the number of people with mild cognitive impairment who go on to develop Alzheimers:

[The logic of that isn’t explained in that NHS Choices article, but there’s an excellent article based on a new book about understanding such statistics which might provide a clue, here:  ]

Labour says it will reserve some government contracts for social enterprises, and some for small businesses, to reduce the power of a small number of outsourcing companies that currently have a large proportion of outsourced business. 

The alcohol industry makes pledges to tackle drink related harm, including ending super-strength products in large cans, under the ‘responsibility deal’. 

No. 10 is accused of ‘burying good news’ by ordering the delay of the announcement, apparently as part of a ‘barnacles’ approach: not talking about anything controversial before the election.

Central funding of GPs’ texting service could be ended from next April, reducing reminders to attend. 

The pursuit of happiness should be established as a clear and measurable goal of government, according to the final report of the CentreForum’s Mental Health Commission which also proposes that happiness should become part of the school curriculum.  This also includes an ‘atlas of variation’ of mental health across the country.

The number of adults receiving social care has fallen by 29% in the last five years according to figures from HSCIC, and 44% of adults receiving social services have as much social contact as they want with people they like, according to statistics published by HSCIC, including the Adult Social Care Outcomes Framework (ASCOF). 

Updated Health Profiles for 2014 are published by PHE. 

A report, ‘Making Mental Health Count: The Social and Economic Costs of Neglecting Mental Health Care’ is published by the OECD. 

7th July 2014

Leading health figures are asking for an independent, cross party debate on funding health and social care, through a letter to the Times from the Royal Colleges of GPs, Physicians and Nursing, various charity leaders, the Foundation Trust Network and others.

The Government needs to stop the unnecessary use of antibiotics in farming and veterinary services as well as health, to tackle the problem of antibiotic resistance, according to a report by the Commons Science and Technology Select Committee. 

Doctors, nurses and pharmacists are urged to resist requests for unnecessary antibiotics in a Joint Statement on Antimicrobial Resistance by the Royal Colleges of GPs, Physicians and Nurses, the Royal Pharmaceutical Society and the UK Faculty of Public Health. 

(Free registration required)

The Government has published a plan to promote green transport, the ‘Door to Door action plan’, promoting joined up public transport, and is providing £15m to promote integration between rail and cycle journeys. 

The ‘6Cs’ nursing values are to be rolled out to the whole NHS.  The values – care, compassion, competence, communication, courage and commitment – were launched by England’s Chief Nursing Officer a year and a half ago as part of the Compassion in Practice strategy.

(Free registration required) 

6th July 2014

The NHS is criticised for providing insufficient mental health support for new mothers, by the National Childbirth Trust which found, through freedom of information requests, that only 50 of 193 responding trusts provide specialist perinatal mental health support. 

(8th July) 

5th July 2014

44% of people would be prepared to pay more tax to fund the NHS with 29% saying they wouldn’t, in an Opinium/Observer poll.  77% agreed that the NHS should be kept free at the point of delivery, with 7% disagreeing. 

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

5th July 2014

80% of Better Care Fund proposals are on course to transform out of hospital services, according to a review by the LGA and NHS England.  The Government has said that £1bn of the BCF will be allocated to out-of-hospital provision, to be allocated in proportion to areas’ success in reducing emergency admissions with the rest used to support NHS commissioned services.  [Presumably this means local areas have to spend their own money up front and only get further support if they meet the targets.  But the BCF is mainly money from the local health pot anyway isn’t it?] 

The King’s Fund says that while the BCF is well intentioned, it is papering over the cracks and politicians must be honest about the scale of the funding pressures facing health and social care:

4th July 2014

Patients are having to wait longer for a number of common operations according to an analysis by the Patients’ Association based on official NHS data.

A ‘Framework for Personalised Care and Population Health’, designed for nurses, midwives and health visitors, but also providing a helpful overview for others, is published by DH. 

3rd July 2014

The Unite trade union, patients’ groups and others are asking for the NHS to be excluded from the Transatlantic Trade and Investment Partnership between Europe and the US, because they say it could lead to American private healthcare providers suing the NHS in ‘secret courts’ if lack of competition led to them losing potential profits.

The growing number of people with long term health conditions could lead to a £5bn a year budget shortfall and requires planning for a workforce expansion in primary and community care, the Health Select Committee has said.  Planning is needed to increase community care before cutting back on hospital services.

There is wide variation in surgery rates for older people across the country, according to research by the Royal College of Surgeons and Age UK, looking at six common procedures for over 65 year olds.

86% of patients rate their experience of their GP surgery as good, though this has fallen by 1 percentage point in the last year, according to the GP Patient Survey conducted for NHS England by Ipsos MORI, with over 900,000 respondents.  The survey found people were finding it harder to get through on the phone, with a rise from 18% to 24%. 

68% of doctors say that the health of patients is suffering as a result of benefit changes, according to a BMJ survey of more than 1,000 doctors. 

There were 5% fewer fire fatalities last year, at 275 deaths, continuing a trend which has seen a 40% reduction since 2004, according to ONS figures. 

Children were shown eating unhealthy foods on children’s tv programmes, with just under half of the food being unhealthy according to a study of more than 82 hours of tv, published in Archives of Disease in Childhood.  However there is no evidence as to whether or not this influenced children’s eating or drinking. 

(4th July) 

David Cameron is accused of giving misleading statistics on A&E waits.  Cameron told Parliament that average waiting times had fallen by over a half from 77 minutes under Labour to 30 minutes now.  However this is the mean average wait until initial assessment rather than the more meaningful median, which has changed little.  Waiting time until treatment has not changed, and total waiting time in A&E has lengthened, according to a House of Commons Library blog, subsequently removed. 

(4th July) The Prime Minister’s use of the figures is to be investigated by the UK Statistics Authority: 

The failure of governments to protect girls from female genital mutilation is an ‘ongoing national scandal’, according to the Commons Home Affairs select committee. 

A publication on ‘Making our Communities ready for Ageing’, including some very concrete proposals, is produced by the International Longevity Centre – UK. 

Quarterly results of a survey on participation in sport, the ‘Taking Part Survey’, are released. 

Bulletin for CCGs: Issue 62 

2nd July 2014

David Cameron says Britain will lead a fight against bacteria resistant to antibiotics and initiates a review to be led by economist Jim O’Neil on how to accelerate the discovery and development of new antibiotics, to report back to G7 leaders. 

(3rd July)

Further cuts of 1.9% in 2014-15 are putting adult social care in crisis, according to ADASS. 

It is said that cancer services could be privatised for the first time in the outsourcing of the services in Staffordshire in a contract worth £1.2bn over 10 years.

(4th July) Guardian letters: 

There has been a sharp increase in spending on independent providers of community and mental health services, but a slow down in spending on non-NHS hospital services, according to a Nuffield Trust briefing, taken from a bigger report to be published next week. 

The number of young Britons visiting self-harm websites has nearly trebled in three years, from 6% to 17% between 2010-13, according to a study of 3,500 children aged 9-16 across seven European countries. 

Labour is to focus its election campaigning over the summer on the NHS, the party has said. 

A joint report on health and social care integration is published by the LGA and NHS Confederation, ‘All together now: the future of integration’. 

A DH funded resource to help HWBs respond to Winterbourne View is produced by the NHS Confederation, LGA, NHS England and Regional Voices. 

A report on two tier local government, from the Local Government Network.

1st July 2014

There is a 30% improved chance of surviving major trauma since the introduction of regional trauma networks in England in April 2012.  Currently about 3,000 people a year die of trauma injuries but the change has led to 600 more lives saved than in 2012 [it is unclear whether this is each year or in total since 2012]. 

A report from the King’s Fund on ‘Future Organisational Models for the NHS’, to improve the finances and quality of healthcare provision is published. 

Guidance for local authorities on commissioning public health services for children, (including health visitors) as this transitions from the NHS to local government by October 2015 is published. 

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