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2015 Q1 January-March

Health and Wellbeing Policy Update: January-March 2015

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 March 2015

The Lib-Dems have promised an additional £2bn for mental health over the course of the next Parliament.  This is in addition to £1.5bn already promised.

19% of 14-17 year olds had tried e-cigarettes and of those that had, more had never smoked before (16%) than had (14%), while 36% were regular smokers, 12% only smoked while drinking and 23% had tried smoking but didn’t like it, according to a survey of 16,000 boys and girls in the North West of England by Liverpool John Moores University and published in the journal BMC Public Health.
(1st April)

Dementia diagnosis testing could be extended to millions more people as doctors are advised to consider testing those over 60 at high risk of cardiovascular disease or COPD.  This was criticised by some doctors as risking misdiagnosis so causing more harm than good.

A new nursing code of conduct came into force on 31st March.  The new code takes account of changes, such as the Francis report, since the last one of 2008, and includes issues such as compassion, whistleblowing, the duty of candour, access to nutrition and hydration and delegation to healthcare assistants.

People who ate green, leafy vegetables once or twice a day halted their mental decline by 11 years according to a study of 950 people with an average age of 81, presented to a conference in Boston.


30th March 2015

Binge drinking is estimated to cost £4.9bn a year from increased A&E admissions, road crashes, police time and court cases, according to research from Bath and Essex Universities presented to the Royal Economic Society Conference.  The figure does not include costs associated with absenteeism, lost employment, reduced productivity and long-term health problems.

Parents tend not to estimate the weight of their children accurately according to research on nearly 3,000 people by four UK universities, funded by the NIHR and published in the British Journal of General Practice.  With children’s weights put into four bands, 68% of parents identified the correct category, 31% underestimated it and fewer than 1% overestimated it.  Out of 369 children who were very overweight, only 4 parents assessed them as such.  Parents were more likely to underestimate the weight if they were black or South Asian, from more deprived backgrounds or if the child was male.

17% of local authorities do not have a policy on supporting the needs of children living with ‘kinship carers’ in other words family or friends other than the parents, despite it being a statutory duty to do so since September 2011, according to a study by the Family Right Group.  It also found that three quarters of authorities hadn’t used local demographic and needs data or consulted with partner agencies when drawing up the policies and plans.|SCSC|SCDDB-2015-031

GPs referring patients to NHS funded commercial weight loss programmes improved the patients’ motivation to lose weight according to a qualitative study published in the British Journal of General Practice.  It helped by framing the intervention as a medical requirement, with weekly vouchers ensuring contact was made with the GP and creating a sense of responsibility in using NHS funds.

There is an association between poverty and the size of those parts of children’s brains related to language, memory and reasoning skills according to brain scans of more than 1,000 children aged 3-20, led by Columbia University in New York and published in Nature Neuroscience.

A self-improvement tool for adult safeguarding which identifies a number of themes of ‘ideal’ service provision has been produced by five bodies, the NHS Confederation, ACPO, ADASS, the LGA and NHS Clinical Commissioners.  [There is a glossary of health and wellbeing terms and abbreviations at:]

A report on the governance implications of different organisational forms following the Dalton Review, ‘Form Follows Function’ is published by the NHS Confederation and NHS Providers.


29th March 2015

The Tories have promised to provide the £8bn for the NHS, £2bn for the four years to 2019-20, requested in the NHS’s Five Year Forward View, with the remaining £22bn to be found from efficiencies and reducing demand.  The Liberal Democrats have already promised this level of funding.

Iain Duncan Smith refuses to say how the Tories will cut £12bn from the welfare bill which the IFS has said “would require pretty massive changes”.

£7.5bn could be raised from the sale of surplus NHS land.  Such disposals are part of an ongoing programme.

All babies in the UK are to be vaccinated against Meningitis B, the first country in the world to do so, after a deal with GlaxoSmithKline over the price of the drug.
(30th March)
(30th March)

A report on ‘Using Communications Approaches to Spread Improvement’ is published by the Health Foundation.


[Weekly email sent out ————————————————————–]


28th March 2015

School teachers say more children have mental health problems than two years ago according to a survey of 850 staff by the Association of Teachers and Lecturers.  Almost 90% of staff said they had had to provide more support for such pupils in the last two years and only 9% said they had had enough training to spot the signs of mental illness.


27th March 2015

The Conservatives promise that all hospitals will provide key, consultant led services seven days a week by 2020.  However the BMA said that funding promised so far is not enough to provide existing services, never mind new ones.
(28th March)
(28th March)
(29th March)

Labour says they would introduce a 5% profit cap on private health companies on contracts worth more than £500k.  They have also said they would try and stop private companies cherry picking more profitable contracts by making tariffs better reflect the complexity of the work.

Some of the ways in which the Tories’ £12bn savings in welfare payments could be made are revealed in proposals from civil servants which have been leaked to the BBC.  They include cutting child benefit for the third and subsequent children, making firms pay for industrial injuries and taxing disability benefits.  These are proposals and have not been agreed by the Conservatives but indicate the scale of difficulty in finding the £12bn welfare savings.  The IFS say even these proposals would not meet the target savings.
(28th March)
Detailed analysis:

A seven day delay before claimants can claim universal benefit has been deferred until after the election.  This delay would be in addition to the existing month and seven days wait between making an application and receiving benefit.  Sam Lister of the Chartered Institute of Housing is quoted as saying: “Even under the old poor law, which the welfare state superseded and dates back to 1590, refusing support to someone who was destitute was unlawful.”
(Free rgn rqd)

Approval for funding to pilot 7 day access has been extended to 37 bids covering 1,400 GP practices in the latest stage of the Government’s ‘Challenge Fund’, worth £100m.  The funding is for one year.
(28th March)

Funding for upgrading GP premises has been allocated to over 1,000 practices from a £190m fund, NHS England has said.
(28th March)

The CQC is to drop the banding of GP surgeries into one of six risk categories and have apologised for the language used, saying the bandings were not supposed to indicate the quality of care provided but that they were simply to help prioritise which practices to inspect first.

The lack of progress in moving people with learning disabilities from mental hospitals to community care is criticised by the Public Accounts Committee.

The Government is to provide £25m to help local authorities with the extra burden of making Deprivation of Liberty Safeguard assessments following the Cheshire West judgement which effectively changed the threshold for when assessments were needed.

There should be a national body to investigate medical accidents, the Commons Public Administration Select Committee has said.  It said the current system was too complicated and too lengthy and that there are 12,000 avoidable hospital deaths each year.

Occupancy for adult critical care beds reached 88.1% last month, the highest since the data started being published.  Occupancy rates above 85% are thought likely to increase the risk of harm.  The rates were lower for other areas including paediatric critical care at 75.9% and neo-natal critical care at 71.6%.

There are suggestions that non-UK residents are being put off seeking necessary or emergency health care because of increased charges to prevent ‘health tourism’, with charges sought from women unable to pay, according to a report from a charity, Doctors of the World, based on a survey of 35 women.
(28th March)

Men who were fit in their 40s were found to be at less risk of getting some cancers, with their risk of getting lung cancer reduced by 55% and of colorectal cancer by 45% according to a study of 14,000 men in Texas between 1971 and 2009, by the University of Vermont  and others and published in JAMA Oncology.  There was no reduced risk of getting prostate cancer and indeed a higher risk for the most fit group.  Other factors, including diet, could be responsible for the effects.  (Previous studies have looked at the link with exercise rather than fitness).

Google is to help produce AI surgical robots in partnership with healthcare company Johnson and Johnson.  Google will provide help with technologies such as artificial intelligence, machine vision and image analysis, with advantages such as greater operator control and accuracy and allowing remote control of devices within the body.

The Health and Social Care (Safety and Quality) Act 2015 receives Royal Assent.  Amongst other things, it requires providers of adult social care to share information about person’s care with other health and care providers and requires the use of the NHS number when sharing information.

The Government responds to the Health Select Committee report on complaints.

Statutory guidance on how councils should work with voluntary and community groups and with small businesses, using the Best Value legislation, has been published.  It includes a requirement to consult voluntary organisations at all stages of the commissioning cycle.  It also says local authorities should not commission services from an organisation that actively or vocally opposes fundamental British values.

55% of NHS Foundation Trust governors would like more training to help them with their statutory duties, though over 80% have been given initial training in each of the last three years according to a survey of 1,264 governors by Monitor.  Overall governors were said to be more positive about their role and making progress with their statutory duties.

NHS England publishes their business plan for 2015-16 with ten priorities relating to: cancer, mental health and dementia, learning disabilities, diabetes, urgent and emergency care, primary care, elective care, specialised care, ‘whole systems change’ and ‘foundations for improvement’.

A report on productivity growth in the NHS is published by the Centre for Health Economics at the University of York.

CCG Bulletin: Issue 80


26th March 2015

The health service ‘has run out of money and is operating at the very edge of its limits’ and while it has performed well in the face of challenges there is now a risk that patient care will deteriorate, according to an assessment by the King’s Fund.  Waiting times are at the highest level for some years, treatment targets are not being met, bed occupancy levels are dangerously high and there could be a deficit of £2bn next year.  The way standards were slipping were the worst since the early 1990s.

Routine invitations for mammogram screening should not stop when women reach the age of 70 the All Party Parliamentary Group on Breast Cancer has said.  There are 8,300 cases of breast cancer a year in women over 70, compared to 12,800 for those in their 60’s and 10,600 for those in their 50’s, but more than half the 12,000 women who die of breast cancer each year are over 70.

Men now spend a higher proportion of their lives in good health than women at 80% compared to 77%, according to figures from the ONS on healthy life expectancy at birth.  Overall life expectancy at birth is still higher for women (83.1 years) than men (79.4 years).  There continue to be significant geographical differences.
(27th March)–england/2011-13/stb-healthy-life-expectancy.html

High streets have been ranked for how healthy they are by the Royal Society for Public Health, by looking at the concentration of outlets that can damage health (such as fast food takeaways, bookmakers and payday loan shops) and those that are likely to be beneficial (e.g. leisure centres, libraries, pharmacies and museums).  The report ranks 70 towns and cities in Britain and, separately, 144 high streets in London.

A toolkit and evidence base on the case for investing in walking and cycling has been published by the Department of Transport.

Statutory guidance on inter-agency working for children’s safeguarding is published by the Department for Education.–2

A report on the progress of local Healthwatch, produced by the King’s Fund has been published by DH.

Two councils are taking legal action against the Government over funding allocations for the Care Act.  The two, West Berkshire and Wokingham are two of three authorities who have had the threshold for care at ‘critical’.  This is changed to the equivalent of ‘substantial’ under the Act which the two councils say will mean they have to deal with many more clients.  The cost of the increased number of clients likely to be eligible is included in Government funding, but is spread evenly across all councils.

A new assurance framework for assessing CCGs has been published by NHS England.

The NHS Outcomes Framework for 2015-16 is published by DH.

A promised review of maternity services is to be chaired by Baroness Julia Cumberlege.


25th March 2015

99% of councils are confident about implementing the Care Act from the beginning of April but a quarter think they do not have sufficient funds, according to a survey by the LGA.

A mental health taskforce has been launched by NHS England to develop a five year national strategy for mental health in England.  It is due to report later in the year.

The benefits of physical activity in its own right, not just to reduce obesity, should be emphasised the Health Select Committee has said, recommending population level interventions on activity and diet.  Amongst other recommendations, they say the NHS should ban unhealthy fast food in hospitals, local authorities should have more powers to ban fast food outlets and there could be a ban on marketing sugary drinks to children.

Air pollution increases the risk of dying from a stroke according to a review of 103 studies which assessed 6.2m stroke events in 28 countries, by the University of Edinburgh, funded by the British Heart Foundation and published in the BMJ.

A programme to encourage doctors back into practice, for instance if they have had a career break, been raising a family or working abroad, has been launched.  It includes a bursary of £2,300 a month and a supervised placement in general practice.

Guidance to schools on teaching about mental health, reducing stigma and counselling is to be provided by the Government.

There have been increases in happiness, life satisfaction and a feeling that what we are doing is worthwhile according to the latest wellbeing figures from the ONS.

Consuming three alcoholic drinks a day can be enough to cause liver cancer and 24% of cases could be avoided if people kept to a normal weight and did not drink, according to the World Cancer Research Fund, based on an assessment of 34 previous studies covering 8.2 million people.

A scheme for disabled people in Wales to form co-operatives to manage their direct payments has been launched by the Welsh Government.

A commission on improving urgent and emergency care for older people has been launched by the NHS Confederation.

Labour has said it will stop food banks becoming a permanent feature of British society by tackling the underlying causes such as benefit delays and sanctions and low pay.

The NHS choice framework for 2015-16 setting out patients’ rights to choice in healthcare, where to find information and how to complain, is published by DH.

There were 1.2m full time equivalent NHS staff in September 2014, an increase of 2.1% over the previous year and an increase of 13.8% since 2004, according to figures from the HSCIC.  The number of GPs increased by 1.7% in the year to September 2014 to stand at 32,628.

Advice to help prevent falls in older people is published by NICE.

Detailed guidance on dementia friendly health and social care environments is published by DH.


24th March 2015

Austerity has impacted on children more than many other groups with the worst effects on low income and migrant children through cuts in benefits and services, including legal aid, according to the MPs and peers’ Joint Committee on Human Rights.

There should be an independent review of the Government’s benefit sanctions regime, the Commons Work and Pensions Select Committee has said.  The cross-party committee said no-one should have their benefits reduced to zero when they were at risk of being unable to feed themselves or pay the rent.  A new policy should be based on evidence of what helps get people back to work, it should be applied fairly and proportionately, it should protect vulnerable people and avoid causing severe financial hardship, all of which the current system does not always achieve.  The committee also recommended that an independent body should investigate all deaths associated with the benefit the person was on.  Over 1m sanctions were issued last year.
Examples of some of the (hopefully more extreme) sanctions:
(25th March) Comment piece:

The Government’s interim evaluation of the alcohol industry’s pledge to remove 1bn units from the market is flawed, raising questions about the claimed success according to an analysis published in the BMJ.

NHS absences for anxiety, stress and depression doubled between 2010 and 2014 from 20,207 to 41,112 according to figures obtained by the BBC.

The number of emergency admissions to hospitals rose by 7.1% on average in 2014/15 according to NHS England Board papers.

Local authorities are having to deal with a nine fold increase in deprivation of liberty assessments, putting strain on staff and services, following a ruling last year by the Supreme Court which lowered the threshold for when such assessments are needed.  The LGA and ADASS estimate the cost of assessments to be £100m for which they say the Government should pay.

Half of suicides of patients under observations in psychiatric wards involved inexperienced staff or agency workers with staff shortages and busy periods also a problem according to research covering a seven year period by the University of Manchester as part of its National Confidential Inquiry into Suicide and Homicide.

Cancer survival rates still lag 10 or 20 years behind many comparable European countries such as Sweden, France, Finland and Austria, despite improvements, according to a study by Macmillan Cancer Support, which looked at survival rates for lung, breast, colon and stomach cancers in 67 countries comparing the period 1995-99 to 2005-09.

There should be a universal parenting programme available to all parents across the UK, provided by public, private and voluntary sector providers, with local authorities having a statutory duty to evaluate provision in their area, according to the All Party Parliamentary Group (APPG) on Parents and Families and the APPG on Social Mobility.

NHS England has launched a directory of NHS-endorsed digital mental health services including online tools, resources and apps.  It is available on NHS Choices.

An interim report on ‘Destitution in the UK’ is published by the JRF.  Destitution is defined as lacking, over the previous month, two or more of: shelter, food, heating, lighting, clothing or basic toiletries.

Case studies on pooling budgets from nine areas commissioned by the LGA and produced by the RAND Corporation has been published.


23rd March 2015

The proportion of local government spending on social care is likely to rise from 41p in the £1 in 2010-11 to 60p in 2019-20, because of reductions in government grant, leaving much less for other services, according to analysis by the Local Government Association.
(24th March)

An ‘Action Plan on Hearing Loss’ has been produced by NHS England and the Department of Health.

52% of 7-12 year olds don’t have a portion of vegetables a day and 44% do not have fruit daily according to a BBC survey of 1,432 children in the UK.

A briefing on how NHS bodies and health and wellbeing boards can tap into funding from the European Structural and Investment Funds is published by the NHS Confederation.

Eric Pickles announces the commencement order of the Local Audit and Accountability Act which means that the abolition of the Audit Commission, announced in 2010, will finally be completed on 31st March.  [Health warning to readers suffering from over-sensitivity to irony] – amongst the Secretary of State’s criticisms of the Commission is that it ‘bullied and cajoled councils into axing weekly rubbish collections’.  Another of its crimes was to hire lobbyists to “combat the activities of Eric Pickles”.

A report on what good, integrated care for children with complex needs looks like, called ‘My Life, My Support, My Choice’, is published by National Voices.


22nd March 2015

Nearly one in five patients say they cannot easily make GP appointments offered and a quarter wait a week to see their doctor according to figures from the GP patient survey obtained by Labour.

[Weekly email sent out ————————————————————–]


22nd March 2015

The number of delayed discharges from hospital (‘bed blocking’) has risen by 20% in the last year with 1,042k days lost last year compared to 873k the previous year.  DH said there were proportionately fewer delayed discharges, since the NHS was seeing more patients.


20th March 2015

The budgets of mental health trusts have fallen by 8.25% in real terms during this Parliament, between 2010-11 and 2014-15, while referrals to community mental health teams rose by 20%, according to research by the BBC and the Community Care journal.

The IFS has challenged the Chancellor to say how he would find £12bn of welfare cuts he is planning.  The Tories have said they will reveal their plans after the election.  The IFS also noted that under Coalition changes, the poorest had been the biggest proportionate losers.
(19th March 2015)

A drug appears to have slowed the early stages of dementia in a trial on 166 people designed to assess its safety, and reported to an international conference on neurological disorders in France.  The drug company, Biogen Idec said it will now move into large scale trials.

There should be more data sharing between public bodies to promote evidence based policy to improve social mobility and reduce child poverty, a report by UCL for the Social Mobility and Child Poverty Commission says.

The results of a pilot scheme on helping people with mental health problems and on Employment Support Allowance into paid work are published by the DH and DWP.

It was the UN’s International World Happiness Day.

In Touch: Issue 3.  (A bulletin for members of the public, published on the third Thursday of the month)


19th March 2015

The total NHS deficit could be £2.5bn next year, compared to the likely £1bn this year, according to Chris Hopson, Chief Executive of NHS Providers, which represents 93% of NHS trusts in England.  The remarks were apparently endorsed by Chris Ham, Chief Executive of the King’s Fund.

More people go to hospital with breathing problems in England than Sweden, despite the milder climate here, it is thought because of poorer home insulation, according to analysis of statistics from the last five years by Friends of the Earth.  The number of people per 100,000 admitted to hospital for chronic lower respiratory disease was 263 in Sweden but 369 in England.

There have been falls in the rates of tooth decay among children, between 2003 and 2013, from 43% to 34% in twelve year olds and from 56% to 46% in fifteen year olds in England, Wales and Northern Ireland, according to the ‘Children’s Dental Health Survey 2013’ covering nearly 10,000 children, and published by HSCIC.  The figures were worse for children from poorer families, with 40% of five year olds from deprived families having tooth decay, compared to 29% from less deprived families.
(20th March)

A report, ‘Acute Hospitals and Integrated Care’ from the King’s Fund draws on five case studies where acute hospitals have been working collaboratively with local partners to build integrated models of care.

Statistics on the number of children who are NEET (not in education, employment or training) by local authority area for 2014 are published by DfE.  They are at their lowest level since comparable records began in 2011, having fallen by 1.4 percentage points over that 4 year period.  There has been a downward trend since the raising of the participation age.


18th March 2015

The impact of the budget on the public sector is summarised (mainly covering things like austerity, efficiency, digital, northern powerhouse and libraries).

The Government is looking at how to integrate spending round the needs of vulnerable groups of people, it has said in the budget, including whether people can be helped to stay in their homes longer and reduce costs to the NHS.

IAPT services (talking therapies) are to be co-located in 350 job centres by summer 2015, it was announced in the budget.  £118m over the next four years was also promised for such services for children.

‘Unprecedented’ cuts to welfare would be needed for the Government to meet its savings targets the IFS has said.

The Deputy Prime Minister re-announces £1.25bn over five years for children’s mental health services.  (This was announced on 14th March 2015).

The King’s Fund has said that a Labour government would be unlikely to be able to obtain an exemption for the NHS from EU procurement and competition rules, to meet one of its election promises.  The only way they could achieve the objective would be by bringing NHS trusts under direct government control which would mean a major reorganisation.  However Labour says it can achieve its objectives by changing ‘the policy architecture of the NHS’ in line with a recent private member’s bill.

The Supreme Court has ruled that the £500 a week benefit cap is lawful but that the effect of the policy is incompatible with the UK government’s obligations under the UN convention on the rights of the child.

There was insufficient oversight of the contract for Circle to run the Hinchingbrooke Hospital, the chair of the Public Accounts Committee, Margaret Hodge has said.  The Committee also said that the NHS would still pick up a substantial bill for the hospital’s failure.

An association between longer breastfeeding and higher IQ has been found in a long term Brazilian study which re-surveyed 3,500 people at age 30 who had been tested as babies.  There was also an association with higher salaries.  The cause of the link isn’t known, but breastfeeding was common across all socio-economic groups and account was taken of the main confounders.  The study was published in The Lancet Global Health.

Following a healthy diet reduced the risk of a heart attack by about a third in a group of 162 non-smoking 40-70 year olds, according to research by King’s College, London and published in the American Journal of Clinical Nutrition.  The diet involved more fruit, vegetables, fish and nuts and less animal fat.
(19th February)


17th March 2015

More elderly and disabled people could be paying for their own care than are funded by the state by 2020 according to the Association of Directors of Adult Social Services.  ADASS and the LGA have said there is likely to be a £4.3bn funding gap by 2020, but the DH is now saying it could be between £5bn and £7bn.

The Government says child and adolescent mental health services need a complete overhaul, in its response to the ‘Children and Young People’s Mental Health and Wellbeing Taskforce’ in a report called ‘Future in Mind’.  The proposals include: tackling stigma; introducing waiting time standards; introducing one-stop-shop support services; and improving access for particularly vulnerable children and young people.

Jeremy Hunt has announced a £68m fund for research in dementia with contributions from leading pharmaceutical companies, Alzheimer’s Research UK and £15m already committed by the UK Government. 

Bright children from disadvantaged backgrounds achieve far fewer A levels, with 35% of those on free school meals achieving level 5 at the end of primary school going on to get three A levels, compared to 60% for others, according to research from Oxford University commissioned by the Sutton Trust.

Pharmacists could play a bigger role in GP surgeries, seeing patients and dealing with medicine related issues, a report from the Royal College of GPs and the Royal Pharmaceutical Society has said.

The largest NHS Trust, Barts, has been put into special measures following a critical report by the CQC of one of its hospitals, Whipps Cross in East London, which was assessed as ‘inadequate’.

Labour says it supports the plan to give control to Greater Manchester of all health and social care spending in the region.

Obese women face a 40% higher risk of developing any of seven types of cancer, at 274 per 1,000 women compared to 194 per 1,000 for those of healthy weight, meaning 18,000 women develop cancer as a result of being obese or overweight each year, according to figures from Cancer Research UK.

A report, ‘Landscapes of Helping: Kindliness in Neighbourhood and Communities’ is published by the JRF.

Informed: Issue 28


16th March 2015

Ministers have been cutting services without properly knowing what impact it was having, whether it was improving efficiency or reducing services, the head of the NAO, Sir Amyas Morse has said in an interview with the FT.  He also said Ministers had pursued projects in which they strongly believed without properly assessing the risks.

Details of the proposed sell-off of cancer services in Staffordshire have been leaked on-line.  Campaigners are warning it could lead to cuts in cancer care services.

The poorest children are more likely to be obese than a decade ago because of rising food prices, low wages and cuts to benefits according to a report by the Fabian Commission on Food and Poverty.  Those on the lowest incomes are having to ‘trade down’ to less nutritious foods.

The ‘bedroom tax’ has created a range of health problems including stress, anxiety, hunger, ill-health and depression according to interviews with 38 social housing tenants and 12 housing agencies in Newcastle by the University of Newcastle and local public health officials, and published in the Journal of Public Health.
Examples of the effect on tenants:

The Government says it wants to extend the approach used in the ‘Troubled Families’ Programme into other services in its response to the Service Transformation Challenge Panel report, ‘Bolder, Braver and Better’ published in November.  As well as developing thinking to feed into the next Spending Review, £5m is to be made available to the Public Service Transformation Network.

A £1.6m programme to attract high flyers into social work is being launched by the Government.  It aims to attract 80-100 people into mental health roles.

Children who watched a lot of tv aged 10 were 42% more likely to watch over three hours television a day aged 42, and they were more likely to be in ‘poor’ or ‘fair’ health, according to research from UCL based on information from the British Cohort Study on 6,000 people born in a single week in 1970, surveyed at the ages of 10 and 42.


15th March 2015

A call by the leaders of 7 Medical Royal Colleges for the next government to provide an extra £8bn a year for the NHS as requested in the Five Year Forward View has been rejected by Labour and Conservatives but accepted by the Lib-Dems.
(The letter):

Social care for people who are dying should be paid by the state, to enable them to die in their own home rather than in hospital, if that is what they wish, the Health Select Committee has said.  They also say that NHS Trusts should have a senior member of staff responsible for the quality of end of life care.

‘Portage’ services which help prepare children with learning disabilities for school or nursery have been cut by 37% of councils in the last year, with 21% planning reductions in the coming year according to foi responses received by Mencap.  A fifth of councils no longer provide the service at all.–disabilities-10108732.html

Half of requests for help for children with special educational needs are turned down, on average according to foi responses from 125 councils in England and Wales.

The number of obese women giving birth has risen 60 fold since 2004-5 from 743 to 47,588 in 2013-14, or from 0.12% to 7.4% of births, according to figures from the HSCIC.

The loss of half an hour’s sleep a night is associated with a 72% increased risk of being obese and increased insulin resistance according to DH funded research from the University of Bristol and Weill Cornell Medical College on 552 people.


14th March 2015

£250m a year is to be made available for children’s mental health making £1.25bn over the next Parliament, Nick Clegg announced, the measure to be included in the following week’s budget.–funding-to-treat-110000-children-nick-clegg-announces-10108215.html

The case of an NHS whistleblower required to pay nearly £100,000 in legal costs after losing her case on a technicality has been passed from David Cameron to Jeremy Hunt to be investigated.

Daily changes in weather do not affect people’s wellbeing, though seasonal changes do, according to research from the University of Westminster merging data from the Met Office with that from the British Household Panel Survey from 1991 to 2008, and due to be presented to the Royal Economic Society’s annual conference this month.


13th March 2015

Inequalities in health and care services are identified in a report from CQC.

Two briefings on how voluntary bodies can engage with CCGs and Health and Wellbeing Boards have been produced by Compact Voice.

[Weekly email sent out ————————————————————–]


13th March 2015

The 95% four hour A&E target has been missed every week for 23 weeks in England and the average for the year will not now be met, in England, Wales, Scotland or Northern Ireland.

Even the best hospitals are failing to meet key targets suggesting systemic problems rather than local issues with poorly performing trusts according to a briefing by the Nuffield Trust looking at the performance of 156 trusts against 6 indicators.

Nine tenths of GPs say cuts in social care have led to more people in hospitals and surgeries, (92% and 88% respectively) according to a poll of 830 GPs commissioned by the Care and Support Alliance (a grouping of 75 organisations).

An agreement making it easier to share patient data between different IT systems has been reached by the two leading system providers, TPP and EMIS.  Their IT systems, SystmOne and EmisWeb are used by the majority of GP practices as well as other providers.

49% of people who had a problem with public services did not make a complaint according to research by Which, based on an online survey by Populus of 4,058 adults, weighted to be representative of the population.  Reasons for not complaining included: not worth the effort (35%), thinking nothing would be done (35%) and worrying about receiving worse treatment as a result (14%).  People were least likely to complain about the NHS at 40% compared to 51% for public services as a whole.

77% of students and graduates with a disability feel they will be discriminated against by potential employers and 76% said they would be concerned about being open about their disability during their recruitment, in a survey of 1,040 graduates and students with a disability by and sponsored by Bank of America Merrill Lynch.

Proposed changes to privacy laws designed to make it easier to share data within health and social care services have been put forward by EU Justice Ministers, and could be finalised by early 2016.  Organisations would be able to process personal data without relying on specific consent, for clinical purposes, the provision of health or social care, for the treatment or management of health or social care systems or services, or for public health.

Disney is to ban depictions of smoking in its films in future unless a character was known, historically, for smoking.

Informed: Issue 27


12th March 2015

A national diabetes prevention programme has been launched by NHS England, Public Health England and Diabetes UK, initially in seven ‘demonstrator’ sites.  The programmes will work on weight loss, physical activity, diet, with support from peers, and professional support online and by phone.

Weight loss support is to be provided for NHS staff, including on eating better, being more active and cognitive behavioural therapy.

Other medical specialities will be able to become GPs more easily, on a fast-track route, with extra training places made available, under guidelines from DH to Health Education England.
DH mandate to HEE:

Health and care providers will have to prominently display their CQC rating, so the maximum number of people can see it, under new guidelines from the regulator.

12 private companies could earn up to £780m from the NHS in the period to December 2018 in a framework agreement through which NHS organisations can purchase various diagnostic tests and operations, many from mobile facilities, in order to reduce backlogs.  Three of the companies have come under criticism, two (Circle and Care UK) by the CQC.

An intensive lifestyle programme has been shown to slow mental decline.  A randomised controlled trial of 1,200 Finish people aged 60-77, published in The Lancet, found that those receiving advice on diet, exercise, brain training and health checks, performed better on various cognitive tests two years later.  They are to be tested again after seven years to see whether the changes reduce dementia.

Social isolation and loneliness is associated with a 30% increased risk of premature mortality according to a systematic review and meta-analysis covering 70 studies with more than 3.4m participants followed for an average of seven years, undertaken by Brigham Young University in the US and published in the journal Association for Psychological Science.

Three local authorities are developing new models of community-led adult social work, following the model of People2People in Shropshire which itself was developed as part of a DH pilot.  It will include proactive and preventive work in both in-house and outsourced services.

A consultation on implementation of the recommendations from the Francis ‘Freedom to Speak Up’ report starts.  The consultation closes on 4th June.

Government grants are being given to food companies to improve their products, such as chocolate and snacks which help cause obesity, costing the state more money, according to a study by the UK Coronary Prevention Group.

A £1m campaign to encourage people to cycle has been launched by the Department of Transport, along with details of how £15m is to be spent improving cycle facilities at 279 railway stations.

Both public and private sectors can sometimes provide the best services according to a report from the CentreForum think tank, which also says that competition works best when there is a realistic prospect of providers losing their contract and where outsourcing deals are smaller and therefore easier to manage.

A report on depression in adults and their access to services, ‘Whole in One’, is published by the 2020health think tank.
Profile of one of the authors, Julia Manning:


11th March 2015

It was NHS Change Day on 11th March.
10 campaigns from the day:

The proposal for standardised cigarette packaging in England has been passed by the House of Commons by 367-113, and is to be voted on by the Lords on Monday 16th March.  England will be the third country in the world to introduce such a law, following Australia and Ireland.  Imperial Tobacco has said it would sue the UK Government to protect its intellectual property rights.
(16th March) An article questions the relationship between how MPs voted and whether they had received hospitality from the tobacco industry.

The 100,000 Genomes Project has identified the first three people who will be eligible for personalised treatment after the diagnosis of rare diseases through the sequencing of their genomes.

A review on how medicines and treatments could be made available more quickly has been set up, to be led by Sir George Taylor.

The number of people waiting over six weeks for medical tests has risen five fold between 2010 and 2015.

Three sets of information suggest there are problems with cancer services.  The Public Accounts Committee says the push to improve cancer services in England has lost momentum in the last few years.  The target of 85% of cancer patients being treated within 62 days was missed in the first three quarters of 2014.  A report from the IMS Institute shows how England spends less on new cancer treatments per patients than many other countries.

The incomes of younger people have fallen most in the recession and the elderly least with pensioner household incomes rising by 10% between 2007 and 2014 while those of working age households fell by 4% according to research by the Resolution Foundation.  Between 2009-2014 there were falls in income for each age group ranging from -12.5% for 22-29 year olds to ‑3.7% for the over 60s.

90% of councils don’t know whether their social worker caseloads exceed safe benchmarks according to foi responses to Community Care from 112 councils in England.

The number of people attending memory clinics has risen four fold in three years, from 217 patients per clinic in 2010 to 1,206 in 2013 (of 200 clinics) according to figures from the Royal College of Psychiatrists.

A National Health Service Bill was introduced into the House of Commons by 12 MPs from 5 political parties.  It intends to abolish the purchaser-provider split, end contracting and re-establish public bodies accountable to local communities.
Comment piece by Caroline Lucas MP:

Concern that the Health Select Committee’s report on expenditure in health and care will not be published before the election is expressed in a letter from the NHS Confederation to the Committee’s Chair.

NHS Safety Thermometer report for February 2014 to February 2015 is published by the HSCIC.  This looks at harms from pressure ulcers, falls, urinary tract infections and Venous Thromboembolisms.

Guidance for NHS Foundation Trust governors on how to communicate and engage with the public is published by Monitor, CQC and DH.

A report on the impact of the cuts on local government and poorer communities is published by the Joseph Rowntree Foundation.

Three reports on social and emotional skills and their impact on adult outcomes are published by the Social Mobility and Child Poverty Commission.  The reports are on: how social and emotional skills developed in childhood matter for adult life; what works in enhancing social and emotional skills in childhood; and what are the views of those directly involved on the ground and what implications does that have for policy makers.


10th March 2015

29 ‘vanguard’ areas for new models of health and care, chosen from 269 submitted plans, have been named by NHS England, with support to be provided from a £200m transformation fund.  There are 14 GP led ‘multi-speciality community providers’ (MCPs), 9 hospital led ‘primary and acute care systems’ (PACS) and 6 bids from care homes.

Children’s social care was assessed as ‘inadequate’ or ‘requires improvement’ in three quarters of the local authorities inspected in England by Ofsted in 2013/14.  They inspected 43 of the 152 relevant councils.
Examples of successful leadership from 9 local authorities:

105,671 households have been helped by the ‘troubled families programme’ which the Government estimates has saved £1.2bn or £12k per family (based on data from 7 local authorities).   £200m is to be made available to extend the scheme to a further 400,000 families between 2015-20.
Spreadsheet of progress information:
Evaluation of benefits:
Press release:

The wealth gap has widened through the recession with the wealth of the richest fifth having risen by 64% between 2005 and 2012-13 while that of the poorest fifth has fallen by 57%, according to a report by the Social Market Foundation, ‘Wealth in the Downturn: winners and losers’.  It also notes other widening inequalities such as that between younger and older people.

The routine detention of children in police cells under the Mental Health Act 1983 in some areas, has been criticised by Her Majesty’s Inspectorate of Constabulary.  More generally they say the approach to detention often uses unsuitable tools and skills and that more should be done to tackle underlying problems.

The number of 18-24 year olds from ethnic minorities unemployed for more than a year rose by 49%, to 41,000, between 2010 and 2014, according to Labour, based on an analysis of official figures by the House of Commons Library.

The Children and Young People’s Health Outcomes Forum publishes its annual report reviewing progress on health outcomes and looking ahead to what it thinks the next government should do to improve the health outcomes of children and young people.

Child mortality statistics 2013 in England and Wales are published by ONS.–childhood–infant-and-perinatal/index.html


9th March 2015

Combined health and social care budgets for ‘high need’ patients are to be trialled in 8 areas of England from April under the ‘Integrated Personal Commissioning Programme.’

27% of CCG board members have a link with a private company involved in healthcare according to research by the Unite union, covering 3,392 CCG Board members.
(10th March)

Many people with cancer have social care needs which are not being met, according to Macmillan Cancer Support, which says only 1 in 5 receive formal support and 160,000 are housebound as a result.

NHS Kernow (the CCG for Cornwall and the Isles of Scilly) has abandoned plans to put £75m of services out to tender. 
(From BBC news – link subsequently down)

[Weekly email sent out ————————————————————–]


9th March 2015

The rate of births by caesarean section vary widely across Europe, with the figure being about a quarter of births in the UK, 17% in Sweden and 52% in Cyprus according to a study on 26 European countries led by UCL and published in the journal BJOG.


7th March 2015

Jeremy Hunt has been criticised for delaying publication of Stuart Rose’s report on the NHS, by Sarah Wollaston, Chair of the Health Select Committee (speaking in a personal capacity).  The report is likely to be critical of NHS management and the health and social care reforms.  DH said publication had been delayed because the review’s remit had been widened.

A campaign to allow friends and family 24 hour access to dementia patients has been supported by Norman Lamb and Andy Burnham.  ‘John’s Campaign’ was set up by Nicci Gerrard following experiences with her own father.
(8th March)


6th March 2015

Many local authorities are not receiving allocations for public health that reflect their needs and the Government is not moving to rectify the situation fast enough, the Public Accounts Committee has said.  Nearly a third of the 152 local authorities currently receive funding which is 20% above or below what would be their fair share.

A report on cuts to local authority revenue and spending by the IFS finds that between 2009-10 to 2014-15, (excluding police, fire and rescue, public health and some social care) government grant was cut by 38.7% per person in real terms and spending per person was cut by 23.4% per person.  The cuts have not fallen equally across the country, with London, the North East and North West being worse hit.  Councils have implemented the cuts in different ways but social care has tended to be cut less than other services.

88% of NHS Trusts and Foundation Trusts have opted for the enhanced tariff, offered by Monitor and NHS England with the rest sticking with current prices until a new tariff can be agreed.  This follows the failure of NHS providers to agree the tariffs which had been proposed.

Proposals to give more rights to people with learning disabilities, autism and mental health problems to live in the community are being put out to consultation by the Government.  It would include rights for a person to challenge decisions made about their care and make it harder to admit people to hospital if there was better support available in the community.  (Interestingly, the consultation does not close until after the election).
(9th March) summary of key points and some reactions:

There is too much attention in the NHS on targets and top down management according to a briefing paper from the Nuffield Trust, “What’s Behind the A&E Crisis”.  It says the increased numbers visiting A&E are not much above what would be expected from population growth.
Blog by the author of the report, Nigel Edwards, and a useful summary:

Chemicals that disrupt hormones are affecting obesity, autism, some cancers and IQ at a cost of €7,500 per person across Europe according to a series of studies led by New York University and published in the Journal of Clinical Endocrinology and Metabolism.  The researchers acknowledge that there is uncertainty over the effects, though.  The chemicals are found in such things as food containers, furniture, carpets, cosmetics, toys and plastics.

The Green Party has said it will offer free social care to over 65’s.

A paper on health inequalities in relation to early childhood health and development is published by the UCL Institute of Health Equity.


5th March 2015

87 CCGs have been approved to co-commission primary care services in addition to the 64 already given full commissioning responsibility.  That means that 151 out of 211 or 71% will have some role in commissioning primary care.

Both health and non-health professionals should tell the relevant authorities if they visit a dangerously cold home under new NICE guidance.  That could include people such as plumbers, heating engineers and meter installers.  They say health and wellbeing boards should set up a single point of contact to where anyone could refer their concerns so that help could be provided with energy or insulation.

People who are optimistic and free of depression are more likely to recover from a heart attack, being half as likely to suffer another heart attack, require surgery or die in the following four years as pessimistic people, according to a study from UCL of 369 people over four years published in the journal Psychosomatic Medicine.  However, part of the difference may have been that optimistic people pursued healthier lifestyles.

The NHS needs to develop a clear plan for how it will save £22bn before the next spending review, the heads of the NHS Confederation and NHS Providers have said.

There is a 19 year difference in healthy life expectancy for women between the most and least deprived areas, according to figures from ONS.
(8th March)–england/2011-13/index.html

A briefing on implementing personal health budgets is published by the NHS Confederation and Think Local Act Personal and is based on the learning from a workshop.  It is called ‘Getting the sums right’.


4th March 2015

Labour has said that not-for-profit care providers could get preferred provider status, with longer, more stable contracts than for-profit providers, in their replacement of the Health and Social Care Act.

169 GP practices contacted NHS England last year about closing or merging their practices compared to 37 the previous year, according to foi responses to Pulse magazine.

More rapid progress is needed towards ‘parity of esteem’ between mental and physical health, a report by the All Party Parliamentary Group on Mental Health says.  It argues for a national target for reducing premature deaths amongst those with mental health problems.

Only 28 of 206 responding councils paid enough for home care to allow for minimum wages to be paid, according to a survey by the UK Homecare Association.  They calculated that commissioners would have to pay £15.74 an hour to allow that, but in fact the average was £13.66.

A claim that less than 1% of last year’s £700m emergency funding reached A&E departments, is made in a report from the Royal College of Emergency Medicine, based on survey results from 100 of 225 emergency departments across the UK.  It is suggested that a failure to invest in front line services led to the winter crisis problems that were avoidable.  The results were dismissed by NHS England and DH who disputed the figures and said that patients could also be kept out of hospital by spending elsewhere.

More then 70% of GPs say they depart from NICE guidance at least once a month according to a survey by Pulse magazine of 515 English and Welsh GPs.

Priorities for a series of workstreams on the use of digital technology in health and care have been agreed by the Government and the National Information Board in a document, ‘Personalised Health and Care 2020: A Framework for Action’.

Paying for health and social care should be put on a more equal footing with the existing level of charges spread more equally across the two sectors and designed to incentivise more healthy behaviour, while maintaining a contribution from the state, according to a report from the Social Market Foundation.

A report on mental health and work, ‘Fit Mind, Fit Job’, is published by the OECD.

Guidelines on sugar intake are published by the WHO.

Later Life Newsletter: 65


3rd March 2015

The ‘Morecombe Bay’ report has found a ‘lethal mix’ of incompetence and cover up, with failings at every level which led to 11 deaths of babies and one of a mother that could have been avoided at Furness General Hospital.  The enquiry looked at cases between 2004 and 2013.  As promised in the Five Year Forward View, the NHS is to conduct a review of maternity services in England.
How parents’ persistence led to change, despite a CQC review finding the hospital compliant in 2010:
Press release:

Paying the ‘living wage’ in social care would cost the country £1.4bn but about half would be clawed back through the knock on effects to tax and benefits, and it could lead to improved services and reduced absenteeism, a report by the Resolution Foundation says.

There has not been an increase in the number of appointments per GP in the three years from 2010-11, although other surgery staff have been seeing more patients, according to an analysis of data from 337 GP practices in England by the Nuffield Trust.  However there could be other pressures such as inspection, revalidation and seeing patients with multiple problems which are causing the feeling of increased stress amongst GPs.

Problems from disabled people’s homes not being suitable are responsible for 3% of GPs’ workloads, at a cost of about £300m a year to the NHS, according to a survey of over a thousand GPs by the Leonard Cheshire Disability charity.
(27th February)

65% of those who had gone through the government’s workplace capability assessment said they were in more pain afterwards and 72% said the process had a negative impact on their physical or mental health, according to a survey of 350 people by the Leonard Cheshire charity.

Ireland has passed a standardised packaging of tobacco law, banning branded cigarette packets, the first country in Europe to do so.

Statistics on obesity, physical activity and diet in England are published in a large report by HSCIC.  Amongst many other things, it shows that 9.5% of children are obese when they start primary school (aged 4-5) but 19.1% obese by year 6 (10-11 year olds), which has remained fairly stable over recent years.

Eric Pickles has said charities should not be allowed to use government funding to influence legislative or regulatory action (described as ‘sock puppets’) and has used clauses in funding by his department to that effect.  He was widely criticised by the charity sector.

Informed: Issue 26


2nd March 2015

Benefits sanctions have been described as inhumane and punitive by a group of churches who say they affected over 1 million unemployed people last year and meant that nearly 100,000 of the poorest children went hungry.  They say that if the same thing happened in the workplace, with a month’s pay being docked for being late for a meeting, we would expect action to be taken against the employer.

Benefit sanctions can leave families dependent on food banks for up to six months, according to a study of 1,711 cases over seven months, by the West Cheshire Food Bank, the Trussell Trust and the University of Chester.  It found that 47% of referrals were due to problems with social security payments.  It found that 23% of referrals were due to administrative and other delays, 11% because of sanctions (with problems lasting up to 26 weeks) and 9% benefit changes.  31% of referrals were because of low income and debt.

Most Britons would support a series of measures to help child health such as banning junk advertising before 9.00 pm (64%), helping pregnant women reduce risky behaviour (77%) and diverting funding for emergency care into health promotion (63%), according to a ComRes poll of 2,118 people for the Royal College of Paediatrics and Child Health.

The Quality and Outcomes Framework (QOF) that measures and rewards GPs’ work has had no effect on premature mortality in the UK according to a study based on an analysis of QOF scores from 8,647 practices and mortality data from the English population of about 53m people people, led by Manchester University and published in the BMJ.
(3rd March)

A two year deal for GPs in Wales should reduce bureaucracy and allow for more working between GP practices and should allow more time for caring for more vulnerable patients.

56% of GPs definitely or probably expect to retire or leave the profession before aged 60, according to a survey of 1,004 GPs for the BBC.  Reasons include workload, working hours, standing within the profession and pay.

‘Commissioning for Value’ packs with information for each CCG across a range of conditions with comparisons to other similar areas are published providing support for CCGs, Public Health and Health and Wellbeing Boards.


1st March 2015

Hospital staff need to be paid less at weekends to improve care, according to NHS Medical Director Sir Bruce Keogh in advance of giving evidence to the pay review body later in the week.  He says paying premium rates makes it harder to keep staff on, wasting valuable facilities and damaging patient care.


28th February 2015

There is a shortfall of 1,000 GPs compared with 2009, in terms of population per GP, according to research by the House of Commons library for the Labour Party.  [The story about advertising for British GPs in Australia to ‘come home’ has been around for a few weeks.]


27th February 2015

Passing control of £6bn of health and social care to Greater Manchester is formally announced.

NICE guidance on maternity care recommends a 1:1 ratio of midwife to pregnant woman.  The recommendations have been widely welcomed, including by the Royal College of Midwives and the Royal College of Nursing.

Labour have said they would review NICE guidance with a view to strengthening it and possibly requiring commissioners to report variance from it.  GP leaders have said that if the guidance were made mandatory, more account would have to be given to the costs of implementing it.

The risk of developing leukaemia rise dramatically with age, with 70% of those in their 90’s having genetic errors that could lead to the disease, according to research by the Wellcome Trust Sanger Institute which analysed blood from 4,219 people.

Guidance for local authorities on implementing the Care Act is published by DH [others may also find this useful as a summary of what is going on.]

Statistics on the projected number of households in England 2012-37 are published by DCLG.

The CQC is consulting on how it should regulate NHS 111 services.

A robot which could lift patients in the future has been developed in Japan.

A briefing on the best incentives to encourage health care providers to follow best practice is published by the Office of Health Economics.

Specialist rehabilitation support for people with vision impairment can help maintain their independence, making them feel safer and more confident, but such support is not equally available around the country, according to research by the University of York’s Social Policy Research Unit, commissioned by the Thomas Pocklington Trust.

Local authorities should not ‘gold plate’ the Equality Act in their procurement process, new statutory guidance under the Best Value Act, out for consultation, proposes.  [ ‘Gold plating’ does not appear to be defined.]


26th February 2015

574 deaths in hospital had dehydration as an underlying or contributory cause in 2013, with 336 involving malnutrition, according to figures obtained by Channel 4 News.
(27th February)


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26th February 2015

The Better Care Fund is unlikely to meet its target savings of £532m, the Public Accounts Committee says.

The number of rough sleepers has increased for the fourth consecutive year, having risen by 14% in the last year, to 2,744 people, and by 55% since 2010.

The sale of energy and sports drinks to young people should be banned, the campaigning group Action on Sugar has said.  They analysed 197 products, 78% of which would be given a ‘red label’ for the amount of sugar they contain, the worst of which had the equivalent of 20 teaspoons in a 500ml drink (three times the recommended maximum for adults).  Many also contain high levels of caffeine.

72.9% of fresh chickens in supermarkets are infected with the potentially lethal bug campylobacter and targets for reducing the problem are not being met according to the Food Standards Agency.  6.8% had infections on the outside of the packaging, with the risk of spreading contamination to other supermarket purchases.  The bug causes illness in about 280,000 people a year and kills around 100.

Certain health professionals, such as radiographers and paramedics could be able to prescribe medicines under proposals being consulted on by NHS England.
(27th February)

The number of outpatient appointments increased by 8.2% in 2013-14 over the previous year, to reach more than 100 million for the first time.  82m or 81% of the appointments were attended.

A response to the report on devolution to local government by the Communities and Local Government Select Committee, is published by DCLG.

An independent review on choice in end of life care recommends that ‘24/7 community end of life care’ should be available in all areas by 2019 and that by 2020 there should be a ‘national choice offer’ on end of life care.

A report, ‘Local Leadership, new approaches’ from PHE looks at how new ways of working can help improve the health of local communities.


25th February 2015

The Greater Manchester Combined Authority is to be given control of its £6bn of health spending together with social care.  Details are still unclear but it appears it would include the portion of spending currently controlled by NHS England (roughly a quarter of the total), with no role for the Local Area Team.  A shadow combined Health and Wellbeing Board is being set up and overall control will ultimately sit with the elected mayor.  It is also reported that CCGs would remain in place.  It is said that this would continue to operate within the NHS structure and conditions.  The changes are likely to come into effect from April 2016.  [Although widely described as ‘devolution’ of funding, much of it appears to be the reverse, an aggregation (of social care and CCG funding) from boroughs to the region.]
(26th February)

GP shortages don’t require recruitment from outside Europe, with plenty of medical students available if they could be persuaded to go into general practice, according to the migration advisory committee, which advises government, including on which occupations can be recruited from outside Europe.  It also says there is no need to recruit nurses from outside Europe, but paramedics, clinical radiology consultants and old-age psychiatry consultants should be added to the list.

Victims of domestic violence are subject to abuse for an average of nearly three years before they get effective help, and have typically been in contact with professionals a number of times before that, according to an analysis of 35,000 cases on the database of charity SafeLives, recorded since 2009.

There was an increase of 2.1% in inpatient hospital admissions in England in 2013-14 compared to the previous year (by 316,400 to 15.5m), according to figures from the HSCIC.

Child poverty could rise by 47% to 3.69m children by 2030 if government policies remain the same according to a report from the Fabian Society.  They also say that the income of high income households is projected to rise 11 times faster than low income ones.  While GDP per person is projected to grow by 32% over this period (according to OBR and ONS assumptions), real disposable incomes for low income families are projected to rise by 2%. They propose that the minimum wage be raised to 60% of median earnings by 2020, a target be set of 80% employment and benefits to rise in line with earnings.
(22nd February)

The coalition’s impact on the lives of people with learning disabilities is given a score of 2 out of 10 in the results of a survey of 1,924 people with learning disabilities and their families (roughly half of each).  It scored worst on income, taxes and work.

A computer programme that can learn a variety of tasks independently, through trial and error, has been developed by Google, apparently the first time this has been done.  [I thought they’d been doing that sort of thing for years.  Why is this relevant to health and wellbeing?  In the medium term, things like improving diagnosis and helping self-management of health.  In the longer term, given evolutionary pressures, perhaps removing humans from the picture.]

Northamptonshire County Council is to be reduced to a core staff of 150, with the remainder of services outsourced – or it says, ‘right-sourced’.  The new organisations to be set up would take on statutory services such as child protection and elderly care.

Eric Pickles says there is scope for more efficiencies in local government, in evidence to the Communities and Local Government Committee.

Statistics on children’s social workers employed by local authorities as at 30th September 2014 are published by DfE.

A report, ‘Leadership and Leadership Development in Health Care: The evidence base’ is published by the King’s Fund.  It identifies three key roles of ensuring: direction, alignment and commitment.

The results of research on how community-based peer support can promote health literacy and reduce health inequalities is published by the National Institute for Health Research.


24th February 2015

Labour says that regulations that would promote competition in health were ‘sneaked out’ the day before the Parliamentary recess.  The regulations would require all contracts worth more than €750k (£625k) to be advertised in the Official Journal of the EU (OJEU).  Previously this would only be required if there was a cross border interest in them.  The DH is reported to have said that this is only a requirement to advertise if there has been a decision to go to market and is not a requirement to go to market.  [The change seems to be quite technical and seems in part to be translating the Public Sector Procurement Directive (agreed last year) into UK law.]
(23rd February) Information from the NHS Confederation European Office:
(5th February, laid before Parliament) The regulations:

A drug taken daily could help reduce the spread of HIV amongst men who have sex with men, according to a study by the MRC Clinical Trials Unit at UCL in 12 NHS Trusts.  It has been reported to a conference and is hoped to be published in a peer reviewed journal later in the year.  Out of 545 participants split into two groups, 3 of those treated with the drug became infected with HIV, while 19 of the control group did not (their use of the drug was delayed by a year).  The drug, Truvada, is already in use in the US but this aimed to test it in ‘real world’ conditions in this country.  There was concern the men might not take the pill regularly or they might engage in more risky behaviour.  The next step is to assess the cost effectiveness of prescribing the drug.
(25th February)

The proportion of pregnancies to girls under 18 is at its lowest level since 1969 with a 13% fall in 2013 from the previous year, according to figures from ONS.  The biggest rise in conception rates over a number of years has been in women aged 35 and over.–england-and-wales/index.html

The NHS Staff Survey 2014 shows a slight deterioration (with 15 of the 29 ‘key findings’ being worse and 11 improved).  68% agreed that they would feel secure raising concerns about unsafe clinical practice, while 57% were confident the organisation would address the concern.

Lincoln is to ban ‘legal highs’ in the city centre, including alcohol and all intoxicating substances, and is said to be the first local authority in the country to do so.

‘Three person babies’ have finally been approved after a resolution in the House of Lords by 280 votes to 48.  The technique combines the healthy mitochondria from a woman with the DNA of the two parents.

GPs should be able to take back out of hours services without going through competitive tendering, and make other changes to make it easier for them to run such services, the RCGP says in a report: ‘The Future of Out of Hours GP Care’.

About two thirds of smokers die from the habit, higher than the half previously thought, according to a large scale study of 200,000 Australians aged over 40 for 6 years.

The extent of tobacco industry lobbying is described in a report in the BMJ, including spending nearly a million pounds on lobbyists and swamping consultation processes.

Informed: Issue 25

CCG Bulletin: Issue 78


23rd February 2015

There should be a new, independent body to investigate the deaths of people detained in psychiatric hospitals, according to the Equality and Human Rights Commission, which found that there had been 662 deaths between 2010 and 2013 in hospitals, police cells and prisons, from ‘non-natural causes’, in its report ‘Preventing Deaths in Detention of Adults with Mental Health Conditions.’  Patients in hospital psychiatric wards were 5 times more likely to die unnecessarily than people with mental health problems in English and Welsh prisons.
(Press release)
(The report)

Single use syringes should be used globally by 2020, the WHO has announced, with a view to limiting the spread of diseases such as HIV and hepatitis.

Integration across health and social care needs to be part of a broader ‘population health’ approach taking account of the social determinants of health, according to a report from the King’s Fund, ‘Population Health Systems, going beyond integrated care.’

Informed: Issue 24

In Touch: Issue 2


22nd February 2015

Eating disorders cost around £15bn a year for the 600,000 affected people, including the financial costs to the sufferers and lost national income, according to a report from PwC commissioned by the charity Beat.

There are indications that the use of e-cigarettes is levelling off.

The number of women diagnosed with alcoholic liver disease reached its highest level in 2013-14 for ten years according to figures from HSCIC.

16-24 year olds are nearly three times more likely to be unemployed than the rest of the population, the highest proportion since 1992, according to an analysis by the House of Commons Library for Labour.  14.4% of that age group is unemployed, compared to 5.7% of the total working population.


21st February 2015

All NHS staff (not just medical) are to be given training in dementia awareness, with a £300m fund over the life of the next Parliament (£60m a year), David Cameron has announced.  The announcement was welcomed by Labour.  [The press release does not say whether this money will be allocated by this Government or whether this is a promise by the Conservative party; however, it was an announcement from the Prime Minister’s office, not the Conservative party.]
(The press release)
(The Challenge document – includes a lot of useful background information on dementia)

One million people have now signed up to be ‘dementia friends’ the Alzheimer’s Society says.

A briefing for local government on how to help people avoid early death (before the age of 75) is published by NICE.  They say that taking action on such things as smoking, alcohol and obesity could save 103,000 people from dying early each year.  It suggests this is likely to be useful for Health and Wellbeing Boards.
(Press release)
(The briefing)

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20th February 2015

Patients with life-long conditions have been fined for not updating their exemption certificates.  While previously such people had been told they were entitled to free certificates for life, the system changed in 2002 with new medical exemption certificates that needed to be renewed every five years.  The NHS Business Services Authority took over responsibility for checking eligibility last September and have apparently been issuing fines without first warning people.  The NHS Business Services Authority said that the requirements are written in regulations and it is the patient’s responsibility to check their entitlement.

Improving children’s mental health services must be a ‘national ambition’ according to a leaked, draft report from a taskforce headed by DH and NHS England officials.

Work is going on to introduce a minimum standard of mental health training for GPs with a task force having been set up to recommend changes to the GP training programme.

The performance of NHS foundation trusts in the last quarter and the three quarters to the end of December 2014, is published by Monitor.  They have an overall deficit of £321m (up from £254m in the previous quarter).  More than half the trusts (78 of 149) are now in deficit.
(21st February)
(21st February)
(23rd February)
King’s Fund response:


19th February 2015

Male suicides are at their highest level for ten years according to ONS figures.  There were 6,233 suicides in men and women above 15 in 2013 which was an increase of 4% on the previous year.–2013-registrations.html

Second annual report on suicide prevention.

A more stringent threshold for which drugs the NHS should pay for is proposed in research from the University of York in research funded by the Medical Research Council and the National Institute for Health Research.  It proposes dropping the threshold from £30k to £13k per ‘quality adjusted life year’ (QALY) since the money released could produce better results elsewhere.

A paper on ‘Rationing in the NHS’ is published by the Nuffield Trust.  It argues that rationing is inevitable and should be made more transparent.  It commends the role of NICE and says it should take back responsibility for decisions on expensive drugs from the Cancer Drugs Fund.

NHS England has offered an ‘enhanced tariff option’ to health providers following rejection of earlier proposals.  It is said to be worth £500m more than last November’s proposal.

People who have been off sick for more than four weeks may be forced to have a fitness-to-work test, in a scheme which has been piloted in 20 surgeries and could be rolled out across the country, it is apparently reported in the Times.

Two third of parents of children with mental health problems thought they did not get enough support, according to a survey for NHS England carried out by the charity Young Minds.  NHS England says it will work with Young Minds to improve parental involvement in developing psychiatric services.

The first mental health trust to be put in ‘special measures’ following an ‘inadequate’ rating by the CQC is the Norfolk and Suffolk Foundation Trust.

Studies on obesity and diet are reported in the Lancet.  It includes an article on which countries have the best and worst diets.  Another suggests food companies have a vested interest in people eating too much.

Support should continue to be given to carers after they stop care-giving, (e.g. if the person they are caring for dies or moves into residential care), because of the risk of depression and other problems, according to a report from the International Longevity Centre UK.

Essays on the integration of health and social care are published by the Social Market Foundation under the title ‘A Problem Shared’.


18th February 2015

The 85% target for cancer referrals within 62 days has been missed for the fourth successive quarter, with 83.8% seen in that time in the final quarter of 2014.

The number of women aged 53-70 screened for breast cancer has fallen for three years in a row, from 77.2% in 2011 to 75.9% in 2014, according to figures from the HSCIC.  The NHS target is 70%.

There have been 268 applications to be new models of care Vanguards to take forward the ideas of the Five Year Forward View.  Fifty are from hospital trusts who would take on GPs on a salaried basis in Primary and Acute Care Systems (PACs) and 170 from GP led consortia who would expand into acute care as Multi-speciality Community Providers (MCPs).
(19th February)

64 CCGs have been approved to take on full commissioning responsibility for primary care from April, with another likely to be added to the list.  Decisions on those which will take on joint commissioning responsibilities are to be made in the next few weeks.

The NHS spent £6.6bn on private health providers in 2013-14, a 50% increase since the coalition government was formed, according to answers to a Parliamentary question.

The financing of local government should be devolved to councils and groups of local authorities an Independent Commission on Local Government Finance, established by the LGA and CIPFA, has said.  It recommends greater local control over council tax (including setting of bands) and single budgets for all local public services, controlled by combined authorities.

Nearly three quarters of paediatricians say waiting times for disabled children have increased and 80% said they could not meet NICE guidelines, in a survey by the British Academy of Childhood Disability, to which 134 of the doctors responded.

Most Scottish NHS Boards are likely to ban e-cigarettes in their grounds, which they are being advised to do, as well as being required to ban cigarettes by April 2015.

60-75 year olds exercised more often and more vigorously following 4 physical activity consultations with a nurse over three months and the use of a pedometer, a randomised control trial of 298 people by St George’s University London and published in the journal PLOS Medicine, has found.  There was still a difference from the control group after twelve months.

Doctors would be asked to intervene if they see antibiotics being prescribed inappropriately under NICE guidelines out for consultation.
(20th February) Feature article:

A report on ‘Behaviour Change and Antibiotic Prescribing in healthcare settings’: literature review and behavioural analysis’ is published by PHE.

NICE publishes a briefing on care for older people in care homes, which should be based on the needs of the residents rather than staff, such as when they have meals and how they can have choice in their personal routines.

Supported living arrangements should be subject to regulation such as CQC inspection, to provide means of redress for poor quality care, Healthwatch England have said in a letter to the DH, after a case was raised in Newbury, West Berkshire.

A report on ‘Implementing the NHS Five Year Forward View’ is published by the King’s Fund.

Interesting article on the state of the health service in England compared to Wales, from the BBC, plus an item from the IFS on spending on health and social care in the two countries.


17th February 2015

Pilots for seven day access to GPs are to be extended by six months after March 2015, NHS England have said.  The scheme was originally set up as part of the £50m Challenge Fund.

There are calls for Lord Stuart Rose’s report into NHS management to be published before the general election.  It was apparently delivered to ministers in December and is said to be critical of the NHS, and so could be politically sensitive.

Pregnant women should have specialist health to manage their weight because of the health risks to their unborn child who is likely to suffer problems later in life, according to the ‘Dorian’ European study on obesity.

A summary of a number of NHS statistics is published by the House of Commons library.

Increasing funding for the NHS through national insurance payments and creating ‘an NHS mutual’ are proposed in a paper from the Policy Network, ‘Mutual Endeavour’.


16th February 2015

Alzheimer’s Research UK has announced that three ‘Drug Discovery Institutes’ are being launched at the universities of Oxford, Cambridge and UCL in a £30m ‘Drug Discovery Alliance’.  This will involve the recruitment of 90 new research scientists.  Dementia affects 830,000 people in the UK and costs the UK economy £23bn a year.

Visitors from outside Europe are to be charged 150% of the costs of secondary care from April.  This applies to anyone, including English people living abroad, without a European Health Insurance Card or S1 form (which includes English state pensioners).  Treatment in A&E remains free.  There is to be a consultation on extending charging to GP services later in the year.

Two GP provider companies are to take over running the out of hours service in Cornwall which Serco’s contract ends on 1st June.

A slideset on the case for tackling obesity is published by PHE.


15th February 2015

NHS England is moving patients with mental health needs out of a private hospital, Vista, in Winchfield, Hampshire after it made insufficient improvement following a failed CQC inspection, reported as indicating a new seriousness to avoid another Winterbourne View scandal.

[Weekly email sent out ————————————————————–]


15th February 2015

Labour is promising more help for perinatal mental health, including training to spot conditions earlier and creating a legal right for patients to receive counselling.

No change to the online marketing of food and drink to children is recommended by a report commissioned by the Committee of Advertising Practice which suggested that there was not enough evidence to suggest it had an effect on children.  The Committee said it would launch another review with the aim of publishing guidance in the autumn.

Under 40% of local authorities are providing adequate child care for those in work or training as required by the 2006 Childcare Act according to a report from the Family and Childcare Trust.


14th February 2015

Obese people and those with drug or alcohol addiction could be forced to accept treatment in order to receive sickness benefit under proposals being investigated by the Government which is asking Dame Carol Black to undertake a review of the evidence.

There has been a call for two academic papers which had been used to argue against plain cigarette packaging to be withdrawn, because of alleged errors in them and because the sponsor Philip Morris International had asked to seem them, and suggested changes, before publication.  The papers were published by the University of Zurich.

A private health company, Optum, one of 12 organisations given preferred status for bidding for NHS contracts, has been accused of fraud in the US courts.  They are accused of claiming funds for patients in hospices who were not terminally ill.

Women are more than two and half times more likely to be carers of people with dementia than men and more likely to get the disease, with 500,000 women now affected with it compared to about 350,000 men, according to a new report from Alzheimer’s Research UK due to be published next month, ‘Women and Dementia: a marginalised majority’.


13th February 2015

‘Exit block’, where lack of a hospital bed blocks patients leaving A&E could be costing 3,800 lives a year, according to research by the Royal College of Emergency Medicine.

There has been a 6% drop in applications for GP training, the second successive annual fall, according to Pulse Magazine.

Regular exercise is a ‘miracle cure’ which could dramatically cut the risks of cancer, dementia, heart disease and diabetes, according to a new review of evidence from the Academy of Royal Colleges.
(Headline: “GPs told to prescribe sex as an exercise”)

There has been a small rise in the number of teetotallers from 19% to 21% between 2005 and 2013, largely because of a 40% rise in the proportion of 16-24 year olds not drinking according to an ONS survey.  The proportion of this group binge drinking fell from 29% in 2005 to 18% in 2013.  However, the survey did not collect information on ethnic or religious background so it is not possible to tell if a rise in the Muslim population contributed, and it is thought there has been a growing alcohol problem in some parts of the population.  The survey also relied on self-reports.

38% of university staff have not disclosed their mental health problem to colleagues and 54% of students with mental health problems hadn’t talked to anyone about getting help, although in both cases they were well supported if they did, according to a survey of 2,000 members of staff and 1,400 students by the Equality Challenge Unit.

A report by Reform, ‘Expert Patients’, looks at how patients can be engaged in their own health, and how this could help save money.

Guidance on how new access and waiting time standards for mental health are to be introduced, has been published by NHS England.


12th February 2015

The CQC publishes information for the public on using hidden cameras for recording someone’s care.  Guidance for providers was published in December.

60% of residential care home workers were ‘reasonably relaxed’ about installing CCTV cameras in communal areas, in a survey of 2,000 GMB union members working for care provider HC-One as part of a consultation.  70% agreed cameras could help identify abuse but 71% were worried about invasions of residents’ privacy and 41% were concerned the managers might use the footage unfairly.

The latest ONS figures for violent crime and sexual offences show a continual fall in violent crime over the last 20 years.  There was the highest number of sexual offences but it is thought this could be because of improvements in recording and a greater willingness for victims to come forward, although only 17% of sexual assault victims said they had told the police.  The number of violence offences in which alcohol played a part, at 53% remains at a similar level it has been for the past 10 years.–2013-14/rpt-about-this-release.html

It is hard for people to keep weight lost off because of biological mechanisms that work to bring them back to their previous maximum weight according to American academics writing in The Lancet.

‘Spending on Late Intervention: how we can do better for less’ is published by the Early Intervention Foundation.  It suggests that social problems affecting young people such as going into care and mental health issues, cost the Government almost £17bn a year, and that this could be reduced by earlier intervention.

Payments to GP practices have been published for the first time, by the HSCIC, with the average being £136 per patient per year, which Pulse magazine notes, is less than a Sky TV subscription.

Informed: Issue 23

A blog on delivering digital technology to the Civil Service. [Not the sort of the thing I would normally link to here but this seems such a great, common sense approach to identifying need, choosing and procuring the right digital solutions that it was worth sharing.  Particularly given the problems health and other public services often seem to have with large IT projects.]


11th February 2015

Jeremy Hunt has promised legislation to protect NHS whistleblowers before the end of this Parliament, following the publication of the Robert Francis’s Freedom To Speak Up report.  Each NHS Trust would have a ‘Freedom to Speak Up Guardian’, reporting to the CE, with a national officer to investigate whistleblowing, located at the CQC.
(14th February) a whistleblower says the failure to support existing whistleblowers will make others less likely to speak out:

MPs have approved a ban on smoking in cars with children present from 1st October by a vote of 342 to 74, with a penalty of £50.
[The regulations were laid on 17th December]

Simon Stevens has told the Public Accounts Committee that hospitals for people with learning disabilities will have to close, post Winterbourne.  This was supported by DH.  CQC are refusing licences for new units.
(Interesting and informative feature article)

One in five suicides worldwide was due to unemployment between 2000 and 2011, with the suicide rate rising six months before the unemployment rate and with rates higher where unemployment is less common, suggesting that fear and insecurity may be significant factors, according to research led by Zurich University published in the Lancet Psychiatry.

Parents’ lifestyle appears to be more important than genetics in determining whether children will be overweight, with adopted children being 21% more likely to be overweight if both parents were, but 27% more likely if their natural parents were.  However, the results were different if only one parent was overweight and there seemed to be a larger genetic determinant for obesity.  The data was taken from the Health Survey for England’s children survey for 1997-2009 involving over 13,500 observations of children and natural parents and 300 of parents and adopted children.

90 genetic regions have been identified as being associated with obesity, explaining more than a fifth of the weight differences between people, according to analysis of the DNA libraries of more than 300,000 people as part of the international ‘Giant’ consortium (Genetic Investigation of Anthropomorphic Trait) and published in the journal Nature.  The role of all the genes is not known, but some are thought to be to do with control of appetite.  In time this could lead to more tailored advice for tackling obesity.  A second study in the same journal suggests some genes could influence body shape.
(12th February)

The number of social workers employed by adult social services departments has been falling by about 10,000 a year since 2011, although some of this is due to outsourcing, according to figures released by the HSCIC.

Seven sites have been selected to develop Patient Centred Outcome Measures for children and young people, NHS England has announced.

UK trained GPs in Australia have been urged to return to the UK in adverts placed in two Australian medical magazines.

A study of treadmill desks found little effect in reducing weight, possibly because participants walked relatively slowly and did not use them as much as planned, according to a study by Oregon State University [limited details of the research are given].

A report on the progress made in applying lessons from the mid-Staffs is published by DH.

A guide on the role of local government and the NHS in building confident communities to improve health and reduce health inequalities has been published by NHS England and PHE.

A study on the impact of lifestyles on the efficiency of health systems in Europe has been published by the EU.


10th February 2015

Hinchingbrooke hospital is applying for £9.6m from the Trust Development Authority to cover a deficit expected to be between £7.7m and £12m at the end of March when the private company Circle hands back the contract.  80% of NHS Foundation Trusts reported deficits half way through this financial year.  Circle says it has saved the taxpayer £23m during the life of its contract.

Pilots for the scheme are to begin before May in Blackburn with Darwen, Somerset and West Hampshire.

A French NGO is challenging the patent for a hepatitis C drug on the grounds that the company, Gilead, did not take an ‘inventive step’, but relied to a large extent on other research and because it is claiming a more extensive patent that originally filed for.  Such a challenge by a medical organisation in Europe is said to be unprecedented.

Positive words are more popular than negative ones in 10 languages studied by US and Australian scientists suggesting an optimism bias in human nature.  [Optimism is associated with better health outcomes.]

If a person has a long term impairment as a result of obesity they could be eligible for disability rights, a Northern Ireland employment tribunal has ruled.

Google is to directly provide health information in response to relevant queries, rather than only supplying links to other sources, in the same way it currently does for dictionary definitions, information about famous people and schedules for big sporting events.  The service is to start shortly in the US, with the information verified by the non-profit Mayor clinic, with a UK service possible at a later stage.
(11th February)
(11th February)

Puerto Rico is considering a bill that would fine parents if their obese children did not lose weight after being given a diet and exercise programme.
(13th February) Feature article:

Guidance on eating fatty foods issued in the 1980s was based in insufficient evidence according to a report in online journal Open Heart, which looked at systematic reviews available at the time.  However, this is not the same as saying existing guidance is wrong (as some news stories seemed to suggest).
(10th February)

‘The Future is Now’ on changes needed in the NHS, using various case studies, is published by the King’s Fund.


9th February 2015

About 130,000 care workers are being paid less than the minimum wage, losing £130m a year in total, according to research by the Resolution Foundation.  This is often because of, wrongly, not paying for travel time between clients, for training or for being on call.

Almost 40% of GP practices would be prepared to accept someone from outside their area under the Government’s scheme to allow patients to accept any GP, according to a survey by NHS England amongst three local area teams.

A claim made in 2013 that death rates in NHS hospitals are higher than those in the US has been disputed in a report by the Academy of Medical Royal Colleges.  Prof Brian Jarman had claimed that 45% more patients died in England because of poor care.  However the new report says there are differences, often because of varying financial incentives between the two countries, in how patients are classified, how many co-morbidities are recorded, the condition of patients arriving at hospital and the numbers that die in hospital rather than being moved elsewhere.


8th February 2015

Jeremy Hunt has ordered an annual review of avoidable deaths in hospitals, with a study of 2,000 patient case notes.

Putting 11 NHS Trusts into special measures appears to have saved lives according to Dr Foster whose analysis suggests 450 were saved between August 2013 and June 2014.


7th February 2015

More than a third (61 / 150) of hospital investigations into avoidable harm are inadequate according to an interim report by the Parliamentary and Health Service Ombudsman which is investigating NHS complaints and is due to report more fully at a later date.  They also say that a number of ‘serious untoward incidents’ were not investigated as they should have been.


6th February 2015

Decisions on next year’s flu vaccine have to be made soon, so may turn out not to be effective.

Southampton hospital said in January that it was finding new strains of flu against which the vaccine was ineffective but PHE is said to have questioned the findings.  There are suggestions that a wider range of flu types should be included in next year’s vaccine.  There are concerns that people may be put off having a vaccination although it is still felt to be worthwhile.
The Mail says PHE knew for six months that ‘the vaccine was defective’ (the article later says that the spokesman initially said they were aware of the mutation in August but later clarified that to ‘the last few months’).


[Weekly email sent out ————————————————————–]


6th February 2015

The King’s Fund has criticised the Government’s reorganisation of the NHS, in a review of its record on health, saying it was damaging, a distraction from tackling the problems the service was facing, and with the complicated array of new organisations leaving a leadership vacuum.

The detention of mentally ill people in police stations must stop, the Commons Home Affairs Committee has said.  Over 6,000 were held in police cells last year, including 236 children under 18.

Private pharmacists have been seeing A&E patients, to free up clinician time, in a trial at a hospital in North Manchester which has been running for 10 weeks.

A consultation on revised arrangements for pooled budgets between councils and NHS bodies, is published, which would allow them to be used for primary care.


5th February 2015

The winter flu vaccine has been found to protect only 3% of people, compared to the normal 50%, according to a study of 1,314 patients published in Eurosurveillance.
(6th February) PHE say they have known about the mismatch of vaccine and strain of flu for some while, but there had not been time to develop a new vaccine.

Organisations approved to provide commissioning support for CCGs in a framework agreement which should make the procurement process for CCGs easier, have been agreed by NHS England.  The approved providers include a number of private and independent providers as well as existing Commissioning Support Units (CSUs).
Two CSUs, in Yorkshire and in the North West, failed to be accredited:

There continue to be problems with implementation of the Mental Health Act, according to CQC’s annual review, including a reduction in the number of beds available, provision of and access to child and adolescent mental health services, people with learning disabilities placed more the 50km from home, and no consent to treatment in a quarter of records checked.

Three charities are to provide 700 volunteers to support 29 A&E departments in England over 12 weeks, with £1.2m Government grant.  Age UK, Red Cross and RVS will work in homes, in casualty and in wards, dealing with social issues.  This builds on 7 pilots announced earlier in the year with £2m support.

More spending is needed on research on anti-microbial resistance, a Government commissioned review headed by Jim O’Neill has said in a second report, along with other recommendations such as tracking how resistance is spreading, reducing unnecessary prescriptions through better testing and training a new generation of scientists in the field.
PHE response:

Agency nurses could cost the NHS £980m this year compared with £485m last year and £327m the year before, according to the Royal College of Nursing.

A pilot scheme for GPs to check the eligibility for health care of people from other parts of the EU, as determined by whether they have a European Health Insurance Card, is to be run in 10 areas later in the year.


4th February 2015

People with learning disabilities have not been moved out of hospitals into community care as promised following the Winterbourne View scandal, the NAO have reported.  3,250 were originally identified to be transferred but 2,600 inpatients (not necessarily the same ones) remain in mental health hospitals.

The larger part of public sector cuts is still to come, with £38bn in the current parliament but £51bn in the next, according to a report from the Institute of Fiscal Studies.

The £72k cap on care costs is to be extended to those over 25, ministers have said, with those needing care before 25 getting it free forever.

The Government is to take over running of Rotherham Council following Louise Casey’s report into child sexual exploitation.

Half of those born after 1960 will be diagnosed with cancer at some point in their lifetime, according to analysis by Cancer Research UK which uses a new way of calculating risk, taking account of population changes in terms of age and lifestyle.  However a healthy lifestyle could reduce the lifetime risk from 50% to 30%.

A review of mental health patients being placed in hospitals a long way from home, has been ordered by the Lib-Dem Care Minister Norman Lamb, after HSCIC figures showed 4.9% (410 out of 8,284) of those in acute beds at the end of October were 50km or more from their home address.

Welfare changes, cuts and sanctions are the main cause of increased homelessness, according to the Homelessness Monitor, a report researched by Heriot-Watt University and published by Crisis and the Joseph Rowntree Foundation.  The report argues that headline figures underplay the full extent of the problem, because many people are helped informally and not declared homeless.

The current death rate is a third higher than normal for this time of year, with ONS recording an increase of 32% (21.9k to 28.8k) in the fortnight to 23rd January compared to the average for that period over the last five years.  Separate PHE figures show above expected death rates for over 65s over a six week period.  Flu and the cold spell are thought to be largely responsible for the increase.  Mutations of the flu virus means vaccinations may have been less effective.
The cost of heating could also be a factor behind the death rate:

PHE is launching an action plan to help reduce health inequalities affecting gay and bisexual men.

E-cigarettes increased susceptibility to respiratory infections and caused mild lung damage in experiments on mice.
(5th February)
(5th February)

The BMA says NHS111 is referring more people to GPs and A&E, but NHS England notes that while the numbers have increased, the proportions going to them are the same.  There were increases compared to NHS Direct as 111 also covers out of hours services.  NHS 111 was only established in 2013.  The BMA says there is anecdotal evidence of non-clinicians in NHS 111 inappropriately sending people to GPs or A&E.

The health sector should end investments in fossil fuel industries, a coalition of medical organisations has said, on the basis that climate change is “the biggest global health threat of the 21st century”.  The BMA has already voted for divestment but the Wellcome Trust (with £18bn of investments) is declining to do so.


3rd February 2015

Radical change is needed if the NHS is to become financially sustainable, with 80% of acute trusts reporting a deficit in the second quarter of 2014-15, efficiency targets not being met and financial incentives acting against local integration of secondary and community care, the Public Accounts Committee says in a report on the financial sustainability of NHS bodies.
Locum doctors are costing £1,760 a day:
Debate and criticism amongst the MPs over privatisation of Hinchingbrooke:

MPs vote to allow three parent babies through mitochondrial donation.
(4th February)
(4th February)

The Government is to provide £74m to local government for local welfare crisis relief schemes, and to manage pressures on social care.
(4th February)

Investing in children’s mental health provides good value for money according to a report looking at costs and benefits published by the Centre for Mental Health for CentreForum’s Mental Health Commission.

Responsibility for commissioning renal dialysis services and morbid obesity surgery is not to be transferred from NHS England to CCGs for the time being, as previously proposed.

A rapid evidence review on the factors which should be taken into account when planning the closer working of primary and community health care services has been published. The report was commissioned by DH.

Informed: Issue 22


2nd February 2015

90 NHS organisations have signed up to Kate Granger’s #hellomynameis campaign, encouraging doctors to introduce themselves and treat patients with dignity and respect.

Doctors should take account of the social costs of lost productivity when signing people off sick for lower back pain which does not necessarily help recovery, according to a study of 800 patients by Keele University published in the Journal of Occupational Rehabilitation.

Later Life Newsletter: 64


1st February 2015

There is a warning about a lack of beds for mental health patients from the Royal College of Psychiatrists.


31st January 2015

There is a significant correlation between the wealth of families five generations ago (the 1850s) and today, suggesting a long term lack of social mobility, according to research on over 18,000 people with 634 rare surnames, using a variety of sources of information, according to researchers from the LSE and University of California and published in the Economic Journal.  At this rate of change it would take until 2300 for the differences to even out.

The lack of beds for mentally ill children means hospitals may have to place 16-18 year olds in adult wards according to an email from NHS East Anglia leaked to the Observer apparently passing on a warning from NHS England on the lack of such beds.

Reducing the benefits cap to £23k would make social housing in the south east unaffordable for large families on benefits, according to the Moat housing association, whose analysis found that every three bedroom house in the 35 areas in the south east that it operates in would be unaffordable to residents receiving full housing benefit, if the cap was reduced as proposed by the Conservatives.


30th January 2015

NHS England has been asked to rethink its policy of publishing death rates in surgery by the Royal Society for Cardiothoracic Surgery, because of concern it might drive risk averse behaviour. 
(31st January) Two expert views on the issue:

A quarter of health and social care patients would not complain, even if in pain, for fear it would impact on their care, according to research by Healthwatch England.  Talking to the Independent, CE Dr Katherine Rake paints a worrying picture of patients not being listened and responded to and government priorities not matching those of the public.


[Weekly email sent out ————————————————————–]


30th January 2015

Obesity rates in the under 10’s may be levelling off but obesity rates amongst the 11-15s are still rising according to research by King’s College London looking at GP electronic health records of 370,000 children between 1994 and 2013 and published in the Archives of Diseases in Childhood.  The annual growth of obesity and overweight numbers was 8% up to 2003 but 0.4% in the following 10 years.

EU trained nurses, dentists, pharmacies and other could be asked by regulators to prove their competence in English, under regulations to be laid before Parliament with a view to the new procedures coming into effect later in the year.
(30th January) (Rgn)

PHE Bulletin


29th January 2015

Proposals by Monitor to cut tariffs have been rejected by 37% of hospital trusts which undertake 75% of hospital work, saying the £1.7bn cut, (or 3.8%), it would imply for their income is not sustainable.   Monitor and NHS England are now considering the next steps, which could be a revision of proposals and re-consultation or referral to the Competition and Markets Authority.  The situation is described as unprecedented.
NHS Confederation response:
King’s Fund response:
Statement from NHS England:

While there have been some reductions in the number of people with learning disability in hospitals following the Winterbourne View scandal, this is virtually matched by the number of new people being sent to such institutions according to a report, ‘Winterbourne View: Transforming Care Two Years On’, published by DH and a number of national health and care bodies.
‘Transforming Care for People With Learning Disabilities – Next Steps’ is published by a number of national bodies.

Learning disabilities census report 2014 as at 30 September 2014.

Satisfaction with the NHS in England rose to its second highest level ever at 65% last year, according to data from the Social Attitudes Survey of 1,937 UK adults analysed by the King’s Fund.  There was a bigger increase in those who had not had contact with the service (54% to 65%) than those who had (64% to 68%) leading to suggestions that this could be people showing support for the NHS as an institution. Satisfaction with GPs fell to its lowest ever level at 71% but still leaving them as the most popular part of the NHS.  In Wales, 51% were very or quite satisfied and in Scotland the figure was 75%.  The survey is directed by NatCen Social Research while the health questions were sponsored by the King’s Fund.

A set of standards for hospital food were published, which were to be made mandatory through the NHS contract, and now a cost-benefit analysis has been added.  

A framework for ‘Improving Young People’s Health and Wellbeing’ to help local areas in the role of promoting health and wellbeing amongst young people is published by PHE.

The BMJ has said all Doctors’ financial interests should be published after it has been claimed that doctors have been offered incentives by private healthcare companies if they refer patients to their hospitals.

DCLG consults on updated regulations on council decision making which consolidate previous changes but also propose that decisions on frequency of refuse collection and parking and enforcing and charges should be made by full council rather than the executive.

Government response on health screening to the House of Commons Science and Technology Committee report.

Research on hospital admissions from care homes is published by the Health Foundation and Nuffield Trust.

Foundation Trust Bulletin January 2015


28th January 2015

Councils will need to find £1.1bn to maintain spending on adult social care in cash terms next year, with a consequent impact on other services, the LGA has said.  The equivalent figure for the previous year was £900m.

Spending on care for the over 65s has fallen by a fifth over the ten years from 2003-4, from £1,188 to £951 per person in real terms.  Over that period the budget fell by 6% in real terms while the over 65 population rose by 17%.

The 35% reduction in council spending over the last five years has not hit councils equally, with reductions ranging from 5-40% and the most deprived areas having had the biggest reductions, according to a report by the Public Accounts Committee, ‘Financial Sustainability of Local Authorities 2014’.  It raised concern as to whether councils, particularly those with social care functions, would continue to be sustainable.  It also criticised DCLG for not fully understanding the impact of the cuts.

For up to 30% of the 4.1m people receiving treatment for asthma, there is no clear evidence of them having the condition, with other people missed though they have it, according to NICE which is consulting on draft guidelines on the most suitable diagnostic tests.
(29th January)
(2nd February)
(4th February) Letter saying headlines have been misleading because of the complexities of diagnosis and that ‘many people who do have it may not show clear signs on clinical testing.’

Downing Street has refused to say whether David Cameron supports proposals for standardised cigarette packaging as it is reported that up to 100 MPs could vote against the measure.

39% of additional doctors registered last year were trained overseas according to GMC figures.  In addition to those 3,000 doctors, 1,000 nurses were recruited from overseas according to information received from 32 of the 165  trusts in England in response to foi requests from the Guardian.

42.6% of Welsh ambulances met the 8 minute target for Category A calls in December, as against a target of 65%.

The BBC has launched an online care calculator providing information on local care costs for over 65s in different parts of the UK and what support might be available depending on personal circumstances.
News item:
The care calculator:

11 new Integrated Care Pioneer areas are announced.

Regulations on displaying CQC regulation ratings for hospitals, GP surgeries and care homes have been laid before Parliament.  The regulations come into force on 1st April 2015, subject to Parliamentary approval.

Results of what is believed to be the first national representative survey of the sex lives of elderly people to include those over 80, by researchers from the University of Manchester has been published in the American journal, Archives of Sexual Behavior.
(29th January)

There is concern on the GMC’s consultation on standards for medical education and training by the BMA which says proposals to cut consultant training by two years wouldn’t allow the same level of expertise to be reached.
(30th January)

A&E attendance figures for 2013-14, headline figure for England and Wales, are published by HSCIC.

Hospital episode statistics for admitted patient care for 2013-14, headline figures for England and Wales are published by HSCIC.

Hospital outpatient activity statistics for 2013-14, headline figures for England and Wales are published by HSCIC.

Maternity statistics for 2013-14, headline figures for England are published by HSCIC.  A quarter of all births are now by caesarean section.

CCG Bulletin: 76

In Touch: Issue 1.  [Evidently a new online newsletter, but unless I’m missing something it doesn’t seem to introduce itself, so it’s unclear what and who it’s for, or what its remit is.]


27th January 2015

Labour sets out its stall on the NHS with six pledges including integrating care from home to hospital; more focus on mental health; preventing illness; and investing in front line staff.
A helpful bullet point summary of proposals:
Bullet point summary from the NHS Confederation including points from Q&A, including that CCGs and HWBs would stay:
More people think the NHS is important than the economy, but as many trust Cameron to fund it as Miliband:
Labour would fund the training of 2,000 more nurses a year:–to-reduce-reliance-on-foreigners-10006538.html
(29th January) Labour would create an integrated out of hours service by bringing GP out of hours services and NHS 111 under the control of the ambulance service:
King’s Fund response:
(29th January) King’s Fund blog:

The Government’s changes to benefits and direct taxes have impacted proportionately more on the poorest than the better off, with families with children under 5 the hardest hit, according to an analysis by a consortium of academics led by the LSE and universities of Manchester and York and funded by the JRF and Nuffield Foundation.  Cuts in welfare were offset by tax cuts for those with larger incomes.

Each GP practice is to have a named health visitor to act as their family liaison officer, from April.
(29th January)

Pregnant women were more than twice as likely to quit smoking with the financial incentive of up to £400 in shopping vouchers in a study of 600 women in Glasgow by the Universities of Glasgow and Stirling and published in the BMJ.
(28th January)
(28th January)
(28th January)
(28th January)

Certain common drugs, including ones for hay fever and insomnia are linked to an increased risk of getting dementia, in research from the University of Washington on 3,434 people aged over 65 and published in the journal JAMA Internal Medicine.  The results related to anticholinergic-type drugs taken every day for three years.  Commentators suggest the results are interesting but not definitive and anyone prescribed such medicines should not stop taking them without checking with the doctor.
(28th January) More general article:

Expected mortality statistics show 9 trusts having higher than expected mortality, 15 lower than expected and 113 as expected.  The Summary Hospital-Level Mortality Indicator (SHMI) is published by HSCIC.

A briefing on ‘Mental Health and Policing’ gives examples of schemes where mental health nurses working with the policy led to a drop in the number of people being detained under the Mental Health Act.  The briefing is jointly published by the Mental Health Network and the Association of Chief Police Officers.

NHS England consults on the prioritisation for specialist services which it commissions.

Consultation on the QOF indicators for GPs and the CCG Outcome Indicator Set for 2016/17 has been launched by NICE.
(29th January) (Rgn)

Informed: Issue 21


26th January 2015

A £200m ‘New Models of Care’ Programme, including the idea of ‘multi-speciality community providers’ (MCPs) and ‘Primary and Acute Care Systems’ (PACs), as envisaged in the Five Year Forward View, has been announced by NHS England and its national partners.  MCPs would be integrated providers of out of hospital care including GPs, community health such as district nurses, dentists and potentially mental health, preventive and social care services.  PACS would include all of that and hospital services.  Various other models, including the integration of care homes and social care are also outlined.
A concise list of the possible features of the envisaged models is given in this expression of interest form for bidding to be included in the pathfinder programme: (pdf)

A £10m fund is to be used to encourage newly qualified doctors to become GPs, with incentives including ‘golden helloes’, payments to delay retirement and additional training opportunities.  The ten point plan picks up on some previous proposals but not one that would require all trainee doctors to have some exposure to general practice.

There is a risk of CCGs becoming unsustainable because of changes to how primary care is commissioned, reduced engagement of GPs with CCGs and cuts to management budgets, according to a report by the Nuffield Trust and the King’s Fund.

The new national occupational health service to be rolled out across the country from the spring, will deal with most cases by phone or online.  GPs will no longer have to issue sick notes for patients off work for more than 4 weeks.

There is evidence that having more money increases happiness and reduces mental health problems, but the evidence on physical health is mixed, with increasing resources improving the health behaviour of parents but leading to unhealthy behaviour such as drinking and smoking in others, according to a systematic review of 54 studies undertaken by researchers from the LSE and published by the Joseph Rowntree Foundation.

Many people with ‘red flag’ cancer warning symptoms do not go to their GP because of worry about wasting the doctor’s time or viewing their symptoms as trivial, according to a qualitative study of 48 people (of whom 45% had not gone to the doctor) drawn from a sample of 1724 over 50 year olds in London, by researchers from London and Hull, funded by Cancer Research UK and published in the British Journal of General Practice.
Persistent heartburn could be a symptom of stomach or oesophageal cancer, so PHE advise people suffering from it to see a doctor:

A third of acute trusts do not display the name of a clinician responsible for the patient above their bed, despite Jeremy Hunt having called for this in June 2013, according to foi responses from 108 trusts to technology and consultancy firm Hotboard.

Siblings with autism often have different genetic risk factors, with research on 85 families finding that less than a third have the same genetic risk while in 70% of cases the genetic risks didn’t overlap, in a study reported in Nature Medicine.  Over 100 genetic mutations seem to contribute to autism.

70% of parents have been badgered by their children to buy junk food that they have seen advertised on TV, with 43% saying they are pestered at least once a week and 39% saying they think TV adverts make it harder to help their children eat a healthy diet, according to a survey by the British Heart Foundation of over 2,100 parents [there is no information to suggest it was a representative sample].

A report, ‘Promising approaches to reducing loneliness and isolation in later life,’ is published by Age UK and The Campaign to end Loneliness.


25th January 2015

Placing a full time psychologist in a homeless hostel improved health and wellbeing and reduced crime to an extent that was estimated to cover its costs.
(Feature rather than news item; case study rather than hard research):–and-enjoys-a-successful-first-year-10000838.html

Informed: Issue 20


[Weekly email sent out ————————————————————–]


23rd January 2015

Spending on the NHS will have to increase by 2.9% p.a. above inflation to maintain its standard of service, according to the Health Foundation.  This compares to an expected rise in GDP of 2.3% a year and will be necessary because they expect efficiency savings of only 1.5% a year, less than anticipated in the Five Year Forward View.  Without this funding there would be a £65bn black hole in the finances by 2030.

A&E waiting time figures have improved and are back at the levels of November, with 92.4% of patients seen within four hours in the week to 18th January (for all emergency centres, not just hospital A&Es)

The poorest households have lost most from tax and benefit changes since 2010 in terms of the percentage of income, although the richest have paid most in absolute terms, according to an analysis by the Institute for Fiscal Studies.  Those on middle incomes fared best.  The average family is £1,127 a year worse off.

The mass prescription of statins appears to widen health inequalities with them having saved 50% more lives amongst the richest 20% of the population than the poorest 20% according to research on heart disease deaths between 2000-07 by Liverpool University published in BMJ Open.  It also found that changing diets and other lifestyle changes had prevented more deaths than statins.

A guide to health and social care information has been published by HSCIC.  Although aimed at journalists, it will also be very useful for others searching for data and statistics.

CQC is consulting on how it regulates substance misuse services.  The deadline for responses is 19th March.


22nd January 2015

The Government is to introduce standardised cigarette packaging in England, (with Wales saying they would follow it), laying regulations before Parliament in time to be agreed before the general election, after earlier delays.  If approved, it is to come into effect from May 2016.  Tobacco companies and others objected.

The NHS is ‘stretched to the limit’ according to the latest quarterly report by the King’s Fund based on an analysis of a range of data, with falls in many performance indicators.  Its survey of NHS finance directors found that 60% of NHS trusts are relying on bailouts from the Department of Health or the use of balances to deal with deficits this year.

The NHS has disregarded the wishes of tens of thousands of patients who wanted to opt out of sharing their medical records, because it was found they could not do so while not affecting their care, as promised, since it would mean they would not be approached for health screening.
Over 100 people who opted out of may have missed invitations for cancer screenings:
HSIC may have to write to ‘millions’ of patients:
Statement from HSCIC.  They are committed to contacting everyone who has ‘laid a Type 2 objection’ (not explained).  They also say: “The numbers or identity of the patients who have registered this objection are not yet known.”
NHSE statement, says “the opt out is not currently live.”

The Government should commission research on food poverty and start measuring its extent, the Environment, Food and Rural Affairs Select Committee has recommended.
(Comment piece)

Monitor says that CCGs should not automatically renew those community services contracts that are now ending, but should explore ways to do things differently and better in future.  Half of CCGs with contracts ending in 2015 plan to extend the contract with an existing provider for at least one of the services, in the 147 CCGs they have heard from.

The CQC has put three GP practices into special measures for the first time.  They are in Reading, Liverpool and Sale, Greater Manchester and will receive external help to improve.
(20th January)

Prison suicides are at the highest level since 2008 at 82 in 2014 according to official statistics due to be published next week, it is reported.

HSCIC expands its mental health statistics to include learning disabilities and also provides data at local authority as well as CCG level.  The monthly figures for October are now published.

A guide on ‘How to provide youth-friendly mental health and wellbeing services’ is published by the Mental Health Foundation.


21st January 2015

A Health Select Committee report on complaints says the inexcusable treatment of whistleblowers is a stain on the NHS.  It says medical professionals are less likely to come forward because of fear of the personal consequences.  It also said there should be a single gateway for complaints.
CCGs which co-commission primary care could respond to complaints on GPs in future, NHS England has suggested in response to the report:
(Response from the Patients Association)

Cuts in social care of £1bn in the three years following 2010 have led to the number of older people receiving home care having fallen by a third, places in day care centres having fallen by two thirds and 40% fewer people receiving equipment and adaptations, according to Age UK.  The numbers receiving help have fallen by 250,000 in three years.  It is suggested this has contributed to the increasing numbers visiting A&E.

Labour claims that the large increase in numbers going to A&E in the last four years is at least in part because of Government policies including cuts to social care and removal of the right to see a GP in 48 hours.

The SNP has said they would be prepared to vote on issues related to the NHS in England on the grounds that it could affect the level of health funding for Scotland through the Barnett formula.

Delays in changing the system of recording deaths in England and Wales through the use of medical examiners reviewing death certificates have been criticised by the President of the Royal College of Pathologists.  The changes were recommended in a 2002 review led by Tom Luce, formerly head of social care policy at DH.  DH said they were committed to reforming the system and had working models in two areas which they were reviewing.

The health of artificially conceived babies has improved over the last 20 years with fewer born prematurely or with low birth weight, according to an analysis of data on more 92,000 Scandinavian children born between 1988 and 2007, led by the University of Copenhagen and published in the peer reviewed journal Human Reproduction.  The most important reason for the improvement is said to be the decline in multiple births as result of transferring only one embryo at a time per cycle.

Three handbooks to help plan services for people with long term conditions (LTCs) have been published by NHS England.  The three areas covered by the guides are: “identifying people in the population with LTCs that are most vulnerable and at risk of unplanned hospital admissions; planning personalised care and support; and best-practice multi-disciplinary working across professional and organisational boundaries.”

A resource to support people working with older people is published by IRISS (the Scottish Institute for Research and Innovation in Social Services).  The advice is split into four sections from the simple to the longer term: small steps, walk, run, fly.


20th January 2015

The Government is providing £25m to the 65 councils most affected by delayed patient discharges to help them tackle the problem, with the money to be spent by the end of March.  This is an average of £380k per council.

The Scottish Government is investing £100m over three years to help reduce delayed patient discharges.

People with mental health conditions are having their benefits sanctioned more than any other condition, at a rate of at least 100 a day, according to research by the Methodist Church based on responses to foi requests to the DWP.
(21st January) (Regn)
(23rd January)

Walking in groups has mental and well as physical benefits, with improvements including reductions in: blood pressure, resting heart rate, blood cholesterol levels, body fat, BMI and depression, according to a systematic review of 42 studies covering 1,843 participants in 14 countries, by the University of East Anglia and published in the British Journal of Sports Medicine.  Walking in groups can improve motivation and reduce loneliness and isolation.

Draft guidance on how much time to spend in the sun, balancing the benefits of increasing Vitamin D with the risks of skin cancer, is being consulted on by NICE.  It is suggested that people should have short bursts in the sun between April and October.

The CQC and GMC could carry out joint inspections on GP practices if they both have concerns, according to a new ‘Joint Operating Protocol’, although this is unlikely to happen often.

Easing the regulations on creating combined authorities has been welcomed by Clive Betts, Chair of the Communities and Local Government Select Committee.


19th January 2015

Nearly 40% of households with children have an income less than that needed to participate in society, while for lone parents family the figure is 71%, according to a report by the Joseph Rowntree Foundation which uses a minimum income threshold derived from consultation with the public and amounting to an income of £16,284 for a single person of working age.  While for younger single people a significant cause of the change is unemployment, for most working households the explanation is more stagnant wages and cuts to in-work benefits.

A Labour Party report on strategies to improve mental health from a taskforce led by Sir Stephen O’Brien, is published as Ed Miliband says a future Labour government would ‘end the scandal of neglect’ of child mental health issues.

Nigel Farage has said that funding the NHS through an insurance based system run by private sector companies is a debate which will have to be returned to, in a Radio 4 interview, having originally raised this in 2012 but having been voted down by colleagues.
(20th January) The UKIP health spokeswoman says UKIP would reject Farage’s proposal if he made it again:
(20th January)

A memorandum to promote joint action to improve health through the home has been agreed between various bodies including DCLG, the Chartered Institute of Housing, the Homes and Communities Agency and various health bodies.  The memorandum is due to be formally announced later in the year.

16m people a year die prematurely globally from non-communicable diseases according to the WHO “Global status report on noncommunicable diseases 2014″.

People are more likely to be able to stop smoking, lose weight or be more active if their partner is doing so at the same time according to a study by UCL funded by the US National Institute on Ageing and the UK Government, with support from Cancer Research UK and the British Heart Foundation, looking at 3,722 couples aged 50 or over involved in the English Longitudinal Survey on Ageing, and published in JAMA Internal Medicine.  Two thirds of men and women became more physically active if their partner did, while only a quarter did if their partner was inactive.

Dementia rates are higher in northern than southern areas according to research from the University of Edinburgh.  It is speculated that differences in getting vitamin D from sunlight might be amongst the causes.  The data included studies of 26,000 twins in Sweden (so eliminating genetic differences) and 37,000 Scots born in a single year, 1921.

Half of dentists did not prominently display a price list as they should, in a survey by Which when undercover researchers visited 25 premises.  In a poll of 1,001 people, 26% were unsure how public and private costs differed, 31% said costs had put them off having treatment and 19% reported unnecessarily paying more than one charge for one course of treatment over the last two years.  Large differences were found in the private costs for the same treatments.

Health charities criticise the sponsorship deal with Coca Cola leading to a rebranding of the London Eye.

A briefing on integrating health and social care personal budgets is published by the NHS Confederation and Think Local Act Personal.

A ‘Practical Guide to Healthy Ageing’ aimed at people over 70 with ‘mild frailty’, has been published by NHS England and Age UK.


18th January 2015

The Lib Dems propose a goal of zero suicides while Labour propose more to be spend on child mental health.  Currently 4,700 people a year die from suicide.  They are promoting the use of an approach pioneered in Detroit.  [See also separate item on Labour task force and commitments, 19th January]
Nick Clegg speech:

There is a big overlap between people in the criminal justice system and those using support services such as for drug addiction and homelessness, according to research by Heriot-Watt University commissioned by the charity Lankelly Chase Foundation.
(19th January) (Rgn)


17th January 2015

The number of nurses taking time off for stress has increased in the last year by 27% in London, by 17% in Wales and 34% in Scotland, according to the results of freedom of information requests by the Observer.  The Department of Health is quoted as saying stress levels are stable across England.


[Weekly email sent out ————————————————————–]


17th January 2015

The LGA is asking for a fifth of VAT receipts on unhealthy foods to be given to councils to use in combating obesity, in a report “Tackling the Causes and Effects of Obesity”.  This should generate £1bn.  They say that research shows that every £1 invested in physical activity or subsidised leisure programmes generates £23 savings in health costs.


16th January 2015

NICE has published draft guidance for consultation on how A&E departments can deal with overcrowding, including bringing in more nurses, with suggested minimum requirements, and moving patients out of overcrowded A&E units.  However, there are already problems in recruiting enough nurses.

Target times for ambulance response of 3 minutes rather than 1 to assess calls before ‘the clock starts’ on the 8 minute target response time, to allow more time for diagnosis of the situation, are to be piloted in two areas covering 13m people.  This won’t apply to the most serious cases.

NHS England is delaying for four months the introduction of an expensive drug to treat Hepatitis C which has been approved by NICE.  This is apparently the first time the use of a drug has been delayed in this way.  It is suggested that it may have been done to save costs.

The proportion of people seen in hospital A&E’s within the 4 hour target was 84.3% last week, a slight improvement of the previous week’s all time low of 79.8%.  For all emergency units (including walk-in centres) the latest figure was 89.8%, up from 86.7% the previous week.

Elderly people admitted to hospital with dehydration are five times more likely to be from care homes than their own home, even after taking account that those from care homes are more likely to be older and have dementia, according to a study of 21,000 admissions to two hospitals in North London by the Royal Free Hospital and published in the Journal of the Royal Society of Medicine.

Informed: Issue 19


15th January 2015

Older people and those from more deprived backgrounds have poorer cancer care outcomes, but outcomes generally have improved since 2010, according to a report by the National Audit Office.  The report also noted that the target to treat 85% patients within 62 days of being urgently referred had not been met for a year.

The four year £250m p.a. infrastructure cash for GPs is to be dependent on meeting targets for greater access to GPs and keeping people out of hospital according to a letter from NHS England to all GP practices inviting them to bid for the funds.

Many examples of people being discharged from hospital without proper support and without information being passed on are to be revealed in a report by Healthwatch England due to be published in March.  Other examples were given in the Independent Information Governance Oversight Panel report published last week.

A revised Code of Practice under the Mental Health Act 1983 has been published.  There is more on involving patients, providing personalised care and minimising the use of police cells as places of safety.
(16th January) Consultation outcome:

CCG Bulletin: Issue 75


14th January 2015

Physical inactivity is the cause of twice as many deaths as obesity – 7.3% as against 3.7% according to a study from Cambridge University and others based on data on 334,000 Europeans followed over 12 years published in the American Journal of Clinical Nutrition.  Those who did the equivalent of a 20 minute daily walk were 16% to 30% less likely to die than those who were inactive.

Council cuts have fallen more heavily on poorer, Labour areas than on Conservative authorities according to two separate analyses.  CIPFA says the average cut in spending power is 6% rather than the 1.8% the Government claims, with a reduction of 7.8% in the North East but 3.4% in the South East.  An analysis by Newcastle-upon-Tyne Council says the average reduction is 2.1% with a cut of 4.3% in the North East and an increase of 0.5% in the South East.  CIPFA also criticise the double counting of the Better Care Fund in both NHS and local government figures.

Half of the funding for local welfare assistance schemes has not been spent by local authorities and there has been a 75% drop in the number of households supported in the two years of the scheme compared to previous arrangements, according to research by the Centre for Responsible Credit based on official data and responses to foi requests from 127 local authorities.

47% of unemployed young people are always or often depressed according to an online survey by YouGov for the Prince’s Trust of 2,161 young people aged 16-25, weighted to be representative of the UK population of that age and published in their Youth Index 2014.

Poor diabetes care, such as not providing adequate check ups, is causing complications and so wasting money according to the charity Diabetes UK.

Public sector workers should be trained in mindfulness to combat stress and absenteeism according to a report from the all party group on mindfulness.

Monitor is consulting on draft guidelines on how it uses its powers to stop health providers blocking the integration of services.

Statistics on fostering in England 2013-14 are published by Ofsted.


13th January 2015

There is a call for fluoride to be added to water supplies across England to reduce tooth decay, in a report by the Royal College of Surgeons faculty of dental surgery, ‘The State of Children’s Oral Health in England’.
Link to pdf of the report:

Favourable socioeconomic status and self-regulatory behaviour in children were found to be the biggest predictors of good cardiovascular health in adults, in a Finnish study of 3,577 children aged 3-18, of whom 1,089 were followed up 27 years later.  The results were published in the American Heart Association journal, Circulation.

People working more than 55 hours a week were 13% more likely to consume ‘risky’ amounts of alcohol, (more than 21 units a week for men or 14 for women), according to a study of 330,000 people across 14 countries, published in the BMJ.
(30th January) Blog summary:


12th January 2015

The Cancer Drugs Fund is to be increased from £280m to £340m, but 25 of the 84 authorised treatments are to be stopped from 12th March (this means 16 drugs taken off the list, as some are used for more than one treatment).  While some, including pharmaceutical companies criticised the withdrawal of drugs from the list, others noted that the whole process is irrational and unfair, in overriding the separate process by which NICE determines the cost effectiveness of treatments across all conditions.
(10th January) Article in anticipation of the report, including a number of criticisms of the Fund:
(13th January) blog from the Nuffield Trust:

Falls in life expectancy for 85 year olds in some areas, such as the North West of England, have led PHE to investigate, to see whether this is likely to be a continuing trend (there are generally fluctuations from year to year).  There is speculation that the cut in adult social care spending of £3.5bn over the last four years and the reduction in the numbers receiving care from 1.8m to 1.3m, may be part of the cause.

42%, or 32 of 77, CCGs questioned, are intending to take full delegated responsibility for commissioning primary care services, according to research by Pulse magazine.

Voluntary organisations are seeking to have a greater role providing support to A&E departments, to relieve some of the current pressure on them.  The proposals are being led by the Association of Chief Executives of Voluntary Organisations (ACEVO).
(16th January) Ways in which volunteers can help:

60% of morbidly obese people had no record of a weight management intervention according to research on the records of 90,000 overweight and obese people between 2005-12 by a team from King’s College London and published in BMA Open.  They also found wide variation between different areas.

Everyone should be regularly weighed to help tackle the obesity problem according to the National Obesity Forum in its annual report, which also recommends clearer labelling of food and more training for GPs.

Guidance on commissioning technology enabled care services, such as telehealth, telecare and self-help apps, is published by the NHS Commissioning Assembly.


11th January 2015

Seven different approaches to improve prevention, diagnosis, treatment and support for cancer are being trialled in 60 sites across England by an NHS cancer task force which includes Cancer Research UK, Macmillan Cancer Support, Public Health England and the Royal College of GPs.  One thing being tried is self-referral to tests rather than going via a GP.
(12th January)
(12th January)


10th January 2015

There has been an increase in the number of planned operations which have had to be cancelled, with 12,345 called off between 3rd November and 4th January, an increase of 32% on the 9,320 cancelled in the same period in the previous year.

There are critical gaps in dealing with the mental health needs of children and young people, according to a survey of headteachers by CentreForum, with those from more than half the schools saying that the referral system to CAMHS is not working.  It also found that 47% of schools use screening tools to identify the severity of pupils’ mental health needs.


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9th January 2015

79.8% of patients were seen by hospital A&Es in the target four hours, in the week to 4th January, with 86.7% seen within the target time in emergency departments overall (including walk-in and emergency care centres).

Circle has announced it is to withdraw from running the Hinchingbrooke Hospital in Cambridgeshire, blaming reduced funding, increased demand, inconsistent and conflicting regulatory regimes and a failure to join up health and social care.  CQC rates Hinchingbrooke as ‘Inadequate’ and has recommended it is placed in special measures.

Nearly a million people went to A&E because they couldn’t get a GP appointment last year, with the proportion unable to get an appointment having risen from 8.85% in 2011 to 10.91% last year, according to an analysis of NHS figures by the Labour Party [there are about 14m visitors to A&E a year].  Meanwhile, a report from the Public Accounts Committee found that the proportion of spending on primary care had fallen from 29% to 23% between 2003-4 and 2012-13.  The report also says many areas are not receiving the funding they are entitled to as the funding allocation system is gradually changed.  The committee said more should be done to validate GP practices’ lists.

NHS spending on CAMHS (child and adolescent mental health services) has fallen by 6% in real terms between 2009-10 and 2012-13, from £766m to £717m (at 2013/14 prices) according to a written parliamentary answer from Normal Lamb.

Changes to allow for seven day a week working have been outlined by DH, including the possibility of losing unsocial hours payments for working Saturdays and Sundays, in their submission to the NHS Pay Review body.
(8th January)

Of the 2.3m households in fuel poverty in England, 1.1m had someone in work, according to a report by the Policy Exchange.  The situation has been made worse by rising energy prices and energy inefficient properties.


8th January 2015

CQC’s inspections of 50 GP surgeries have found 1 to be ‘outstanding’, 42 ‘good’, 7 ‘requires improvement’ and none ‘inadequate’.

Melanie Dawes is to replace Sir Bob Kerslake as permanent secretary at DCLG, it has been announced.  She is currently head of the Economic and Domestic Secretariat in the Cabinet Office.–2

A synthesis of evidence on supporting self-management for people with long term conditions, and systematic review on how self-management can reduce care provision, are published by NIHR.

The latest statistics on substance misuse treatment for young people is published by Public Health England.

A self-directed 48 week walking programme did not reduce falls in the over 65s, although there were other benefits from increased physical exercise according to a randomised controlled trial of 386 physically inactive over 65 year olds in Sydney, published in Age and Ageing.


7th January 2015

A new class of antibiotics has been discovered, using techniques which could be used to find even more.  The last class of antibiotics developed for clinical use was discovered in 1987.  It is hoped that the new antibiotic, teixobactin, may be less susceptible to resistance.  However, it only works on some bacteria (but these include MRSA and TB).  It has so far been tested on mice.  The first trials on humans could begin within two years.
(8th January)
(8th January)
(8th January)

Half of hospitals reported that at least 10% of beds are taken up by patients who are physically able to leave according to a survey of the heads of 50 NHS trusts across England for the Guardian.  55% of respondents said the problem was worse now than a year ago.  Cuts to social care are widely blamed for exacerbating the problem.

Two national leaders have been appointed to support the implementation of the new care models identified in the Five Year Forward View.  They are Samantha Jones, Chief Executive of Watford, St Albans and Hemel Hempstead Hospitals and Sir Sam Everington, a GP from Tower Hamlets.

NHS Safety Thermometer information for England, December 2013 – December 2014 published.  (It measures harm from pressure ulcers, falls, urine infections (in patients with a catheter) and venous thromboembolism (VTE)).

Informed: Issue 18


6th January 2015

The A&E 4 hour waiting time target was met for 92.6% of patients in the last quarter, October-December 2014, the worst quarterly result in a decade according to official statistics.
Possible reasons for the A&E crisis:
(7th January)
(7th January) More expert opinions:
How the £700m Government emergency funding announced earlier in the year is being spent:

83.1% of hospital A&Es met the four hour waiting target in the week before Christmas, with 88.8% of all emergency centres (including walk-in and emergency care centres) meeting the target.

Eight more hospitals have declared major or critical incidents, bringing the total to 15 (although it appears there are not standard definitions for such states).

More councils are cutting back on the council tax support scheme, for which the Government cut the funding when they handed the responsibility to councils in April 2013.

The Lib-Dems say they will increase spending on the NHS by £8bn a year, by 2020-21, with increases after that in line with growth in the economy, which, they say, is more than has been promised by Labour or the Conservatives.

Macmillan cancer support say the number of cancer survivors is creating a crisis for the NHS, with a record 2.5m people likely to be living with it or its after effects in 2015, an increase of 400,000 over 5 years, based on projections by researchers from UCL and King’s College London.,Macmillanrevealstoday.aspx


5th January 2015

Five more hospitals have declared major incidents, with increasing pressure on A&E.

Later Life Newsletter 63


[Weekly email sent out ————————————————————–]


5th January 2015

A campaign to encourage parents to reduce their children’s sugar consumption is being launched by Public Health England.  It will include sugar swap tips on lower sugar food and drink alternatives.  In a pilot of the approach conducted by the University of Reading, sugar consumption fell by 40% over a month.

Attempts to reduce health inequalities in Scotland have not been effective according to Holyrood’s Health committee, which says that a ‘joined-up approach across a raft of policy areas’ is needed.


4th January 2015

Labour says the NHS has missed 7 out of 15 patient rights as set out in the NHS Constitution in the last year, including missing targets on A&E waiting times, ambulance response and first treatment for cancer.  The Tories dispute some of the figures used.

UKIP would require all 130,000 foreign NHS workers to undergo language tests according to comments by Nigel Farage on a Sky News programme.  (Doctors applying for a licence to practise medicine in the UK must already demonstrate competence in the English language).
(6th January) Background information:


3rd January 2015

The number of meals on wheels served has dropped by 63%, or 220,000 meals since 2010, according to an extrapolation from figures obtained by Labour from 84% of relevant councils from FOI requests.  The biggest fall was in the last year, when it fell by a half.

Surgeries offering health checks for people with learning disabilities were twice as likely identify problems as those not in the scheme, according to research from UCL on over 8,000 patients published in Lancet Psychiatry.  Six out of ten surgeries offer such health checks, which were introduced in 2008.


2nd January 2015

Making the NHS a seven day a week service is undefined, unfunded and unrealistic, the BMA has said in a submission to the Doctors’ and Dentists’ Review Body .  It says the changes would require a significant resource investment and question whether that is available.  They also said there was a lack of evidence as to whether patients wanted diagnostic tests or planned operations at the weekend.  The BMA also criticises proposals to remove the GP training supplement which could make it harder to recruit GPs.

20% of GP surgeries have had an influx of patients following the closure of nearby practices according to a survey by Pulse magazine of 602 GPs.

The Independent Information Governance Oversight Panel’s first annual report finds ‘pockets of exemplary practice’ in health and social care organisations sharing information, but a need for improvement overall.  The panel is chaired by Dame Fiona Caldicott.

Children, Families and Maternity e-bulletin (9pp).


1st January 2015

The variation in cancer risk in different types of tissue is largely explained by the number of lifetime cell divisions of that tissue, (not the same apparently as ‘two thirds of adult cancers down to bad luck – this is about relative risk not absolute numbers of cancers), according to a study from the John Hopkins University School of Medicine in Baltimore. The study looked at the number of times self-renewing stem cells divided in 31 different types of tissue and compared this with the incidence of cancers in those tissues.  It found that 65% of cancers across a range of tissues were largely caused by random mutations (but with a high margin or error, with a 95% confidence interval of 39% to 81%).  9 out of 31 cancer types had incidence rates higher than predicted by bad luck. The article’s abstract says: “These results suggest that only a third of the variation in cancer risk among tissues is attributable to environmental factors or inherited predispositions. The majority is due to “bad luck,” that is, random mutations arising during DNA replication in normal, noncancerous stem cells.” The researchers said that early detection was therefore important for dealing with most cancers.
(2nd January)–not-lifestyle-or-genes–to-blame-9953337.html
(2nd January)
(2nd January)
(2nd January) article explaining how this item has been generally incorrectly reported – unfortunately I didn’t find it easy to follow):
(5th January)
(13th January) reviews some of the criticism of the reporting of the research, but still doesn’t totally clarify it for me:

The Friends and Family Test (FFT) is rolled out to mental health and community health services from 1st January 2015.

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