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2014 Q4 October-December


Health and Wellbeing Policy Update: October – December 2014

This is a weekly update of key policy items relating to health and wellbeing (mainly in England).  If you would like to receive these as an email you can contact me ‘webmaster at equwell dot org dot uk’ (replacing ‘dot’ and ‘at’ with the respective signs).

31st December 2014

Three of the ten ambulance trusts were at a ‘critical’ state over the Christmas period, one below the most severe on the six point scale used, with demand having increased over the previous year.
(1st January 2015) Analysis and comment:


30th December 2014

Checks are to be made on those who have claimed free prescriptions to try and cut down on the estimated 29m prescriptions wrongly given out each year, at a cost of £237m.

People would be less likely to take diet advice from someone who was overweight, with 48% saying they would be less likely to take advice on diet and exercise from an overweight GP, in a Populus survey of 2,100 adults commissioned by the Royal Society of Public Health.


29th December 2014

The Government is aiming to double the number of people on the transplant register, which currently has 20.8m on it, with a new campaign which includes prompting people using universal credit and state pension, passport application and electoral registration websites to consider registering.

Public Health England have launched an anti-smoking advertising campaign with the message that cigarettes rot you from the inside out.  The campaign also says that roll ups can be as bad for you as manufactured cigarettes.  Although the proportion of people smoking has fallen to its lowest ever level of 18.4% of people, it still kills 80,000 people a year.
(Research review)
(Press release)

There is an average 11% vacancy rate for social workers with many authorities relying on agency staff to provide cover.


28th December 2014

An overly complex management structure in the NHS is inhibiting initiative, a report by Sir Stuart Rose, commissioned by the Government, is expected to say.  He also criticises poor management, training and development practices.

There is a large illegal market for prescriptions drugs, such as for erectile dysfunction, slimming and depression, because of the ease of access through the internet and because it is more profitable and less risky than narcotics.  The global market for counterfeit drugs is estimated to be $200bn, while that for cocaine and heroin is £160bn.


27th December 2014

3,278 doctors have expressed concern at the delay in introducing plain cigarette packaging in an open letter to the Prime Minister and Health Secretary published on the BMA website.


26th December 2014

A programme to support people losing weight is to be developed by NHS England, Public Health England (PHE), Diabetes UK and those local areas that have already made most progress with preventive diabetes programmes.  Simon Stevens said anti-obesity schemes could begin saving the NHS money in three years.

Lifestyle factors were the cause of 587,000 cancers over five years, or 40% of cases, according to analysis by Cancer Research UK.  They estimate that 315k cases were attributable to tobacco, 145k to poor diet, 88k to being overweight, 62k to alcohol, 56k to exposure to UV radiation in sunlight, and 17k to physical inactivity.


25th December 2014

A ban on alcohol companies sponsoring sports clubs and events has been called for by leading doctors and nurses, in a letter to the Guardian.  They say there is evidence that exposure to alcohol advertising leads young people to drink more and to drink at an earlier age.
The letter:


24th December 2014

Proposals to cut the rates paid for specialised NHS services have been criticised by clinical specialists in a letter.  These are services commissioned directly by NHS England rather than by CCGs.

The NHS’s Medical Director says there should be zero tolerance to 12 hour trolley waits in A&E, in a leaked letter (part of a story on the current pressures on the NHS more generally).

A report on hypothecating tax for health spending by the think tank CentreForum suggests that such funding has major flaws.

A GP practice’s leaflet directing people to alternative sources of help has been reissued, with distribution paid for by NHS England despite its earlier criticism of it following a hostile reaction in the press.


23rd December 2014

More than a quarter of private tenants have cut back on food to meet their housing costs, and just under a quarter had cut back on heating, according to a survey of 1,183 private tenants by the National Housing Federation.

Alcohol consumption amongst the over 45s is most affected by health, relationship status, income and education, with wealth, well educated men who are single in middle age being most likely to drink in later life, according to a ten year study of 4,500 people by researchers from Keele University and UCL.


22nd December 2014

In a project to map the DNA of 75,000 people, the first 11 hospital trusts to be involved have been named.  The project was launched by the Prime Minister in the summer (and announced before that).

The lives of 85,000 ‘troubled families’ have been ‘turned around’, according to DCLG reports of progress in implementing the scheme in local authorities.

Lifestyle changes could prevent 80,000 people a year in getting dementia in Britain according to a report to be presented to the World Innovation Summit for Health in Doha in February.

The lessons for developing 5 year strategic plans, derived from support given to 11 local health economies by NHS England, Monitor and the NHS Trust Development Authority is published (24pp).


21st December 2014

18-34 year olds are less satisfied with their GPs, find it harder to get an appointment and are twice as likely to go straight to A&E or a walk in centre, according to analysis by the CAB of data from the NHS GP patient survey, covering 900,000 people.  30% of 18-34 years olds rated their GP as ‘very good’, while 64% of those aged 75 and over did.  14% of 18-34 year olds said they were unable to see a GP the last time they tried, compared to 6% for over 55 year olds.
(22nd December)

There have been proposals to increase ambulance target response times, in a leaked document from the Association of Ambulance Chief Executives.  Targets for ‘Red 2’ cases – serious but not life threatening – could be increased from 8 to 19 minutes.  DH said that no decisions had been made.
DH now says the changes are now unlikely to be implemented by the first week of January as originally planned:

There has been a shortage of GP recruits, particularly in the North East, East Midlands and Yorkshire and Humber where between a third and a quarter of GP training places have not been filled.

A case of discrimination on the grounds of obesity has been won by a 21 stone man in a High Court judgement.  He was dismissed after being off work for seven years.


20th December 2014

A&E waiting times hit record levels for a second week, with 89.8% achievement in England against the four hour target for the week ending 14th December.
(19th December)

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


19th December 2014

Real terms spending on GP and mental health services is to be increased next year, as details of how the extra £1.98bn for the NHS announced in the autumn statement is to be allocated are published by NHS England in ‘The Forward View into action: planning for 2015/16.’  This includes the allocation to each CCG.
(22nd December) Press release:

Guidance for how mental health patients can exercise their right to choose who provides their care and treatment, has been published by NHS England.  The guidance is aimed at commissioners, GPs and providers.

A stem cell therapy has been approved for the first time by the European Medicines Agency.  The treatment is for a rare eye condition.

A memorandum of understanding between Monitor and Healthwatch has been published, covering respective roles, principles they will follow and their agreed governance framework on joint areas of work.

Monitor publish an assessment of the quality of NHS Foundation Trust 5 year strategic plans, (2pp).


Bulletin for CCGs: Issue 74


18th December 2014

Central government grant to local authorities is to be cut by an average of 8.8% next year, not counting inflation, according to an LGA analysis of the Government’s announcement.  According to the LGA the figure is 3.7% if the Better Care Fund (BCF) is included, but that has restrictions on its use and is to be jointly to be commissioned with CCGs [and presumably if it is included as local government spending it should not be included as NHS spending, so does that mean health spending is not keeping pace with inflation?]  The Government says councils face an average cut of 1.8%, by including the BCF and business rates.  The LGA says core government funding to councils has been cut by 40% since 2010.  The council tax rise limit of 2% before a referendum has to be held is to be maintained, despite speculation it might be reduced.
‘Spending power’ figures for individual councils:
Criticism of the cuts from Tory councils:

No new money is to be made available for the Local Welfare Provision Grant, which provides emergency funding, it was confirmed in the financial settlement.  This has been described as a gift to loan sharks.  The proposals are open for feedback until 15th January 2015.

There has been the highest number of patients admitted to A&E in England since records started over a decade ago, with concerns that the system is running at maximum capacity and so would not be able to cope with excess demands (such as a major outbreak of flu or the norovirus).  Performance against the 4 hour target has slipped just below 90%.
(19th December)

Police cells will no longer be appropriate places of safety for under 18s suffering mental health problems under planned changes to mental health laws.
(15th December 2014)

Obesity could constitute a disability if it hinders ‘full and effective participation’ at work according to a judgement by the European Court of Justice, which is binding across the EU.  This means employers could have to make special adjustments such as providing larger chairs or special car parking.

The NHS is to provide financial incentives for GPs to bring pharmacists into their practices, as part of a £200m budget for developing primary care.

The law on when councils have a duty to house homeless people should be clarified this week in three Supreme Court appeal judgements.  Part of the issue is the criteria of whether a homeless person is ‘less able to fend for himself than an ordinary homeless person’.

An association was found between exposure to air pollution and the risk of autism, though the evidence did not prove a causal link, in research by the Harvard School of Public Health on 245 children with autism and 1,522 without.

A report on how local authorities are making savings, produced by Shared Intelligence and Grant Thornton UK LLP, is published by DCLG (171pp)

A report, ‘Inclusive Integration: how whole person care can work for adults with disabilities’ is published by IPPR.

The allocation of public health funding to local authorities and the conditions of the grants, is published by DH.

The number of young people not in education, employment or training (NEET) in each local authority in England, is published by DfE.

Informed: Issue 17


17th December 2014

Public health spending is not always aligned with local areas of concern a report by the NAO has said.  It said PHE has made a good start in supporting local authorities with their new public health responsibilities but it was too soon to say whether the agency’s approach is achieving value for money.

Eric Pickles is sending three commissioners into Tower Hamlets after failing to receive assurances that the council would take on board criticisms over its governance.  The commissioners will take control of grant making, council property sales and publicity and have responsibility for appointing the statutory positions of head of paid service, chief finance officer and the monitoring officer.

Pregnant women at risk of mental health problems should be given more support both during and after pregnancy, according to new guidelines from NICE.

Nick Clegg says he would not support the TTIP (Transatlantic Trade and Investment Partnership) if it undermined this country’s ability to do what it wanted with its public services.

The latest updates on global and national causes of death from the Global Burden of Disease Study 2013, are published in the Lancet, and show that globally people are living six years longer than 1990, except in sub-Saharan Africa.
(18th December) Dementia is the third largest cause of death in the UK, according to Alzheimer’s Research UK, based on this research:

About one in five nurses recruited to the NHS last year were from abroad, according to HSCIC and not the ‘four out of five nurses’ (with 64% from Spain, Portugal and the Philippines), calculated by the Health Service Journal and reported in the media.
Blog on the issue, including the requirements to be able to speak English:
(18th December)

Smoking with children in a car is to be banned under regulations being laid by the Government, subject to Parliamentary approval, and due to come into force on 1st October 2015.
[Approved 11th February 2015]

There were reported to be disagreements in cabinet about whether to save the local welfare assistance scheme which provides emergency help for those in extreme hardship.

The rules allowing three people to contribute to the creation of a baby mainly to deal with ‘mitochondrial diseases’, have been announced by the government and will now need Parliamentary approval.  Only two of the adults would be classed as parents.

Eric Pickles announces a grant of £23.4m to ‘Local Government Improvement and Development’ [which it says is formerly the IDeA – actually the company that still exists is the Improvement and Development Agency for Local Government, which operates under the auspices of the LGA] to deliver support to councils.  This is about 10% less than the previous year.  They intend to explore how the budget for improvement services can be opened to competition allowing councils, council groupings, think tanks, mutuals and others to bid for such funding.


16th December 2014

Consultants PwC have been holding seminars with hospital trusts about forming combined primary and acute care services organisations as envisaged in the Five Year Forward View.

Up to 15% more GPs are to be trained next year as well as 205 physician assistants, according to Health Education England’s workforce plan for next year.

When people felt younger than they really were they tended to live longer, according to data on 6,500 participants in the English Longitudinal Survey on Ageing, followed up over eight years, by University College London.  The association maintained even taking account of health, mobility and functioning.  After eight years the death rate was 14% for those who felt younger than they were but 25% for those who felt older.  There was a strong association with cardiovascular death but none for cancer death.


15th December 2014

Eric Pickles’ proposal to reduce the council tax cap on increases from 2% to 1% before a referendum has to be held is said to be opposed by Theresa May (on the grounds that it puts police budgets under too much strain) and the Lib Dems (on localism grounds).

An association has been found between working shifts and poorer health, using data from the Health Survey for England, which shows that those working outside 7:00-19:00 have higher rates of obesity (30% vs 24% for men) and more likely to have long standing health conditions (40% vs 36% for men and 45% vs 39% for women).  However there could be other factors involved such as people on lower incomes being more likely to work shifts.
(18th December)


14th December 2014

Iain Duncan Smith has said it is worth considering limiting child benefit to two children.  He made the comments on the BBC’s Sunday Politics programme, and said it could “help behavioural change”.  [Presumably this meant that any child thinking of being born third or later in the family would resist being brought into the world realising that there would be less money to look after them (regardless of how deserving the pre-foetus felt itself).]


13th December 2014

The number of litigation claims against the NHS has nearly doubled from 6,562 in 2009-10 to 11,945 in the last financial year.  As a result, the NHS has increased the amount it puts aside for such claims from £8.7bn to £15.6bn.


12th December 2014

The medical innovations bill is a ‘quack’s charter’ according to Dr Sarah Wollaston, chair of the Commons health committee.  The Bill, championed by Lord Saatchi, would allow doctors to try unproven medicines on dying patients.

Monitor will regulate on new mental health waiting time targets and is consulting on when the changes should be introduced.

A third of NHS providers have at least one board position not permanently filled, according to research published by the King’s Fund, ‘Leadership Vacancies in the NHS.’

Use of social media by older people improved their cognitive capacity and their physical and mental wellbeing, in a two year trial involving 120 people in Italy and the South West of England, assessed against a control group.

A policy framework on the Better Care Fund is published by DH, setting out: “the legal and financial basis of the fund; conditions of access to the fund;    the assurance and approval process; payment for performance metrics.”  The website says: “This document sets out the agreed way in which the Better Care Fund will be implemented in 2015 to 2016.” but the document itself says, “It is not intended to act as further guidance to local areas on implementation of the fund.”

Better NHS employee experience was correlated with better outcomes from patients and employees in NIHR funded research analysing existing data.


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


12th December 2014

A&E continues to struggle, with just under 92% seen within four hours in England, the lowest since April 2013, in the latest weekly figures.  (The Guardian has the figure as 87.7% seen within four hours in England, which is just in the major units).

The number of children admitted to hospital for self-harming is at its highest level for 5 years, with the increase between 2009/10 and 2013/14 being 93% for girls (from 3,090 to 5,953) and 45% for boys (from 454 to 659).  The increase could be partly because of better recording.

The scheme to share patient information may be delayed until well into 2015, as GP surgeries in pilot areas will not be signed up until the new year.  The scheme was delayed last February by at least six months because of public concern.
(16th December)
(11th December) report by the Patients Association on

Food outlets will have to inform customers of the presence of 14 allergens including nuts, milk, mustard and lupin seeds, as EU regulations come into force on 13th December.

Research suggests that making homes more energy efficient could increase asthma risks, if appropriate adaptations are not made.  The research is from the University of Exeter Medical School and is based on 700 properties.


11th December 2014

The failure to stop anti-microbial resistance could mean 10m extra deaths a year globally (more than currently die from cancer) and a cost of £64tn by 2050, according to a report by economist Jim O’Neill, chair of a review commissioned by David Cameron.  The cost was said to be likely to be an underestimate as it did not cover all social and health costs.  The largest number of deaths would be in Africa and Asia.
Estimating the economic costs of antimicrobial resistance, from the Rand Corporation:
Five Year Antimicrobial Resistance Strategy, annual progress report:

Food prices rose by 12% between 2007-13 while household consumption fell by 6%, according to the Family Food Report 2013 from DEFRA.  The average energy intake is 5% higher than recommended but is on a downward trend.  Purchases of fruit have fallen by 13% since 2007, while purchases of vegetables have fallen by 3.4%.  On average, households purchased the equivalent of 4 portions of fruit and vegetables per person per day.
Family spending 2013:

Plans by the main Devon CCG to ban routine operations for smokers and the morbidly obese have been dropped following feedback from the public and professionals.

Eight pilot schemes to develop CAMHS services are being funded with £500k from the Government.

PROMS (Patient Recorded Outcome Measures) statistics for 2013-14 are published by HSCIC.

A summary of mortality trends in the United Kingdom 1983-2013 is published by ONS.

The NHS Outcomes Framework for 2015-16 has “a limited number of changes.”


10th December 2014

A third of health contracts awarded since April 2013 have gone to the private sector, according to figures obtained through foi by the BMJ on 3,494 contracts awarded by 182 CCGs.  DH said that 6% of NHS spending goes on the private sector.

50% of women and 43% of men in England take prescription drugs, at a cost to the NHS of over £15bn a year, according to figures from the HSCIC.  Nearly a third of prescriptions were for cardiovascular disease.  More than a tenth of women were taking antidepressants and this rose to 17% of the poorest women.  The report, ‘The Health Survey for England 2013’ also has information on smoking, obesity, eyecare, shiftwork and social care for people over 65.
(11th December)

The hyping of health news reports often originates with the press releases rather than from journalists, according to research based on 462 press releases issued in 2011, by researchers from Cardiff and Swansea Universities and the universities of New South Wales and Wollongong in Australia, published in the BMJ.  However there wasn’t an association between exaggeration and coverage, suggesting there is no need to hype the press release to get it reported.

The Secretary of State sets out the criteria for judging whether health bodies are meeting their health inequality duties.

A basket of local indicators on child poverty is updated.

Statistics on outcome indicators for looked after children are published by DfE.

Patient safety information, the ‘NHS Safety Thermometer’ for November 2013 to November 2014 is published by HSCIC.

Informed: Issue 16


9th December 2014

Maternal death rates, which are already low, continue to fall, but ‘indirect deaths’, such as from flu, suicide or heart disease, have not fallen and more could be done to reduce these, according to an assessment from Oxford University.  357 women died during pregnancy or in the six weeks following between 2010-12.

Inequality has restricted economic growth in richer countries according to a report from the OECD.

Prescription by GPs of insulation and energy efficient measures reduced GP and outpatient visits, cut costs and increased warmth, in a small scale (12 homes) pilot in Sunderland.  (The scheme is sometimes called ‘boilers on prescription’).
(10th December) (Rgn)

Jeremy Hunt says he does not want to stand in the way of social prescribing by GPs, if CCGs want to commission that.

Under 75 mortality rates for cancer in England fell by 15% between 2009 and 2013, according to the National Cancer Strategy 4th Annual Report, published by DH.  NHSE have also said that one year survival rates will be added to the measures by which CCGs are judged (the CCG Assurance Framework).

Statistics on adult social care published by HSCIC show an increase in spending in real terms from £15.9bn in 2003-04 to a peak of £18.2bn in 2009-10, with a subsequent fall to £17.2bn in 2013-14.

Community care statistics for 2013-14 are published by HSCIC.

Outcome measures from the adult social care outcomes framework (ASCOF) are published by HSCIC.

DWP is piloting a scheme to reduce benefits sanctions for vulnerable homeless people, in Sussex.

Sir Bob Kerslake’s review of Birmingham City Council is published.

PHE is consulting on its strategy for research.


8th December 2014

A Church of England funded study on foodbanks, including politicians from each of the main parties, has said more needs to be done to meet the needs of hungry people in Britain today.  It recommends state backed foodbanks, changes to the administration of benefits, a national living wage and cuts to phone, energy and credit charges.
Iain Duncan Smith promises to respond positively to the report:
Over 900,000 Jobseeker allowance claimants were subject to a sanction in the last year according to figures from DWP following an foi request:
(7th December) The Archbishop of Canterbury says he was more shocked by what he found in British food banks than what he’d seen in Africa, because it was so unexpected:
(7th December) Clegg calls for a rethink on how the benefits sanctions regime is administered:
Mail online headline: “Welby faces food banks backlash: Archbishop calls for state war on hunger but MPs say feckless parents waste cash on cigarettes and drink”:
Digest of news coverage on the report:
The All Party Inquiry site with link to the report:

People vulnerable to air pollution should be protected, by not siting schools, hospitals and care homes near main roads, providing air filtration for existing premises and over time getting rid of diesel engines, the House of Commons Environmental Audit Committee recommends.  Air pollution kills around 29,000 people a year.

Extended surgery opening hours and being able to see a GP on the same day, matter most to patients, while weekend opening is seen as less important, according to a survey of 1,700 people by the London School of Hygiene and Tropical Medicine.

GP morale is falling and 74% report unmanageable or unsustainable workloads in a BMA survey of 140 GPs.

21% of patients are registered with a GP where they can see their records online, at September 2014, up from 2% the year before.  91% of patients’ GPs provide the ability to book or cancel appointments online, up from 64% a year before.

Complaints about health and social care should be taken more seriously, and complaints welcomed as a way to help improve the quality of care, the CQC says in a report, ‘Complaints Matter’.

Alcohol consumption in Scotland has fallen by 9% since 2009, and there has been a 25% drop in alcohol related conditions since 2007/8 according to an NHS Scotland report.  However alcohol sales are still 17% higher than in England and Wales.

The closure of the Independent Living Fund was not unlawful in breaching equality laws a judge has ruled, after a judicial review was brought by two severely disabled men.

Child sex abuse is a national health epidemic, with up to 11 million victims and consequences for mental and physical health, according to one of the members of the independent panel of enquiry into historical sex abuse set up by the Home Secretary.

Later Life Newsletter 61 (1 page)


7th December 2014

The number of senior nurses has fallen since 2010, although the number of nurses overall as risen, according to figures obtained by the Labour Party.

Two thirds of local authorities didn’t provide any emergency accommodation to children who had run away, despite there being around 18,000 such cases annually, according to information obtained from fois by the Railway Children charity.


6th December 2014

Laws on plain packaging should be introduced before the election, according to separate calls from politicians from the three main parties.

Text messaging, followed up by a phone call if needed, helped people remember to take their medication in a randomised controlled trial involving 300 people.


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


6th December 2014

Access to shops and restaurants by disabled people has been criticised, with a fifth of shops excluding wheelchair users, according to a Government commissioned audit of 30,000 premises.
(9th December)


5th December 2014

Chains of hospitals owned and run by profit making companies but providing public services is one of a number of options for future health care identified by a Government commissioned review led by Sir David Dalton.

The CQC has apologised for wrongly assessing 60 GP practices as being at risk of providing poor care in its recent banding exercise, following a comprehensive review of the data used, which led to one indicator being removed from the assessments and the data for 4 others being modified.  The BMA says the banding system should be withdrawn.
(6th December)

Being obese can reduce life expectancy by six or more years and lose up to 19 years of healthy life, according to research from McGill University in Canada, based on US data and published in the Lancet Diabetes and Endocrinology.

There was another record week of A&E attendances with the 95% four hour target missed for the 72nd week in a row.

More breastfeeding and for longer could save the NHS £40m a year, according to health economists from Brunel University, because of the health benefits to both babies and mothers.  (The Mail Online has the figure at £50m.)

The chances of having surgery for the most common forms of cancer declines significantly with age according to research by Cancer Research UK on 367,000 patients who had surgery between 2006-2010.

A third of NHS trusts do not record complaints made by third parties not directly involved, according to foi requests obtained by Healthwatch England.
(Comment piece by HWE CE)
(Comment piece by HWE Chair)
HWE press release:

Bulletin for CCGs: Issue 73


4th December 2014

George Osborne has reiterated that a future Tory government would freeze working age benefits for two years, which he stated at September’s Conservative party conference.

Monitor proposes a system of GPs working alongside A&E departments in a report, ‘Exploring International Acute Care Models’, looking at healthcare in seven other countries.
(5th December)
The report (33 pp):

67% of GPs believe there has been an increase over the last year in the number of patients who would have benefited from legal or specialist advice on benefits, with 65% believing there has been an increase in relation to debts and financial problems, according to research by ComRes, commissioned by the Legal Action Group, on 1,001 GPs with data weighted to be representative by region.  Asked how much not having access to legal or specialist advice on social welfare issues can negatively affect health, 48% said to a great extent and 40% to some extent.
Report from the LAG (pdf):
Detailed results from ComRes(pdf):

A fifth of 16-24 year olds suffer from psychological problems according to the ONS.
(Article mainly 5 tips for how to combat problems)
(Full report from ONS):–2014/rpt—exploring-the-well-being-of-young-people-in-the-uk–2014.html


3rd December 2014

More detail on how the £2bn for the NHS is to be spent, has been provided, including £1.1bn to enhance GP surgeries and new ways of caring for patients and support for children with eating disorders.
Brief digest for the NHS on the Autumn Statement:
Health secretary’s statement on future funding of the NHS:
(1st December) £300m p.a. for GPs for four years:
(1st December) GPs will be expected to work closely with social services, job centres and other community services:
There is to be a £200m transformation fund to kick start some of the changes envisaged in the Five Year Forward View.  Upgraded GP surgeries in England will provide chemotherapy and dialysis.
(5th December) Priority will be given to existing bids for improving GP surgeries:
(2nd December) £150m over five years to help children with eating disorders:
(2nd December)

A levy on tobacco companies is to be consulted on, the Chancellor has said, arguing that since tobacco imposes costs on society, the tobacco industry should make a greater contribution.

Births at home or in a midwife led unit can be safer than hospital for mothers who have already given birth and have a straightforward pregnancy (about 45% of the total), according to new NICE guidance.  It should still be up to the mother as to where to have their baby.

Primary school pupils from poorer areas are almost twice as likely to be obese as those from more well off areas according to figures from the HSCIC, based on 1.1m primary school children measured.  By the last year of primary school (year six) 13.1% from well off areas were obese but 24.7% from the poorer areas were.

74% of NHS Trust finance directors are forecasting a worse financial position this year, according to a survey across Trusts and CCGs by the Healthcare Financial Management Association.

Morbidly obese people and smokers will have to make lifestyle changes before they are able to have certain elective operations, the main Devon CCG is proposing, to save money.  They are also proposing to only provide one hearing aid instead of two, restrict shoulder surgery and delay knee and hip operations for the morbidly obese.
(4th December)

A fifth of older people in care homes and a quarter of those at home without a carer are dehydrated according to figures presented at a Royal Society of Medicine Conference.  There could be a number of reasons including a lost of sense of thirst as people age and concern about incontinence issues.

Informed: Issue 15


2nd December 2014

Home care is not organised as well as it could be and is nearing crisis point, with some services users treated by up to 50 different members of staff a year, according to the ‘Key to Care’ report from a commission led by Paul Burstow, and published by LGIU.  About 60% of staff were on zero hours contracts and up to a third were not paid for travelling between clients.

People rarely spot symptoms of potential cancer, with only 1% of 915 people who had at least one of 17 ‘alarm symptoms’, recognising that this could be a sign of cancer, although 60% did visit a doctor anyway.  The full study by Cancer Research UK looked at 1,724 over 50s in three GP surgeries in East London, with the findings published in the journal PLOS ONE.
(3rd December)

80% of patients reported a good A&E experience in the fifth national A&E survey.

The scheme basing mental health professionals in police stations and courts is to be extended to 13 more areas in April 2015, joining the existing 10 trial sites, called Liaison and Diversion, meaning that half the English population will then be covered.

The European Commission is consulting on changes to the working time directive.  The consultation is open until 15th March 2015.


1st December 2014

300,000 disabled people are on housing lists waiting for accommodation to meet their needs, according to a report by charity Leonard Cheshire, which wants all new homes to be built so they could be easily adapted to meet disabled needs.

Cancer screening should be broadened to more than those with a family history of the disease, the Eve Appeal is proposing, after research by University College London and the University of Manchester found a higher proportion of a gene mutation that increases the risk of developing breast cancer was found in the Ashkenazi Jewish population, which meant that 56% of those carrying the mutation would not have had the relevant test based on family history alone.

Up to 40% of minorities may have their ethnicity wrongly recorded in their NHS records, affecting analysis of equalities and disease prevalence, according to research published in the journal of the Royal Statistical Society.  The rate of error was 5% overall, but was higher for minorities.

Diabetes in middle age can impair brain function by the equivalent of 5 year’s ageing according to US research on 16,000 people followed since the 1980s.

The HIV virus is becoming less virulent and infectious as it adapts to human immune systems, according to research from Oxford University.
(2nd December)

Proposals for changes to the way health services are paid for and particularly a greater use of capitation payment, would help integration of services according to a consultation by Monitor.


30th November 2014

Plans to restructure A&E services have been put on hold, it is reported.  The plans which were outlined last year by NHSE Medical Director Sir Bruce Keogh would have transformed up to 70 A&E’s into major emergency centres, treating the most critically ill, with the remaining 225 to deal with the rest.  It is suggested that one reason may be the political impact of threatening to downgrade a number of A&E units in the period leading up to the election.
(3rd December) In a letter to the Guardian, the NHSE says the programme is still on track and intending to identify 40-70 emergency centres to have specialist services:

The Chancellor has said he will increase funding for the NHS by £2bn next year in his autumn statement.  However this is criticised as spin, as £750m of the money is reallocated funding from elsewhere in the Department of Health.  Money from the £1.1bn bank fines over foreign exchange rate rigging is to be used over four years to improve GP services.


28th November 2014

Bedblocking was at its highest level ever in October, with 96,564 bed days where patients were fit enough to leave but waiting for social care.  This compares to 78,487 in the same month the previous year.

A new data sharing system to help prevent child abuse has been launched.  The Child Protection – Information Sharing (CP-IS) will now be rolled out across the country with the aim of linking local authorities, emergency departments, out of hours GPs and walk in centres.

Additional spending on GPs of £72m a year could save £135 a year through reductions in A&E attendance and ambulance use, according to a report by Deloitte commissioned by the Royal College of GPs.

£90m is to be invested through the Transformation Challenge Award which it is estimated will save £900m longer term.

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

28th November 2014

2,200 mental health beds out of 19,000 have been closed since 2011, according to research by the BBC and the Community Care journal, and 7 mental health patients have killed themselves since 2012 after being told there was no bed available.  Adult acute admission wards have had an average monthly occupancy rate of 101% over the last two years, when the recommended level is 85%.

There was the lowest number of excess winter deaths last year in England and Wales since records began in 1950, with a mild winter and little flu problem, according to figures from ONS which indicated there were 18,200 excess deaths (11.6% more people) of whom 14,000 were over 75.

NHS England is to award £0.5m to a charity or not for profit organisation to identify evidence based approaches to self-care, as part of a ‘Realising the Value’ programme.

Regional Voices launches a survey on how the voluntary sector is engaging with Health and Wellbeing Boards.


27th November 2014

The need to do more to tackle alcohol related disease is highlighted in an expert report by the Lancet Commission, which notes that the UK and Finland are the only European countries where the prevalence of liver disease has increased, with cheap and easy availability of alcohol being a problem amongst young people and more middle class drinking at home.  There is poor detection, with blood tests commonly used rather than the more reliable scanners.

The number of children in care is at its highest level since 1990 and has risen by 14% since 2008, possibly as a result of the 2007 Baby P case, according to an NAO report.

There are many elderly people struggling at home, including 70,000 with severe needs receiving no help and 160,000 inadequate help, according to research based on official figures and the English Longitudinal Study on Ageing, by Independent Age and the Strategic Society Centre.

The proportion of obese or overweight children increased from 25% at age 7, to 35% at age 11, in the Millennium Cohort study of 13,000 people born between 2000 and 2001.

Bariatric surgery is a cost effective way of dealing with the costs of Type 2 diabetes according to NICE, which says there should be two or three times as many operations.  6,500 people had the surgery in 2009-10, but 2 million people could now be eligible.  It is argued that the surgery pays for itself in two or three years.  24,000 people die prematurely every year because of Type 2 diabetes.  It costs £10bn p.a. for the care of diabetes and its complications, about 10% of the NHS budget.  Others argue that other approaches should be used for weight loss.

Over half of the 23,600 mental health ward inpatients had been in hospital for 117 days or more at the end of March 2014, according to a report, The Mental Health Bulletin, from HSCIC.

Nick Clegg announces £214m for cycling with the aim of doubling the number of journeys by bike by 2020.

A single set of guidance for NHS commissioners and provider trusts is being produced jointly by NHS England, Monitor and the Trust Development Authority, to try and take forward the ideas in the Five Year Forward View in a co-ordinated way.

Research identifying early indicators of child neglect is published by DfE.

Two new laws, the Duty of Candour and the Fit and Proper Person’s Test come into law.

Statutory guidance on promoting the health and welfare of looked after children is being consulted on by DfE and DH, closing on 9th January.

NHS Reference Costs 2013-14 provides information on how NHS providers spent money providing healthcare.

Detailed spending figures from NHS England have been analysed by the Guardian to show where the money was spent, including on private companies and management consultants.

A report, ‘The Bigger Picture: understanding disability and care in England’s older population’ is published by The Strategic Society Centre.


26th November 2014

A report on post-Winterbourne View action says there should be a charter of rights for people with learning disabilities or autism and that government funding should kick start the programme of closing assessment and treatment (A&T) units.  The team producing the report, ‘Winterbourne View – Time for Change’, which was commissioned and published by NHS England, was led by Stephen Bubb.  The Government broadly accepted the thrust of the report.
More detailed reporting and analysis:

Recommendations for improving public services are made in a Government commissioned report, ‘Bolder, Braver and Better’, from the Service Transformation Challenge Panel chaired by Sir Derek Myers and Pat Ritchie.  It recommends: the use of the person centred approach of the Troubled Families programme to address multiple and complex needs; reallocation of existing funds to be available for transformation; and better use of data and technology for smarter services.

A reconfiguration of primary care in London, at an additional cost of £300-800m a year, is being proposed in a new Strategic Commissioning Framework which, it is suggested is the first model of how reconfiguration changes in the Five Year Forward View might be implemented.  The framework, published by the NHS England Local Area Team and London CCGs, has been produced by boards with large and broad membership, following widespread consultation.

The reward for each dementia diagnosis of £55 for GP surgeries is to be dropped after next March, NHS England has said.  They said it was always intended to be a short term measure.

The NHS in England should be given an additional £2bn next year, the King’s Fund argues.
Press release:
Autumn statement briefing:

GPs should be available in A&E departments to deal with less urgent cases the College of Emergency Medicine recommends in a report.

NHS England is consulting on changes to the NHS payment system for 2015-16, including changing the rules on funding emergency admissions, setting a 3.8% efficiency target, ensuring parity of esteem for physical and mental health and a new mechanism for sharing costs of increased spending on acute specialised care.
Guide to the NHS payments system for patients:
Comment from the NHS Confederation and mental health charities says spending on mental health is falling:

Reforms to the Private Finance Initiative are likely to increase costs to the NHS according to a report from the Centre for Health and the Public Interest.

Government proposals to tackle child poverty do not take up key proposals from the recent report by the Social Mobility and Child Poverty Commission, according to critics.

Survival rates from lung cancer are worse in the UK than most other developed countries, but it does much better for breast cancer, according to a WHO study looking at data from 67 countries covering more than 25m adults and 75k children and published in the Lancet.  Obesity is the cause of cancer in 13,000 women a year in the UK (8.2% of all cancer cases) but only 7,200 men (4.4% of all male cases).

10 million people in England could be deficient in vitamin D, according to NICE which says that supplements should be more easily available and that local authorities should provide free tablets for children.

Out of hours care is hindered by a lack of integration and insufficient resources according to a survey of 1,000 GPs, for a report ‘Urgent and Important: the future for urgent care in a 24/7 NHS’ by Care UK.

Health literacy amongst older people was associated with internet use and participation in cultural activities, in a study on 4,500 over 50’s who were part of the English Longitudinal Study of Ageing, published in the Journal of Epidemiology and Community Health.

A Conservative minister has joined calls for DWP funding to be reinstated for the £180 emergency local welfare assistance scheme which was transferred to local authorities.  The minister is Amber Rudd, minister for climate change.

Proposals for new local NHS payment schemes to support integrated care, are published by Monitor.


25th November 2014

19% of people now smoke, down from 46% in 1974, with 58% of people never having smoked, according to ONS figures.

The ‘Learning Disability Alliance England’ (LDA) has been launched by more than 90 organisations and 1200 individuals.

Tackling depression should be a global priority, according to Kofi Annan, former UN Secretary General, who says it should be made one of the Millennium Development Goals.  As well as less funding going to mental health, it is often treated separately, even at different hospitals, from physical health.

Evidence for ‘The Reconfiguration of Clinical Services’ is published by the King’s Fund, suggesting that while important, it is not sufficient for tackling the challenges facing the health service.

NHS England acted unlawfully in not involving patients in primary care commissioning decisions, in a case where a GP practice was threatened with closure because of withdrawal of the Minimum Practice Income Guarantee.  NHS England is now considering how it should comply with its duty and the MPIG withdrawal has been delayed for two years.

Discussing weight loss with patients was amongst the most difficult conversations GPs have, according to a self-selected online survey of 600 GPs by Pulse magazine.  Among the reasons was their view that such interventions would have little impact alongside all the other factors affecting diet and weight.

The free helpline for the elderly, ‘Silver Line’ has taken nearly 300,000 calls in its first year, most about people feeling lonely or isolated, and is now working with the CQC in providing health and support.

The performance report for NHS Foundation Trusts for the second quarter of 2014-15 is published by Monitor.

Informed: Issue 14


24th November 2014

Nick Clegg announces a cross-governmental task force on mental health to improve services.

As many people from working as workless families are now in poverty, with two thirds of those finding jobs in the last year receiving less than the living wage according to research by the Joseph Rowntree Foundation.

UK families are 26 days away from ‘being on the breadline’ on average, in the event of a financial shock, according to research by Legal and General.

Attitudes towards disabled people have improved over the last 20 years, but problems remain, according to a survey by the charity Scope, which found that the number being called names has fallen from 38% to 17% during those 20 years while the number saying they were stared at has fallen from 59% to 30%.  42% of respondents said they had missed out on a job ‘every time’ or ‘a lot of the time’.

Talking therapy reduced the risk of death by suicide by 26% after five years according to research by John Hopkins university that looked at 22,000 people who had attempted suicide, 5,000 of whom received talking therapy, with further assessments over 20 years.


23rd November 2014

Statistics on A&E pressures will not be published until December, although the winter situation reports were available weekly from last November.  The reason for the delay is unclear.

Only 7% of people want doctors to decide on their end of life care, but 91% are by default leaving it to doctors because they do not make provision, such as through an ‘Advanced Decision’, according to research by YouGov for ‘Compassion in Dying’.


22nd November 2014

A report on general practice and community care recommending a change from the ‘cottage industry’ model to practices working together ‘at scale’, ‘An inquiry into patient centred care in the 21st century’, is published by the Royal College of General Practitioners.  It also proposes government should provide a transformation fund to drive change in general practice.
(24th November)

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


22nd November 2014

Labour says the fines from banks for manipulating currency exchanges should be given to the NHS.


21st November 2014

A record number of people were admitted to A&E last week, leading to 89.4% of patients being treated within four hours, meaning that the 95% target has now been missed for 70 consecutive weeks.

‘Getting it Right for Families’ is published by the Early Intervention Foundation, identifying areas of good and promising practice in integration across health and local authorities in intervention from conception to age 5, drawing on the experience of 20 localities.


20th November 2014

The worldwide costs of obesity are more than for armed conflict, only slightly less than for smoking and represent about 2.8% of economic activity, according to a report by the McKinsey Global Institute.  The cost to the UK is £47bn.  No country reduced its prevalence of obesity between 2000-2013.
(Extensive report)

New guidelines to help GPs spot the early signs of cancer have been published for consultation by NICE.
Thresholds are lowered for referrals for a cancer assessment:

The life expectancy of newborn boys varies by 8.7 years between South Cambridgeshire and Blackpool according to the latest figures from ONS.

There has been a fall in death rates from cancer for under 75s in England over the last ten years according to figures published by HSCIC.  It remains the leading cause of death for this age group.  While the rate fell in 298 local authority areas, it rose in 24 (with the 5 areas with the highest death rates all in the North West).
(21st November).

The CQC has ranked mental health trusts into four risk bands as a basis for deciding which to inspect.  5 out of 39 banded are in the highest risk category, band 1 (there are 57 trusts, but 18 were not banded as they have already been inspected).

A description of what good complaint handling should look like has been published by Healthwatch England, the Local Government Ombudsman and the Parliamentary and Health Service Ombudsman.  Other organisations which have signed up to using the expectations include NHS England, the CQC and the Trust Development Authority.

The Government announces new actions for supporting school pupils’ mental health including helping schools to teach pupils about mental health, providing a blueprint for providing counselling services and an invitation to voluntary organisations to bid for some of the £25m for projects for improving young people’s mental health in schools.

The Royal Bournemouth Hospital is threatening legal action against patients who won’t leave hospital after a week’s notice, if they are well enough to go.

Informed: Issue 13 

Bulletin for CCGs: Issue 72


19th November 2014

The plans of neither the Coalition nor Labour will meet the expected £30bn funding gap by 2020, with too much reliance placed on savings from integrating health and social care, for which there is no evidence, according to a commission of enquiry set up by the Health Service Journal and including senior health leaders.

Detailed and rigorous research on food banks which links their use with social security payment issues has been dismissed by the government as being inconclusive.  The report, ‘Emergency Use Only’, commissioned by the Church of England, Oxfam, the Trussell Trust and the Child Poverty Action Group, included collection of detailed data from 900 clients at three food banks, 40 in depth interviews with clients at seven food banks in a diverse range of areas and an analysis of the caseload of 178 clients at one food bank.
Press release:
The report:

16% of single tier and county councils are not expected to end this year within budget and 52% are not well placed to deliver their medium-term financial strategies, according to a report from the NAO.  It criticises DCLG for not monitoring in a co-ordinated way the impact of funding reductions on services.

Outcome data for 5,000 surgeons is published on a website by NHS England.  Only three surgeons are outside the expected range and in each case it appears that this was because of a high proportion of complex and risky cases.
Analysis and commentary; why there are problems with the data:

Private sector companies have won 131 contracts, worth £2.6bn, out of 195 tendered in England since April 2013, according to campaign group, the NHS Support Foundation.  DH said use of the private sector had increased from 5% to 6% of NHS spending since May 2010.

Concern has been expressed about privatisation in the health service as an International Arms Company, Lockheed Martin is involved in discussions about bidding for a £1bn contract to provide support services for GPs, for which apparently no NHS organisation was allowed to bid.

The CQC publishes guidance on the use of hidden cameras to check on the care being given to relatives or oneself.

Many trainee doctors are unwilling to raise safety concerns according to a report by the GMC based on its annual survey of 50,000 trainee doctors.  Nearly a tenth of respondents reported bullying.

48% of transgender people under 26 had attempted suicide, compared to about 6% of all 16 to 24 year olds, according to a survey of 2,000 people in England between 2010-2014 by charity Pace, in partnership with three universities.  (Figures from previous research were 32% and 35% of transgender people attempting suicide).

The proportion of people with severe learning difficulties or mental health needs, who are in employment has fallen, respectively from 7% to 6.8% and from 8.8% to 7.1%.

A link between being overweight and aggressive prostate cancer suggests that 10% of advanced prostate cancers in the UK could be prevented by men keeping to a healthy weight, according to a review of 104 studies by the World Cancer Research Fund and Imperial College London.

There is a reduced mortality risk from quitting smoking in spite of the subsequent weight gain which commonly happens, according to Japanese research looking at over 4,000 people.  Those who gained more than 2kg after quitting still had a 26% lower risk of death.

Multi-national comparisons of health systems data is published by The Commonwealth Fund.

Pharmacy statistics from 2004-5 to 2013-14 are published by HSCIC.


18th November 2014

16% of GP surgeries are at risk of offering poor service, according to a risk assessment exercise by the CQC designed to help the inspection process.  Those surgeries most at risk will be inspected early on.  The assessment is made on the basis of 28 indicators.
(17th November) GP leaders say the indicators are simplistic and create more sticks to beat GPs with:
(20th November)

The Patients Association says it has no confidence in the Parliamentary and Health Service Ombudsman and will no longer be referring callers to it.
Patients Association press release:

An action plan to improve the detection, treatment and prevention of high blood pressure has been launched by a consortium of national bodies led by Public Health England.  Diseases caused by high blood pressure are estimated to cost the NHS £2bn a year.  High blood pressure affects more than a quarter of adults, but 5 million people are unaware they have it.
The action plan (44pp):
Guidance and information available:

There are estimated to be a record 108,000 people with HIV in the UK, a quarter of whom are unaware they have the infection, according to figures from Public Health England.

The inability of Colchester hospital to deal with patient demand, which led to a ‘major incident’ being declared, could be indicative of problems likely to emerge in other areas, particularly if there is increased pressure this winter from cold weather, flu or the norovirus.

The health of future generations will be at risk if more isn’t done to help children, with children’s mortality the second worst in Europe, and British girls the fattest of 22 countries in Europe, according to a report, ‘Vision2015’ by the Royal College of Paediatrics and Child Health.

A private member’s bill aims to remove key aspects of the Health and Local Care Act 2012, particularly the parts relating to competition.  The Bill is being proposed by Clive Efford MP.  Few such bills are passed into law.

Healthy life expectancy for those born in 2009-11 is 66 years for girls and 64 for boys, according to analysis by ONS.

People should not avoid running to protect their knees, with those who run regularly, at any stage of their life, having a decreased chance of developing osteoarthritis, according to analysis of data from an observational study involving 2,700 participants, by the Baylor College of Medicine in Houston, Texas.

People on lower incomes had on average 8 fewer teeth by their 70’s, compared to richer people, according to analysis of data on 6,000 people over 21 from England, Wales and Northern Ireland.

Changes in the mechanisms of government since 2010 and challenges for the next government are set out through 120 graphs in ‘Whitehall Monitor 2014’ from the Institute for Government.
Six key points are highlighted in this blog:

A report on public reporting of health and care to enable people to make better choices, is published by the European Observatory on Health Systems and Policies.

A report by the thinktank Reform proposes reform of public services with a move away from contracting to more licensing of services, in ‘Markets for Good: the next generation of public service reform’.  They also propose that government should set explicit target profit margins as a motivating factor.


17th November 2014

Nutritional standards in Scotland could be made statutory, with more investment and higher standards, if proposals in a consultation are agreed.

There has been a slight increase in the number of women over 60 being treated for alcoholism, from 6% to 10% (with a slightly smaller increase for men), with falls amongst those aged 18-29, according to PHE figures quoted by the Priory.

Shift workers are more likely to put on weight because our metabolism is lower at night and we burn fewer calories, a study has shown.
(18th November)

More could be done to support over 75’s leaving hospital according to a report from the Royal Voluntary Service.
(Free rgn rqd)

A report on how health care provider boards can ensure their organisation is well led, is published by the King’s fund (‘Exploring CQC’s well-led domain’).


16th November 2014

Interim research results of a longitudinal study of young people in England are published.

A report on the support needs of older people leaving hospital, ‘Let’s End Going Home Alone’ by the RVS and King’s Fund is published.


14th November 2014

The latest Winterbourne View Concordat quarterly data shows there were 1,680 people with a transfer date to leave inpatient care, compared to 577 in the previous quarter.


The Adult Social Care Outcomes Framework indicators for 2015-16 have been published.


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


14th November 2014

The Government is making £300m more available for winter resilience, bringing the total to £700m, which is 75% more than last year.
Only 3.5% of the fund is to be made available to primary care:

Less then 10% of people who are obese would describe themselves as such, and the proportions are decreasing, according to research published in the BMJ, commissioned by the Cancer Research UK which looked at 65 people with a BMI of over 30.


13th November 2014

Jeremy Hunt tells the NHS to save £10bn by reducing the use of agency staff and management consultants, selling off unused land and property, use of technology and reducing medication mistakes.
The speech:

The ‘Personalised Health and Care 2020’ report, promises patients online access to their GP records by April 2015, with access to all health and social care records by 2018.  Patients are also to be able to add their own notes to the records.  Published by the National Information Board and DH, it is described as ‘a framework for action’, not a strategy or national plan.

Labour has said it will enable GPs to refer patients for exercise as the first option for treatment.

The YMCA says that benefit sanctions were the leading cause for their referrals of 5,000 young people to food banks last year, accusing ministers of having their heads in the sand over welfare changes.  The government is quoted as saying that there is no robust evidence that their reforms are linked to increased use of food banks.

A lack of trained radiologists is leading to delays in patients receiving the results of scans the Royal College of Radiologists warns, on the basis of a snapshot survey of about 50 radiology departments, a quarter of the total, in October.

Dame Fiona Caldicott is appointed the National Data Guardian.

Patient reported outcome measures (PROMs) for 2013-14 are published by HSCIC.


12th November 2014

Out of hours GP services suffer from potential conflicts of interest between CCGs and GPs involved in service provision, lack of public awareness by the public as to which emergency services are available and wide variation in performance of, and satisfaction with, such services, according to a report by the Public Accounts Committee.  The committee said NHS England needs better GP workforce information and a model to predict future demand.

The GPs’ quality and outcomes framework (QOF) has led to reductions in emergency admissions, leading to savings of £92.5m according to research published in the BMJ.

There is more variation in communication with, and trust of, doctors within GP practices than between them, particularly at the lower end of performance, so the Patients’ Survey should provide information on individual GPs, according to a study reported in the BMJ.

Delays in treatment are threatening the sight of thousands of people with macular degeneration, with nearly 70% of those with wet age-related macular degeneration having to wait more than the recommended two weeks to start injections, according to a survey of ophthalmologists by the Royal College of Ophthalmologists and the Macular Society.  The reasons for the delays are thought to be staff shortages and insufficient priority given to the disease, with which 40,000 people a year are diagnosed.

Nurses and other medical staff are less likely to wash their hands later in a shift, and possibly comply with other rules, as the stress and workload drains their mental reserves, according to a study by the University of Pennsylvania covering over 4,000 nurses and others in 35 American hospitals, which found that hand washing fell by an average of 8.7% in a twelve hour shift.

A report on how the NHS can help reduce poverty is published by the King’s Fund.

Statistics on the NHS Safety Thermometer for October 2013 to October 2014 are published by HSCIC.

Informed: Issue 12


11th November 2014

The target of £1bn savings from the Better Care Fund is overambitious and unlikely to be achieved according to the NAO.  It says it will be hard to reduce emergency admissions by the nationally mandated 3.5% within a year when they have gone up by 47% of the last 15 years, and suggests that target is based on optimism rather than evidence.  The redesign of the process and resubmission of proposals from local areas has left less time for implementing proposals this year.  The biggest risk is protection of social care services with 21 areas identified as having significant risks.  The programme is now expected to save £314m.

The number of NHS Health Checks conducted has increased by 10% in the last year, but the 48% taking up the offer is still well below the 66% target.

Lib Dem care minister Norman Lamb says the NHS needs an additional £1.5bn by April with an additional £1bn each year thereafter.

A third of UK councils no longer provide a ‘meals on wheels’ service according to research by the National Association of Care Catering.

A quarter of workers on low pay in 2001 moved to higher pay ten years later according to a report by the Resolution Foundation for the government commission on social mobility.  The majority cycled between lower and higher pay, with 12% stuck on low pay for every year of the decade.

Almost 24,000 wheelchair users are waiting for social housing because of a big shortfall in accessible housing according to Aspire, which says just 5,000 accessible homes were built in 2013, the lowest level since 2005.
(Rgn rqrd)

Portrayal of mental health on television is improving and helping change attitudes according to a report by the Glasgow media group which looked at dramas, soaps and sitcoms between January and March 2014, and which was commissioned by ‘Mind’ and ‘Rethink Mental Illness’.

A report on how CCGs are innovating with (two) new forms of commissioning for integrated care is published by the King’s Fund.

A toolkit to help Healthwatch representatives on Health and Wellbeing Boards [hey, that’s me!] is published by the LGA.


10th November 2014

The Treasury has asked Permanent Secretaries to identify £25-30bn of cuts for the two years from 2016-7, it is reported.  Although that level of cuts has been expected, it was not known that detailed plans were being sought to identify them.

There has been a 163% increase in those using foodbanks provided by the Trussell Trust from 583k to 913k between 2012-13 and 2013-14, the charity reports.  The three main causes for referral were benefit delays, low income, and benefit changes.

Accountability arrangements between the Government and NHS England are extremely complicated and evolving, according to a report by the Public Administration Select Committee on ‘arms length bodies’.  It said it was not acceptable for DH to take two years to update its ‘accountability system statement’ for NHSE, leaving relationships unclear during a period of major organisational change.

In ‘Next Steps Towards Primary Care Co-commissioning’, NHS England provides guidance to CCGs, and says it wants as many CCGs as possible to start co-commissioning GP services by next April.

Maps showing places of safety, such as mental health units, for children have been published for the first time and show that a number of areas have no facilities at all.  In a quarter of the 23,000 incidents in the year to March, the person was taken to a police station, and 753 of these incidents involved people under 18.

Bariatric surgery achieves weight loss and the associated health conditions, with two thirds of those having Type 2 diabetes showing no sign of it two years later, according to a study on over 18,000 operations between 2010-13 by the National Bariatric Surgery Registry.  Over that period 550 people under 25 had the surgery.

Many elderly residents of care homes in Wales quickly become institutionalised, lose much of their individuality and have a poor quality of life, according to a report by the Older People’s Commissioner for Wales.


9th November 2014

The self-esteem of 14-15 year old girls has fallen from 41% to 33% since 2007, according to a survey of 30,000 pupils by the Schools Education Unit.


8th November 2014

An intensive weight loss scheme in Denmark has helped 70% of 1,900 children lose weight, by adapting 15-20 elements of the child’s lifestyle.  Weight loss was maintained for four years and required just over 5 hours of medical consultation per year.  It has now been adopted by 8 other municipalities in Denmark.

A child’s emotional health is the most important predictor of future life satisfaction according to LSE research published in the Economic Journal and based on data on about 9,000 people born in 1970 and then tracked through the British Cohort Study.  Emotional health was found to be more important than such things as academic performance, money or career success.

CBT treatment for anxiety for teenagers is often not adapted to their particular needs but is simply age adapted from the treatment for younger children, so missing some of the distinctive needs teenagers have, according to research from the University of Reading based on 200 young people in Berkshire.


7th November 2014

32% of CCGs have said they want to performance manage GP contracts, and 15% said they wanted to take over the whole contract, according to an analysis by Pulse magazine of 145 CCG proposals submitted in June.  Submissions on co-commissioning have to be submitted by January.

The Government has said they will not require trainee doctors to have at least one GP placement, in reply to a parliamentary question.


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


7th November 2014

NHS trusts are being put at risk from financial pressures according to a report from the NAO, which found that the government supported struggling trusts with £500m last year.  A quarter of NHS and foundation trusts were in deficit at the end of the financial year.

A data sharing guidance leaflet for health professionals is published for consultation by DH.


6th November 2014

The NHS could save over £2bn by reducing unnecessary testing, diagnosis and treatment, and other efficiencies such as increasing ward rounds so patients can leave hospital more quickly, a report by the Academy of Medical Royal Colleges says.  The authors say there is an ethical duty to reduce waste.  The BMA said that much is already being done and the primary duty should be to patient care.

Around 50 doctors have called for the £55 reward for each dementia diagnosis to be withdrawn on ethical grounds, in a letter to the BMJ.

A small test study has found a drug which appears to be effective in targeting MRSA.  A version is already available for use on the skin and targets ‘bad’ but not ‘good’ bacteria.

More people are moving down the occupational status hierarchy than up, for the first time, according to a study by Oxford University and the LSE of over 20,000 Britons born in 1946, 1958, 1970 and 1980-84.  About three quarters of people end up in a different one of 7 occupational categories to the one in which they were born, which has been fairly constant over time, but it is hard to move up, with a child of a higher professional or managerial father 20 times more likely to end up in a similar status job than a child with a working class father.

Older people with a higher sense of purpose and wellbeing lived on average two years longer than others in research studying over 9,000 British people, conducted by UCL in the UK and the universities of Princeton and Stony Brook in the US, published in the Lancet.

The midlife dip in happiness seen in the west is not replicated in other areas of the world, with a constant decline in Eastern European, former Soviet countries and South America, and a constant low level in sub-Saharan Africa, according to a study reported in the Lancet based on Gallup World Poll data from 160 countries.

Australian men can now expect to live beyond 80, (compared to 78.9 in the UK), joining Switzerland, Japan and Iceland as countries where life expectancy for men and women is over 80.  The achievement is attributed to the country having a good health care system and effective public health which has reduced tobacco consumption.–but-why-do-they-live-so-much-longer-than-britons-9844200.html

Mindfulness meditation, yoga and being involved in a supported group improved health at a cellular level (maintaining telomere length which otherwise shortened) in a Canadian study of 88 breast cancer survivors.

‘Commissioning for value’ support packs for CCGs are published by PHE, providing ‘pathways on a page’ for 13 conditions, and helping identify priority areas which offer the best opportunities to improve healthcare locally.

Bulletin for CCGs: Issue 77


5th November 2014

Child and adolescent mental health services have ‘serious and deeply ingrained problems’ according to a report from the Health Select Committee.  Problems include access to inpatient services, cuts in funding, detention of young people in police cells, the quality of education for inpatients, the difficulty of receiving CAMHS services and unacceptable variation in perinatal mental health services.  The Committee criticised a lack of data, with the most recent information from ONS being from 2004.  There were 263 children held in police cells last year because of a lack of hospital beds.

The cost of living went up 50% for low income households but 43% for high income ones between 2002-3 and 2013-4, according to a report by the Institute for Fiscal Studies for the Joseph Rowntree Foundation.  This means that there are 300,000 more people in absolute poverty than official figures say.

A briefing on the link between health and wellbeing and educational attainment (14pp) is published by PHE.

A data sharing protocol for supporting ‘troubled families’ with health needs is published.

A guide on the use of social media by Health and Wellbeing Boards is published by the LGA.


4th November 2014

The Government is to intervene in Tower Hamlets, after an extensive auditor’s report by PwC found that is had failed to comply with the best value duty in relation to grant making (where £400,000 had been awarded to an organisation that didn’t meet minimum eligibility requirements), property transactions and spending on media advisers to the mayor.  The report cost just under £1m which, together with the fees of 3 commissioners, is to be met by the council.

Nearly half of respondents said their NHS complaint was badly handled according to a report by the Patients’ Association, which had surveyed 1200 people who had complained.

Some poor employed households are living on £6.10 a day with unemployed households having £3.26, after rent, food and energy costs, according to the ‘Real Life Reform’ survey, which is tracking the impact of welfare reform and austerity on 70 tenants from 8 social landlords.  The report finds the families taking on increasing amounts of unsustainable debt.

NICE could ‘kitemark’ health apps, NHS England has said.
(13th November)

‘Is General Practice in Crisis?’ asks a briefing from the Nuffield Trust, examining the increasing demands on GPs, which suggests there are problems with funding, GP numbers and structure, with the need to have larger and networked practices.  The number of single handed practices has halved in seven years.

A briefing, ‘People in Control of their own Health and Care’, from the King’s Fund finds that there is evidence that it has a beneficial impact, it is generally supported in policy, there is some evidence of how to do it well, but there is a lack of systematic improvement.

Quarterly Public Health Outcome Framework data is published.

A new set of standards to help local authorities commission adult social care services has been produced by the Health Services Management Centre and Inlogov.

Informed: Issue 11


3rd November 2014

Greater Manchester is to have an elected mayor as part of a deal with transfers control of £2bn of public funds in addition to the £5bn already controlled in the area.  The mayor will oversee areas including transport, social care, housing and police budgets.

Tobacco companies have won the right to challenge European rules on packaging at the EU’s Court of Justice.

CCGs would be able to set their own QOF (Quality Outcome Framework) arrangements locally, without agreement from NHS England, under proposals under consideration.

The living wage rises by 20p to £7.85 an hour.

Shift work adversely affects cognitive ability and was found to ‘age’ the brain by over six years, according to research on 3,000 people in France by researchers from the universities of Toulouse and Swansea.  There was recovery from the effects of working irregular hours, but it took five years.

Draft guidance on the ‘duty of candour’ has been produced.


2nd November 2014

Urgent action on climate change is required to avoid ‘severe, widespread, and irreversible impacts’, according to the first comprehensive report since 2007 by the UN’s Intergovernmental Panel on Climate Change (IPCC).  Death and ill health is likely from droughts, storms, heatwaves and other extreme weather, food shortages and increased conflict.  The lowest cost solution would be for carbon emissions to peak by 2020 and fall to zero later in the century.  Even if the emission of greenhouse gases stops, the effects are likely to continue for hundreds or thousands of years.  The longer it is left to take action, the more expensive it will be.
Most of the world’s electricity must be generated from low carbon sources by 2050:


1st November 2014

The cost of agency nursing staff has been increasing at about 20% a year for the last four years for NHS Foundation Trusts, and now stands at £1.3bn, with another £1.2bn spent by non-Foundation Trusts.

Over 1,000 companies are now paying the living wage.  The rate rose on Monday 3rd November.


31st October 2014

21 out of 30 adult social care CQC ratings have been good, so far.

Jeremy Hunt says care home staff should be able to update GP records so that doctors can monitor patients’ health more easily, but GP leaders advise caution.

25 of 2,500 men who stuck to a healthy diet and lifestyle were found to be more healthy 35 years later, according to Cardiff University study based in South Wales.  The healthiest delayed dementia by 12 years and heart disease by 6, compared to the least healthy.


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31st October 2014

Welfare reforms have increased family debt by 70% in the last year according to ‘Real Life Reform’, a report by 8 social landlords tracking 70 families.

Alcoholic drinks should have their calorie content displayed on the label to help combat obesity, the Royal Society for Public Health says.


30th October 2014

CCGs should, with local authorities, co-commission public health and social care the Health Secretary has said.

Staff morale is the biggest concern of NHS finance directors, with 47% raising it as an issue in the King’s Fund’s latest quarterly report.  Waiting time targets for A&E, inpatient treatment and cancer treatment were all missed in the quarter.
Interesting graph showing trend of increasing demand for hospitals:

The Government is said to be considering cutting disabled benefits, by bringing the employment and support allowance (ESA) to virtually the same level as the jobseeker’s allowance.

Only a quarter of former Remploy disabled workers are in jobs, a year after the factories closed, according to the GMB Union.

As well as recruiting more GPs and improving recruitment and retention, there needs to be a fundamental review of primary care, to solve the ‘GP crisis’, according to a report from the NHS Confederation and the National Association of Primary Care, ‘Not More of the Same.’

Labour’s proposals to move health commissioning from CCGs to Health and Wellbeing Boards have been criticised by NHS Commissioners, the CCG body.  They said the proposals risk ‘losing essential clinical leadership’ [although CCGs would still have some decision making role through their place on the HWB.]

Cancer survival rates for 19 of the 24 most common cancers are continuing to improve according to figures from ONS.–adults-diagnosed/2008-to-2012–followed-up-to-2013/stb-cancer-survival.html

Performance on diabetes and hypertension by GP practice, CCG and local authority area are shown on a new website, ‘Healthier Lives’ from Public Health England.

The Government is said to be ‘trumpeting’ the benefits of the Better Care Fund in keeping people out of hospital.
But is it enough …
Interesting blog – it’s not reducing hospital admissions but moving people round the system quicker that will make most difference:
The NHS Confederation welcomes the BCF but is concerned about the ability to achieve the financial savings promised:

The annual report from the Chief Social Worker for adults, outlines progress in Lyn Romeo’s first year in the role.

The Government’s strategy for supporting carers over the next two years, is published by DH.

The Faculty of Public Health set out 12 priorities for improving public health.


29th October 2014

It is reported that the Government is continuing to develop a market in child protection, despite a decision earlier in the year to back down from privatising those services, according to the Guardian which reports on a Whitehall seminar in September which looked at new opportunities for how social care is provided.  They include the possibility of new bodies (‘newcos’) to run children’s social care independently of the council.

Dementia is the biggest cause of death for women, while coronary heart diseases is for men, according to figures from ONS.  Cancer is the biggest cause of deaths for both, if the various sorts are grouped together.–deaths-registered-in-england-and-wales–series-dr-/2013/index.html

Many NHS Trusts are relying on financial bailouts, but there is doubt as to how long such funds will be available.

Health checks and screening have downsides which it is difficult to explain to the public as they tend to regard them so positively, according to a report by the House of Commons Science and Technology Committee which is calling for a more standardised approach to providing information about screening.

Too many patients are being sent home from hospital too early according to a report by the Parliamentary and Health Service Ombudsman, summarising 161 cases, where this was one of the main issues.

The Government claims to have almost met its target of helping 120,000 ‘troubled families’ nine months early, having brought nearly 118,000 into the scheme.  They say that 69,000 had ‘turned their lives around’ according to criteria such as an adult in the family going into work or a child no longer being absent from school.–2

Options and proposals post-Winterbourne for moving people with learning disabilities out of residential units, which has not yet happened as planned, are explored in an interview with Stephen Bubb who is leading a steering group on how the voluntary sector could help, which is due to report before Christmas.

The number of children living in workless households has fallen to the lowest level since records began 18 years ago, according to ONS statistics.

The school experience of children living in poverty is explored in ‘The Children’s Commission on Poverty’ from the Children’s Society.

A report on how social workers and GPs can work effectively together is published by the College of Social Work.

Interesting profile of the health systems of: China, South Africa, India, Brazil, Egypt, Italy, the United States and Germany.

A ‘What Works Centre’ for Wellbeing is to be set up, joining a number of other ‘What Works Centres’.  The centre is supported by a number of Government departments and public bodies.  The centre will award grants to successful bid teams in spring 2015 and should become fully operational by the end of that year.  It is to be led by Lord Gus O’Donnell, former Cabinet Secretary.
(28th October) Measuring wellbeing:

Quality and Outcomes Framework data (in essence, GPs’ performance indicators) are published by HSCIC.  Achievement falls from 96.7% to 92.4%.
(28th October)

A guide on how good governance can help Health and Wellbeing Boards make an impact is published by the LGA.


28th October 2014

Only 1.5% of public health budgets in England are allocated to mental health according to research from Mind, based on foi replies received from 86 of 152 authorities.  £40m has been allocated to mental health, £108m on obesity, £160m on smoking and £671 on sexual health.  However the LGA said authorities do a lot to help mental health which is not badged as such.  DH is quoted as saying, “Councils are independent but we expect them to share this priority.” (sic)

Two thirds of the British public think that the gap between the rich and the rest has a negative effect on society, with 47% thinking the country has become less fair under the coalition against 12% thinking it has become fairer, according to a YouGov survey for the Centre for Labour and Social Studies (Class).

Social inequality has a bigger impact on health than either low income or wealth on their own, according research from Stirling University looking at data on 40,000 adults from two surveys.

Child poverty has increased in 23 of 41 developed countries since 2008, and has fallen in 18, according to a Unicef report, ‘Children of the Recession’.  The proportion of children living in poverty in the UK increased from 24% to 25.6%.  In Norway, the lowest country, it fell from 9.6% to 5.3%.  In Greece, the highest, it rose from 23% to 40.5%.

The UK’s gender equality world rank has fallen from 18th to 26th, according to a report from the World Economic Forum in its ‘Global Gender Gap’ report.

A report on Adult Social Care Funding is published by the LGA and ADASS.

Informed: Issue 10


25th October 2014

A ‘personal inquiry’ into care homes for older people is published by the Joseph Rowntree Foundation.

The number of visitors to NHS Choices has risen by 40% since last year and 160% since 2012 according to data from HSCIC.  It is suggested that this is because of the difficulty of getting a GP appointment.
(27th October)


24th October 2014

There could be 90,000 Ebola deaths in just one county in Liberia by mid December, unless the narrow window of opportunity for effective international action is taken now, according to mathematical modelling done by the School of Public Health at Yale University.

Hospitals spent £2.5bn on agency staff last year, according to figures obtained by Frank Field MP.

Care Act regulations and guidance are published by DH.  The LGA disagrees with Government that there is sufficient funding to cover the costs of implementing the Act.  Fact sheets about the Act have also been updated.
(23rd October)

Informed: Issue 9


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23rd October 2014

The NHS Five Year Forward View calls for 1.5% increased spending above inflation and an investment fund to reconfigure the health service, with healthcare moving from hospitals to the community.  Together with other changes such as hard hitting national action on public health issues like smoking, alcohol and obesity, it says this could meet the £30bn funding gap anticipated by 2020.  Each of the parties loved the report, wouldn’t promise the £8bn asked for, said this endorsed their approach and that the others had got it wrong so nah, nah, nah, nah, nah.
More details:
Commentary (28th October): politicians continue to support the report:
The report:
Simon Stevens defends the use of private treatment within the NHS:
The parties refuse to commit to the £8bn sought:

Public Health England publishes 7 priorities for the next 5 years.  The priorities are: Tackling obesity; reducing smoking; reducing harmful drinking; ensuring every child has the best start in life; reducing dementia risk; tackling antimicrobial resistance; and reducing TB.

The number taking up GP training positions has fallen by 2.7%, with only 88% of places being taken up, despite efforts to increase the numbers training to be GPs. 

More than a third of people with conditions which worsen over time are being put on reduced ‘work-related activity group’ benefits which are designed for people likely to recover enough to work, according to five charities that obtained the information through an foi request.  In the last five years, 7 out or 10 people with degenerative diseases such as MS, Parkinson’s or rheumatoid arthritis, have been assessed two or more times on the same claim.–despite-no-possibility-of-improvement-9811910.html

Deaths from respiratory diseases in Britain are 70% higher than the European average according to a EU report.  However PHE said such differences should be regarded with caution because of differences in the way deaths are coded in different countries.

PHE publish ‘Everybody active, every day’, with proposals including: making activity the norm; developing leadership and expertise; creative environments that support active lifestyles; and up-scaling successful programmes nationwide.  A lack of exercise is said to be as dangerous as smoking and responsible for a sixth of deaths.

Summary hospital-level mortality indicators (SHMI) for 2013-14 are published by HSCIC.  115 trusts had expected values, 17 were lower than expected and 9 were higher.

Bulletin for CCGs: Issue 70


22nd October 2014

There have been criticisms of the payment to GPs of £55 for each dementia diagnosis through the Direct Enhanced Service (DES), because of the ethics of interfering with the doctor-patient relationship.
(21st October)
NHS England says the scheme should draw GPs’ attention to dementia:

Two thirds of GPs are not following NICE guidance to extend the use of statins to more low risk patients, a survey of more than 560 GPs by Pulse Magazine has found.

The WHO is warning of the spread of antibiotic resistant TB, particularly in parts of the former Soviet Union.  Globally, 5% of TB cannot be treated with routine antibiotics but in Belarus, 35% of new cases are drug resistant.  They have increased their estimate of the number of people with disease from 8.6m to 9m.

NICE is recommending that nursery age children should have lessons in how to brush their teeth.  More than a tenth of three year olds have rotten teeth.

Consultants and specialists should spend more time outside hospitals, according to a report from the King’s Fund which includes 6 case studies.


21st October 2014

The rise in the number of prison suicides has been caused by ‘resource, population and policy pressures’, including staff shortages, the Chief Inspector of Prisons for England and Wales says in his annual report.

Too many people suffering mental health crises are being taken to police cells, because beds are not available, because of staff shortages, or because they are too drunk or too young, according to a report from the CQC.  In 2012-13, of over 21,000 people detained under S136 of the Mental Health Act, over 7,000 ended up in a police cell.

There is concern that lighter touch regulation in care homes currently being agreed through Parliament, may reduce standards despite widespread concern about abuses.  The Government, however, says that read alongside CQC guidance the new regulations will be in many respects stronger.


20th October 2014

The NHS needs an above inflation rise if it is to cope with increased demand while maintaining quality and safety, Sir David Bennett, Chief Executive of Monitor, has said, with the sentiment echoed by the Health Foundation and the King’s Fund.

The Social Mobility and Child Poverty Commission reports, with a prediction that poverty (defined as households with income below 60% of median earnings) is likely to rise, for the first time since records began, by a third in the decade 2010-20, and blaming all political parties for not taking this seriously enough.
Milburn calls for a £250m national parenting programme:

Lack of social integration is estimated to be costing the British economy £6bn a year, including £1.2bn from cardiovascular disease, according to the Social Integration Commission, chaired by Matthew Taylor.

Maternal mental health problems cost the equivalent of £8bn a year, when taking into account the long term impact on children, according to research by the LSE and the charity the Centre for Mental Health, commissioned by the Maternal Mental Health Alliance.  About £1.2bn of the costs fall on the NHS and social services.  The report also found there was no specialist perinatal mental health service in 40% of areas in England, 70% in Wales and 80% in Northern Ireland.  They estimate it would cost £337m to bring services up to recommended levels.

A 40% rise in deaths from liver disease over 12 years has been largely caused by an increase in alcohol consumption according to a study by PHE.  It is the only major cause of death rising in England but falling in the rest of Europe.  There are also large regional variations.  It was the underlying cause of death in nearly 11,000 people in 2012.

GP member practices tend to have worse relations with CCGs than other groups with 44% of GPs feeling that the CCG does not act on their views, according to a 360 degree stakeholder survey conducted by Ipsos MORI for NHS England.

A whole family approach to weight reduction, with a series of specific measures such as better playgrounds for children and help with slimming for pregnant women, are recommended by the All Party Parliamentary Group on a Fit and Healthy Childhood.

Drinking sweet fizzy drinks was associated with a more rapid ageing of cells in research on over 5,000 people aged 18-65 by the University of California at San Francisco.  They found that those drinking the equivalent of two cans a day had reduced telomere length equivalent to cells ageing by 4.6 years, the same as smoking.  This is said to be the first research linking consumption of soft drinks to premature ageing.


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19th October 2014

There is a risk to public health from the Government’s clampdown on migrants’ access to health care according to a report from Demos, which says that about a sixth of the 580,000 undocumented migrants avoid seeing a GP.


18th October 2014

The NHS is to encourage its staff to lose weight by joining gyms or weight-watching programmes.
(19th October)


17th October 2014

Negotiations on seven day working have broken down between the BMA and NHS employers. The BMA says it is not prepared to sacrifice patient safety or doctors’ wellbeing, but the employers say they are dedicated to safe patient care.

Labour say they would reduce cancer waiting times for tests and results to a week by spending an extra £750m over five years using a new levy on tobacco companies.

The suicide rate in prisons is at its highest rate for 9 years according to information obtained by the Guardian.
(18th October) The shadow Justice Secretary says the Government should launch an enquiry into prison deaths:

US teenagers bought fewer sugary drinks when signs were displayed saying how much exercise was needed to burn of the calories.

Doctors may be less likely to be prosecuted for helping someone take their own life if they are not their own patients according to clarified guidance on assisted dying from the Director of Public Prosecutions.

A £150m primary school sports programme to build on the Olympics legacy could be used better to reduce obesity, according to Ofsted.

Healthwatch England’s annual report 2013-14 is published.


16th October 2014

There is too much variation in the quality and safety of health and social care in England according to the CQC’s fifth annual report.  Out of 82 hospitals inspected in the year, 48 ‘required improvement’ and 5 were inadequate, but this is unlikely to be representative as the first inspections included a focus on Trusts where there were already concerns.

Jeremy Hunt says medical errors are costing the NHS between £1bn and 2.5bn a year, and that money could be saved by tackling them.  However medical leaders say that many of the problems are caused by issues such as understaffing and that an investment of resources would help recoup the cost of errors.  [N.B. policy errors can also waste money.]
The report, from Frontier Economics, which was the source of the Secretary of State’s comments:

Cycling campaigners criticise the Government’s plans to double cycling by 2025 as insufficient and without adequate resources.

Those on slow and steady diets (over 36 weeks) were no more likely to retain weight loss than ‘crash diets’ (over 12 weeks), according to Australian research on 200 people with a three year follow up, challenging the current advice to lose weight slowly.  However, there may be harmful effects of rapid weight loss which the research did not study.  The study also excluded certain groups such as those who smoked, who had diabetes or were severely obese, which may limit its generalisability.
Very helpful detailed analysis:

Local first time buyers could get priority access to new homes under proposals in a review led by Sir Michael Lyons for the Labour Party.

A report, ‘Decisions of Value’, on the relationships, behaviour and environment necessary to deliver better care, is published by the NHS Confederation and the Academy of Medical Royal Colleges.


15th October 2014

92% of CCGs do not provide 24 hour a day telephone support for people dying at home, which guidelines say they should, according to the charity Sue Ryder, which received responses from 180 of the 211 CCGs.  Nevertheless, the UK has some of the best palliative care in the world according to the Worldwide Palliative Care Alliance.

Six scenarios for local authorities in terms of how they deal with austerity, are identified in a report by Grant Thornton and Inlogov.

Informed: Issue 8


14th October 2014

The mental health waiting time targets signalled earlier in the week are formally announced.

Britain is the only country in the G7 where inequality has increased since 2000 according to a report by Credit Suisse.  The richest 10% control 54% of Britain’s wealth.  Globally, the richest 1% own more than 48% of the world’s wealth while the bottom half of the population own less than 1% of the total wealth.

A quarter of all children in the UK live in relative poverty once housing costs are taken into account, according to figures published by the ‘End Child Poverty’ campaign.

Up to 250,000 instances of poor care go unreported every year, and just under a half of those who complained said they received no apology, according to a report from Healthwatch England, ‘Suffering in Silence’.
NHS Confederation response:

Health professionals should say when something goes wrong and offer an apology, remedy or support, the heads of eight regulatory bodies have said.

Mortality figures from ONS show how the gap between male and female life expectancy is narrowing.

Mothers receiving poor maternity care ought to be able to reduce the amount hospitals are paid by commissioners, by a small amount, a report for Boris Johnson by Lord Darzi is proposing.
(15th October) £1bn over 5 years would let London GP surgeries open 12 hours a day:
The report:

The health risks of energy drinks means a cap should be set on caffeine levels, according to a WHO study, which also notes the risks of combining them with alcohol.
(15th October)

Living near a busy road was found to be as big a risk factor for heart disease as smoking or obesity in American research on over 107,000 women with an average age of 60, part of the Nurses’ Health Study from 1986 to 2012.

There has been a slight fall in the number of people drinking above safe limits, from 10m to 9.6m, but it is still costing the NHS £2.8bn a year according to a report from Alcohol Concern.

A report on ‘System Leadership’, drawing on lessons from the north west of England is published by the King’s Fund.


13th October 2014

Nine out of ten care homes and hospitals have aspects of dementia care that are poor or variable meaning that most dementia sufferers are likely to receive poor care at some point, even though overall there was more good care than bad, according to a CQC report, ‘Cracks in the Pathway’.

30% of lung cancer patients die within three months of a diagnosis, and will have seen their GP an average of 5 times before being diagnosed, according to a study of over 20,000 cases in 440 GP surgeries between 2000 and 2013, from Nottingham University, published in the BMJ journal Thorax.  About 35,000 people die of lung cancer in Britain each year.  In Sweden, 45% of people survived for a year (between 2004-7) compared with 30% in Britain.
(14th October)
(14th October)

Loneliness affects nearly half of men over 50, which is over 700,000 people and that is expected to rise to more than 1 million in the next 15 years, according to research based on the English Longitudinal Study of Ageing jointly produced by Independent Age and a coalition of bodies including UCL, IFS, NatCen Social Research and Manchester University.

Children who had been bullied by siblings were twice as likely to be depressed or to self harm, according to a study which followed nearly 7,000 children from the ages of 12 to 18, and which was published in the journal Pediatrics.


12th October 2014

Sure Start children’s centres are facing severe cuts despite 50,000 extra families using them, according to a report by 4Children.  They calculate that spending on children’s centres and early years services has fallen by 20% over three years.
(14th October) article by Anne Longfield, Chief Executive of 4Children:

There is a shortfall of 10,000 nurses compared to 2010, based on nursing numbers per head of population, according to figures obtained by the Labour Party.

The obesity crisis requires a 5-10 year, cross-sector strategy to tackle it, according to a report by 2020health, called, ‘Careless Eating Costs Lives’.


10th October 2014

Ebola is ‘entrenched and accelerating’ in West Africa, the BBC reports WHO saying. [Obviously there is much more reporting on ebola than this, not covered here.]

Key aspects of health care are starting to deteriorate, and more than a third of NHS staff suffered a stress related illness last year, according to a report by the Nuffield Trust and the Health Foundation, ‘Cause for Concern’, their second annual QualityWatch statement.
Mental health patients have to wait a median of 48 days for their first outpatient assessment:

PHE urges doctors not to prescribe so many antibiotics, as it finds a 6% raise in prescriptions between 2010 and 2013 and estimates that up to a half of prescriptions may be inappropriate.
Targets to cut antibiotic prescribing could be included in the GP contract:

A guide on ‘How Healthy Are We?’, including the main drivers of health and inequalities, is published by the King’s Fund.


9th October 2014

E-cigarette advertising can be shown on television from next month after a relaxation of the rules.  However there will still be restrictions such as not being able to show under 25s using them, or appealing to under 18s.

The CQC publish the details of how they will regulate adult social care.

A report on ‘Financial Failure in the NHS’ from the King’s Fund looks at the reasons for its financial deterioration.

A report on public engagement from Involve, argues that it is success requires involving other stakeholders as well as the public.

A report on access to natural environments and its influence on health and wellbeing and inequalities is published by the UCL Institute of Health Equity.

A guide to European Union Health Policies is published by the WHO (‘Everything you always wanted to know … but were afraid to ask’).

Informed: Issue 7

Bulletin for CCGs: Issue 69


8th October 2014

Nick Clegg promises new mental health waiting time targets to match those for physical health, with an additional £120m to be spent over the next two years.
Analysis and comment:

CQC inspectors will be able to see GP records without patient consent, Pulse Magazine reports as a handbook for regulation is launched.

A report on children’s wellbeing from ONS which draws on other studies finds 77% of children aged 10-15 satisfied with their lives, but 12% being a victim of crime and 12% frequently bullied.

A basket of healthy foods was found to be three time more expensive than the less healthy alternatives, with the healthy foods having become relatively more expensive between 2002 and 2012, according to research from the University of Cambridge published in Plos One.
(9th October)

The full social costs of household debt are estimated to be £8.3bn, according to a report, ‘Cutting the Cost’ from the charity StepChange.

The Secretary of State calls on health and wellbeing boards to engage more with providers.
The letter (pdf):

A consultation on a ‘never events’ policy framework review has been published by NHS England.  This is open until 31st October.


7th October 2014

Normal Lamb has said he would like to see health and social care spending merged by 2018, but through locally agreed arrangements rather than a national system.

GP and hospital patients’ data is to be stored in regional ‘Accredited Safe Havens’ (Ash), which critics are suggesting would have many of the same features as the scheme which was postponed earlier in the year and continues to be piloted.

The proportion of over 18’s smoking has fallen to the lowest level since records began in 1940, and was 18.7% in 2013.  Some of the statistics are ‘experimental’ and more reliable data is expected next month.

Almost as many teenagers smoke cannabis as cigarettes according to a study on the effects of the drug on health.

Anti-viral drugs for flu were more likely to be recommended in reviews funded by the pharmaceutical industry according to an Australian study of 26 systematic reviews.  17% of independent reviews were positive about the anti-viral drugs, whereas nearly 80% of those with ties to the industry were favourable.


6th October 2014

Australia is the first country in the world to see a decline in skin cancer rates according to a new book.  There has been a bigger decline amongst younger age groups who have grown up with the relevant public health messages.

The roll-out of e-referrals, which replaces ‘choose and book’ has been delayed to spring 2015, from the planned November 2014.

Proposed EU regulation of e-cigarettes are to be challenged by a British company in the European Court of Justice on the grounds that they reduce choice and deprive consumers of a source of recreational nicotine.

A 3d printed model of a baby’s heart helped US surgeons save the child’s life.  The model of the unusually shaped heart was designed from MIR scans and enabled the surgeons to plan the operation in advance, whereas previously they would have needed a separate investigatory operation.

Trends in acute activity up to 2022 are set out in a report from the Nuffield Trust.


5th October 2014

Leading health charities, doctors’ and nurses’ organisations call on politicians to tackle the NHS’s financial crisis in a letter to the Independent.
The letter:


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5th October 2014

The results of a survey on drug use, conducted with 1,080 UK adults, is published by the Observer which commissioned it from Opinium Research.


4th October 2014

The Lib Dems have promised to fund the NHS by an additional £1bn a year from 2016-7, above the real terms stand-still budget promised by David Cameron.


3rd October 2014

Out of hours GP care is generally safe and well led and is improving, despite problems in some areas, according to CQC inspections of 30 services which cover a third of the population.  The working hours of GPs should be monitored in order to protect patient safety, Prof Steve Field, CQC Chief Inspector of GPs has said.
(1st October)

Jeremy Hunt says he would like to see CCGs co-commissioning social care (with local authorities) and primary care (with NHS England).

NICE are recommending that a drug which reduces the desire for alcohol be made available to people if they drink 5 units a day, for women or 7.5 for men, which would make around 600 people eligible.  The drug, nalmefene, which is already prescribed in Scotland, has been found to cut drinking by 60% over six months when combined with counselling.
Analysis: should there be ‘a pill for every ill’?

Publishing information in the ‘transparency code’, including all expenditure over £500, is to be a legal requirement for councils, DCLG has announced.

Four pilot schemes to help people with mental health problems back to work, have been launched by the Government, with funding of £2m.


2nd October 2014

The first Chief Executive of the Civil Service is to be John Manzoni, the head of the Major Projects Authority.

People with diabetes under 40 receive far fewer of the annual recommended checks than older people, according to the National Diabetes Audit 2012-13 published by HSCIC.

Women who scored highly on tests for neuroticism were twice as likely to suffer from Alzheimer’s in old age, if they were also under long term stress and particularly if they were also shy, according to a study over 38 years of 800 women, 153 of whom had developed dementia.

A report on digital health technologies is published by the US Commonwealth Fund.

Informed: Issue 6


1st October 2014

David Cameron promises to maintain NHS spending in real terms in a new Conservative parliament, in what is described as a bidding war with Labour.

624 deaths a year could be saved by minimum alcohol pricing, compared to 14 deaths a year from the Government’s ban on sales of alcohol below the cost of the tax on them (and so would be 50 times more effective) according to research from the University of Sheffield based on survey data and mathematical modelling and published in the BMJ.

A review of GP contracts means that practices will have to publish the average salary of their GPs online by March 2016, and patients will be able to see their medical record online, free from next year.
Only coded information will have to be made available, not free text or third party information:
(30th September)
(30th September)

The number of requests to councils for deprivation of liberty assessment has risen from 8.6k in 2013-14 to 33.5k so far this year according to figures obtain from foi requests by Community Care magazine.  Official figures are released by HSCIC.
(2nd October)
(2nd October)

Doncaster outsources its children’s services, including child protection to an independent, not-for-profit company.
Analysis and comment:

Norway is the best country in which to grow old according to an index of the quality of later life applied to 96 countries by HelpAge International.

Guidance on developing a local suicide action plan for local authorities is published by PHE (10 pages).

An alcohol, drugs and tobacco support pack to help Health and Wellbeing Boards with their JSNA and JHWS has been published by PHE.

The right to personal health budgets for people with continuing healthcare needs comes into force.


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