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2015 Q2 April-June

Health and Wellbeing Policy Update: April-June 2015

This is a weekly update of key policy items relating to health and wellbeing (mainly in England).  It is in reverse chronological order (most recent at the top).  It is grouped in three month blocks: click here for other quarters.  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).

30th June 2015

Problems with the NHS 111 service have been found in a Daily Telegraph undercover investigation with the South Central Ambulance Service (SCAS).  Amongst the allegations are that ambulances were not sent even if someone appeared to be suffering a heart attack, that if ambulances were ‘stacked’ because of a backlog of requests they would only be sent for heart attack or stroke victims, and that computer data could be changed to make it look as though ambulance response times were being met.  SCAS has said it will hold an internal investigation.

Death rates from emergency bowel surgery are higher than they should be because of failure in a range of processes in some hospitals, according to a clinical audit of emergency laparotomy, funded by the Government and commissioned by the Healthcare Quality Improvement Partnership.  Looking at data from 192 of 195 eligible NHS hospitals it found that 11% of patients die within 30 days of surgery.  Problems included delays in diagnosis and in being operated on, and not being given the right post-operative care.

The last day of the Independent Living Fund in England was 30th June, with responsibility passed to local councils from 1st July, but with a cut in total funding from £300m to £262m and no ring fencing of the money.  The fund allows very disabled people to continue to live in their home in the community.  Scotland and Northern Ireland have decided to keep national schemes and Wales has guaranteed funding to individuals until at least next year.

A safe staffing framework for mental health wards has been published by NHS England.

A ‘Call to Action on the Future of Health and Wellbeing Boards’ is published by the LGA and NHS Clinical Commissioners.


29th June 2015

Training for doctors’ receptionists in how to spot the signs of stroke could save several thousand lives a year by getting quicker treatment, it is suggested, in the light of research from Oxford and Birmingham universities based on 520 mystery shopper type calls to 52 practices and published in the British Journal of General Practice.  150,000 people a year suffer a stroke and about 52,000 people die from one.

Real, median, disposable incomes have fallen by £500 a year since 2008, according to the ONS’s annual assessment of households’ finances, although some groups such as retired people have seen an increase.  While the richest fifth of households paid six times more tax than the poorest fifth, it was lower as a percentage of their income (35% to 38%).  More than half of households received more than they pay out in taxes.

Sugary drinks are estimated to kill 184,000 adults globally, and 1,316 in the UK, from diseases such as diabetes, heart disease and cancer, according to research drawing on 62 dietary surveys across 51 countries between 1980 and 2010, combined with information on the harms of sugar, undertaken by Harvard, Tufts and Washington Universities and Imperial College, London and published in the American Heart Association’s journal Circulation.
(30th June)

Statistics on obesity are brought together in a briefing from the House of Commons Library.

Guidance on implementing the mental health crisis concordat, for adult safeguard boards has been produced by the LGA.


28th June 2015

New guidance on the duty of candour says that professionals should provide personal, heartfelt (sic) apologies face to face if something has gone wrong.  They should say ‘I am sorry’ rather than offer general regrets on behalf of the organisation.  If there has been a problem, NHS staff should share all they know and believe to be true and respond honestly to questions, in plain English.

Two thirds of products were found to have more salt than declared on the label but most were within the 20% tolerance allowed, according to a Channel 4 Dispatches programme on salt.  It also found that the number of children treated for high blood pressure had tripled over ten years to just over 1,000 admitted to hospital between 2012-14.  Of 73 companies that signed up to the ‘responsibility deal’ pledge to reduce salt in their foods, only 12 had met the target.

The closure of 112 children’s centres this year is among a range of cuts to services for new mothers, likely to impact on both mother and baby health.  This is likely to affect such things as breastfeeding and mental health.

Safe alcohol drinking levels are likely to be reduced when official guidance is renewed later in the year, taking into account factors such as the evidence on increased cancer risks since the current guidelines were set in 1987.

Increasing the minimum price of alcohol by 10% led to a fall in crimes against the person of 9%, including of sexual assault, violence, murder and drink driving according to Canadian research on changes between 2002 and 2010 in British Columbia, published in the Journal of Studies on Alcohol and Drugs.


27th June 2015

The amount of costs that lawyers can claim in clinical negligence cases will be capped at a given percentage of the award to the client, if Government plans go ahead.  They are to consult on the proposals in the autumn. Such a change could save the NHS £80m a year on overall costs of £259m for such legal fees.  A lawyer is reported as saying costs are already managed by the courts.
(28th June)

Research on end of life care from the previous year is brought together in ‘What We Know Now 2014’ from PHE’s End of Life Care Intelligence Network.


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26th June 2015

Child sexual exploitation referrals rose by 30% last year according to research by Community Care magazine based on freedom of information requests.

Monitor is setting up a team to provide help in reducing the cost of agency staffing, working initially with three Trusts.

There has been an increase in purchases of ready meals and takeaways over the last forty years, according to a comparison of buying habits in 1974 and 2013 in DEFRA’s annual Family Food Survey.


25th June 2015

Convictions for violence against women rose by 16.9% last year, to 78,773, but with a rise in prosecutions of 18.3%, the conviction rate fell, according to figures from the Crown Prosecution Service.

Hospital admissions related to alcohol increased by 5% to over 1m between 2013 to 2104, continuing a long term trend, while a narrower measure where the primary reason for admission was alcohol showed an increase of 2% to 333,000 according to a report from the HSCIC, summarising data from a range of sources.  However, there was an increase in adults saying they do not drink, from 19% to 21% and a reduction in those who had binge drank in the previous week, from 18% to 15%, which it is thought could help reverse the trend of alcohol ill health in the longer term.

A report on children’s health showed a doubling of the number of girls taken to hospital for eating disorders over the three years between 2010-11 and 2013-14, from 840 to 1,656.  The report also shows a decrease in the proportions getting the recommended amount of exercise, an increase in sedentary behaviour, increases in the numbers eating their five a day and a reduction in drug taking.  Amongst 15-19 year olds, there were more than twice as many referrals to psychological therapies for young women as young men (34,000 to 16,000).  There was an increase in the proportion of those with mental health problems amongst older age groups (15-24) but falls in younger children (5-14).

The LGA is calling for councils to be given more powers to prevent child sexual exploitation through ‘disruption orders’ which allow social workers to intervene if there is fear a child is being groomed.

The proportion of children in absolute and relative poverty remains unchanged despite predictions it would rise, according to figures from the DWP.  Alan Milburn, Chair of the Child Poverty and Social Mobility Commission, said the UK was not on track to meet the statutory target of ending child poverty by 2020.  In households where at least one person had a disability, absolute poverty after housing costs rose by 300,000 to 5.6m, although relative poverty stayed the same at 5.1m.

Britain was ranked 44th out of 145 countries in a global wellbeing index, based on surveys by Gallup and Healthways (a natural food chain).  The top spot was retained by Panama.  The index looks at five elements: purpose, social, financial, community and physical.
(25th June)

The first combined metro area mayor starts next week, on 1st July in Greater Manchester.  The existing Policy and Crime Commissioner, Tony Lloyd takes on the role on an interim basis prior to the election of a directly elected mayor in 2017.

A ‘Trial Advice Panel’ has been launched by the ‘What Works Team’ in the Cabinet Office, which in partnership with the Economic and Social Research Council, will offer advice to government departments on designing and implementing controlled experiments, with a view to producing more evidence based policy.

A report, ‘Shaping the Future: a strategic framework for a successful NHS’ from the Health Foundation identifies five interlinked layers which it says should be addressed: active cost management; process improvement for quality and efficiency; new ways of delivering care and support; scientific discovery, technology and skills; focus on population health.

How data and technology can transform health and care services over the next five years, is set out in a short document (9pp) from the National Information Board, setting out six priority areas for change.

A review of research on residential care for looked after children is published by the Department for Education.

A research report, ‘Organisation, Service and reach of children’s centres’ is published by the Department for Education.

Statistics on ‘Households Below Average Income’ between 1994-5 and 2013-4, is published by DWP.

‘Ageing: the silver lining: The opportunities and challenges of an ageing society for local government’ is published by the LGA.


24th June 2015

A ‘taskforce’ on child protection, is being set up, the Prime Minister has announced.  Made up entirely of ministers, its role will be to ‘drive improvements’ in the protection of vulnerable children through ‘reforms’, promoting innovative models of delivery and ‘overhauling’ the way local agencies work together.
(25th June)

Figures on the number of deaths following loss of benefits are being prepared for publication David Cameron has said, although Iain Duncan Smith had said two days previously that his department does not collate such numbers.  The Information Commissioner ruled in April that the DWP should publish data on the deaths of incapacity benefit and ESA claimants, but the DWP appealed the decision.

New guidance from NICE on workplace health for employers and employees recommends such things as working reasonable hours, taking regular breaks and giving staff more control over their time.  27m days in 2012-13 were lost to illness including stress and back pain.

Co-operatives in health and care have grown by 50% in the last five years, with turnover having risen from £40m to £60m according to a report from Co-operatives UK.  The co-operative sector as a whole turned over £37bn last year.


23rd June 2015

Earlier referral to cancer tests by GPs could save 5,000 lives a year, NICE has suggested in new guidelines.  They are suggesting that GPs should be able to make referrals directly, without having to go via specialists.  They have also provided guidance to patients and doctors on spotting cancer symptoms. England currently lags behind many other European countries’ survival rates and late diagnosis is thought to be a key problem.

Much of what is needed to prevent climate change is also good for health, such as more walking and cycling, reducing air pollution, eating less red meat and healthier, sustainable, local foods, according to research led by UCL and including international experts, for the Lancet.  Conversely, climate change could reverse the health gains of the last 50 years.

The number of children looked after by local authorities increased by 1.26% in the year to March 2015, according to a freedom of information request answered by 109 councils.  Extrapolating to all authorities and bringing in other official figures, this suggests that over the period of the coalition government, the number of children in care rose by 8.1%, the number of vulnerable children placed on child protection plans rose by 32.6% and the number of S47 enquiries into whether children are at risk rose by 42.5%.  The official statistics are due to be published in the autumn.

A review into why so many looked after children end up in the criminal justice system, set up by the Prison Reform Trust, is to be chaired by Lord Laming and to last nine months.  Of 15-18 year olds in custody, nearly two thirds of girls and a third of boys have spent time in care, while 1% of all children in England are in care.

Micro-enterprises (of fewer than 5 people) provide more personalised and better value social care but struggle to get referrals from local authorities, according to research from the University of Birmingham.

The cabinet has discussed the possibility of changing the definition of poverty.  It is argued that the current relative definition (60% of median of incomes nationally) can be misleading and subject to change not reflecting any difference in material circumstances.

Patients’ summary care records are to made available to community pharmacists (with the patient’s consent) with support from the Health and Social Care Information Centre (HSCIC).

NHS staff will be encouraged to identify their stress and support will be given to deal with it under a new programme from NHS Employers.

Statistics on walking and cycling by area showing 47% of people walking five times a week but only 3% cycling five times, are published by the Department of Transport.  The figures are based on the ‘Active People Survey’ carried out by Sport England.

A report, ‘The impact of the coalition government on disabled workers:
Workplace experiences and job quality’
by the Public Interest Research Unit for the campaign group Disabled People against Cuts, is based on information from 137 disabled workers and 141 organisations.
Press release from PIRU:
Description and link to the report from DPAC:

A factual briefing on GPs in England is published by the House of Commons library.


22nd June 2015

3,300 non-European nurses could be forced to leave the country by 2017 because of changes to the migration rules despite there being a staff shortage, the Royal College of Nurses has warned.  Under the new rules which come into effect next April, workers from outside the European Economic Area will have to leave after six years if they are earning less than £35,000 p.a.  Out of 665k registered nurses in the UK, 571k are from the UK, 29k from the EU and 66k from the rest of the world.
Analysis and comment:

55% of smokers and ex-smokers have respiratory impairments, despite being shown to be disease free by lung function tests, according to a study of 8,872 people aged 45-80 who had smoked at least a packet of cigarettes a day for ten years.  The research, by National Jewish Health in the U.S., published in the journal Internal Medicine, did further, detailed tests to discover other conditions such as emphysema or shortness of breath.

Jeremy Hunt has said there will be some flexibility in the election promise of 5,000 more GPs by 2020, and later said that the 5,000 figure was a ‘maximum’, although DH insists the target still stands.
(24th June)
(24th June)

Claims by David Cameron that the ‘troubled families programme’ has saved £1.2bn are criticised as unproven by Jonathan Portes of the NIESR, who is reported as saying the claims were ‘pure, unadulterated fiction’.  The programme is to work with an additional 400,000 families over the next five years.
(23rd June)

Capita is to be the sole provide of GP back-office support under the Primary Care Support Services contract, worth about £400m over 7-10 years.

Hospital doctors are being bullied for raising concerns about safety according to the BMA, based on a survey of 500 Welsh doctors which found 60% had raised a safety concern in the previous three months and 60% of those had experienced bullying or harassment as a result.

A JRF report asks ‘How Can and Should UK Society Adjust to Dementia’, using a social model of disability.


21st June 2015

Initial results from a trial testing earlier treatment for eating disorders suggest it encourages speedier recovery and fewer dropouts.  Only 45 patients have so far been through the one year trial, which has been running for nine months, at the South London and Maudsley Foundation Trust, funded by a £75k grant from the Health Foundation.


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21st June 2015

Vaccinations against meningitis for 2 month-olds through to university students are to start from August in England and Scotland, with Wales and Northern Ireland thought likely to follow suit.  The vaccination of babies against Meningitis B is said to be the first national, publicly funded programme in the world.
(22nd June)
(22nd June)
(20th June)
(22nd June)
(22nd June)


20th June 2015

Reductions in child poverty since the 1990s have reversed, figures out next week (25th) are expected to show.


19th June 2015

The Government is offering a ‘new deal’ for GPs in return for 7 day working, including 5,000 more GPs (as promised before the election), 5,000 more support staff (including 1,000 ‘physician associates’), help for those wanting to return to practice and financial support for working in more deprived areas.
The speech:

Hunt says GPs should move away from a mentality of clocking off at 7pm and should continue to have a responsibility for patients after that time.

Ten priorities for commissioners to transform the health care system are published by the King’s Fund, updating an earlier document from 2011.

A report on the government’s use of payment by results schemes is published by the NAO.


18th June 2015

The College of Social Work, set up after the death of Baby P, is to close due to lack of Government funding.  The body, which had 16,000 members (against a target of 31,000) was supposed to be the voice of social work.  A proposal by the College that it should take on other functions, which would have brought in more income, was rejected by the Government.
(19th June)
(19th June)

There is a continuing longer term fall in children’s fitness levels with the annual rate of decline twice the global average (0.95% to 0.43%) according to research by the University of Essex on 300 10-11 year olds from Essex schools, following similar research in 1998 and 2008.  Government policies are thought to be an important factor in the decline.  The least fittest child from a class of 30 in 1998 would be one of the five fittest children in a class of today.  The researchers say they did not find an obesity problem, though, with the average BMI below 1998 levels.
(19th June)

Overall 11.4% of pregnant women smoke, the lowest figures since records began in 2006-07, but the figure varies widely in different parts of the country, with a figure of 2.1% in central London but 27.2% in Blackpool, according to figures from the HSCIC.

A three year review into the reasons for premature mortality amongst people with learning disabilities has been set up by NHS England, the Healthcare Quality Improvement partnership and the University of Bristol.

Former GP Dr Sarah Wollaston has been re-elected as chair of the Health Select Committee.  (She beat David Treddinick, who is said to have championed the use of homeopathy and astrology to treat patients).

The new duty of candour has been criticised for providing fewer rights for patients of GPs, nursing homes or private practice than hospitals, by the charity Action Against Medical Accidents, which is threatening to seek a judicial review.  It is suggested that the Government may be prepared to change the duty.

Finland’s health ministry has issued advice on how to avoid sedentary behaviour, such as to eat, watch television or take a coffee break standing up.  Sedentary behaviour has been found to be harmful to health independent of other physical activity, and for those sitting for more than 7 hours a day every additional hour sitting increases the risk of death by 5%.

Meat sold in British supermarkets was infected with a strain of MRSA, called CC398.  Nine of 100 samples tested by the Guardian were infected, mostly in meat from Denmark, though other studies have found infection in British meat.  The bug is killed by cooking the meat and isn’t much of a threat to humans though it can cause skin complaints and more serious problems.  It is thought that early action now, through reducing the use of antibiotics could prevent the situation becoming as bad as in Denmark.
(20th June) Farmers call for a clampdown on the illegal use of antibiotics on farms:

Three reports on tackling poverty from different think tanks are published by the Joseph Rowntree Foundation:
‘Tackling the Systemic Causes of Poverty’, from the New Economics Foundation
‘Reducing Poverty Through Policies to Cut the Cost of Living’ from the Institute of Economic Affairs
‘Ideas to Tackle Poverty for the Long Term’ from the IPPR


17th June 2015

The number of allegations of sexual assault against children has risen by 38% in the year to 2013-14, to a total of over 31,000, according to an annual report by the NSPCC, ‘How Safe Are Our Children? 2015’.  The number of children referred to social services is at its highest level since 2010.

There has been no increase in the detection of child abuse despite a 300% increase in referrals to children’s social care since the Children Act 1989 was introduced according to an evidence briefing published by the Economic and Social Research Council.
(Link to pdf)

The Government is continuing with plans to make social workers liable to five year jail sentences for a criminal charge of wilful neglect, with a consultation later in the year, minister Karen Brady has said.

The NHS is estimated to be losing £300m a year from missed GP appointments, with 61,000 people not attending, according to a survey of 500 GPs by the Daily Mail and GP Magazine.

The number of people kept in hospital because social care  was not available increased by 19% in the year to 2014-15, at a cost of £669m, according to an analysis of NHS figures by Age UK.

The number of emergency calls for ambulances rose by 6% in the year to 2014-15, to nine million calls, up from 5.6 million ten years ago, according to figures from the HSCIC.  72% of responses to the most serious emergencies were within the 8 minute target (against a target of 75%).

About a fifth of users of public services experience some problem, but complaints and redress systems are confusing and people are less likely to complain than they would for private sector services, according to a report from the NAO.

Summaries of some of the complaints received by the Parliamentary and Health Service Ombudsman have been published.
Response from the NHS Confederation:

The ability of people with learning disabilities to live independent lives is threatened by cuts to benefits and social care services, risking leaving people cut off from work and communities, according to a letter to the Guardian from over 100 charities and Brian Rix, President of Mencap.
News item:

Financial incentives to improve GP services should not be overused and the government should consider the use of other levers, according to a briefing from the Nuffield Trust.

A feasibility study into having free wi-fi in all hospitals and GP surgeries has been commissioned by the National Information Board.  The NIB also gave timelines for other initiatives including the availability of approved health apps by the end of the year.
(19th June)

The launch of the e-referral system to replace ‘choose and book’ was dogged with technical problems, leading it to being taken off line.
(19th June) The system is up and running again:

The Government has brought forward a review into the deprivation of liberty safeguards (DOLS) to the end of 2016 rather than summer 2017 after greatly increased workloads for councils following the ‘Cheshire West’ judgement last year.  It will still be some years before a new framework is in place.

The 2015 child health profiles are published by PHE.


16th June 2015

About 22,000 asthma sufferers are being put at risk because they are being given inhalers for relief without the steroids needed to tackle the underlying inflammation according to Asthma UK, based on patient records from 520 GP surgeries.  The UK has one of the highest rates of, and deaths from, asthma in the world, with about 1,250 people a year dying from it.  The problems identified affect a small percentage (0.4%-2%) of the 5.4m patients being treated for asthma.

A review on the safety and effectiveness of medicines, and particularly statins was requested in February by the Chief Medical Officer, Sally Davies, who asked the Academy of Medical Sciences to undertake it, according to the BBC who obtained a copy of the request.  The Academy has appointed Sir Michael Rutter to head a working group to scope the review and he starts next week.

The role of local safeguarding children boards is confused and needs to be clarified according to a review commissioned by the LGA which argues that they must have a realistic remit and be funded properly.

Claims by dentists on NHS Choices that they were taking on new patients were false in a third of cases with 37% subsequently saying they had no availability and a further 36% only offering appointments after two weeks, according to mystery shopping on 500 dental surgeries by Which.

Patients shown pictures of their clogged arteries were more likely to take action such as losing weight or stopping smoking, according to a randomised controlled trial of 189 people in Denmark, reported to a European conference.

Trans-fats are to be banned in the USA within three years the US Food and Drug Administration has said.


15th June 2015

Only about half of seven year olds are getting the recommended 60 minutes exercise a day according to UKactive, a not-for-profit organisation.  They say that more schools should record and track children’s physical activity.  Based on foi requests they say only 43% of schools currently monitor the length of time children are physically active.
(16th June)
(16th June)

Healthwatch England has set out a seven point plan for improving complaints by patients.

The number of diabetics in the UK has increased by 62% in nine years from 2m to 3.3m between 2004-5 and 2013-14 according to official statistics.  Diabetes is said to cost the NHS nearly £10bn a year.

There are calls for cervical cancer screening to be extended beyond the age of 65, as 20% of the 3,000 cases each year, and half of the deaths, are in women over 65 according to research by Keele University, published in the BMJ and a report by Jo’s Cervical Cancer Trust.

A ‘morning after’ pill has been licensed for girls under 16 for the first time, after being given approval by the European medicines agency.
(16th June)

There should be a cut in the number of NHS organisations because there aren’t enough good leaders to go round according to a panel of experts convened by the Health Service Journal.  Ministers are also being asked to publish a list of non-foundation NHS trusts which are not viable.  The Trust Development Authority is said to have divided the list of 90 such trusts into six categories including one of those which would have to be taken over in order to survive.

The annual report on health trends in prisons and other prescribed places of detention is published by PHE and shows that 93% of prison disease reports are accounted for by cases of hepatitis B and C.
(Press release)

A survey of Healthwatch and voluntary sector representatives on Health and Wellbeing Boards on Public Health commissioning is being conducted by Regional Voices until 3rd July.


14th June 2015

If the proposed £12bn package of welfare cuts includes £5bn to child tax credit then almost two thirds would fall on the poorest 30% of households and two thirds of those affected would be in work, according to research by the Resolution Foundation.

Long delays for treatment for people with eating disorders is putting lives at risk, it is claimed by experts, with one survey by the charity Beat, finding that of 435 patients with an eating disorder, 41% waited more than 6 months after being diagnosed for treatment and 19% waited for more than a year.

70% of jobs at top accountancy, financial and law forms went to people educated at private or selective schools according to research by the social mobility and child poverty commission, chaired by Alan Milburn, with personal style, accent and mannerisms amongst the things taken into account by recruiters.
(15th June)


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13th June 2015

27% of people were unhappy with the health or other public service they received in the last year but only 34% of those had made a complaint according to a survey of 4,200 people by the Parliamentary and Health Service Ombudsman.  Healthwatch England said that according to their figures, one in five with a poor experience of health complained.,-according-to-new-research

127 of 151 NHS wheelchair services do not provide them for short term use according to a report by the Red Cross, ‘Putting the Wheels in Motion’, which argues they should do more, taking the pressure off it and other charities which provide wheelchairs.


12th June 2015

People having mental health crises felt their treatment from police and ambulance crews was more caring than from medical and mental health professionals according to a report by the CQC, ‘Right Here, Right Now’, based on feedback from 1,750 people who had been through a crisis.  The proportions saying they received the help they needed in a timely way, were 35% from A&E, 38% from the community mental health team, 41% from the crisis resolution home treatment team and 65% from the police.  Overall, 42% of patients said they did not get the help they needed. 1.8m people sought help for a mental health crisis last year.
Approved Mental Health Professionals (AMHPs) could be regulated by the CQC to address inconsistencies in levels of provision locally:

There has been a fall in the rate of binge drinking and abstinence from alcohol amongst young people according to a briefing from ONS.
(13th June)
(13th June)

The adult social care efficiency tool, which facilitates comparisons of spending and quality between local authority areas, has been updated.

In Touch: Issue 5


11th June 2015

The NHS could save £5bn a year including £2bn from better staff organisation and £1bn from better procurement, according to a report from Labour peer, Lord Carter.
Press release:
The report:

The Government may have underestimated the costs of implementing the Care Act and so underfunded local government according to an NAO report, ‘Care Act First-phase Reforms’, which found flaws in how the Government implements ‘the new burdens doctrine’ and said it should be more transparent in its approach.

Monitor and the Trust Development Authority are to have a single leadership as the two bodies increasingly work more closely together.  DH says that hospitals need the same kind of support and intervention, whether they are Foundation Trusts or just Trusts, so it makes sense to have closer working between the two bodies.

There is pressure from within Government and the Tory party to slow the pace of welfare cuts, it is reported, along with the suggestion that cutting tax credits could inflict lasting damage on the party.

Being obese or overweight increases the risk of breast cancer, but it is not then reduced by losing weight, potentially increasing the importance of not gaining weight in the first place according to a US study of more than 67,000 women followed for a median of 13 years published in the Journal of the American Medical Association.

A brief on staff engagement for NHS employers drawing on good practice from other sectors is published by NHS Employers.


10th June 2015

A pilot of 7 day access to GPs in Greater Manchester showed a reduction of 3% in A&E attendances but little impact on satisfaction.  It is now to be rolled out across the region.
(11th June) A 7 day GP access pilot is to end after four months, because of lack of take up.  The pilot was in Hambleton, Richmondshire and Whitby.

A new NHS e-referral system replaces ‘Choose and Book’ from 15th June.  Choose and book was criticised as not making a difference to efficiency or patient choice because it was slow to use, limitations of coverage and lack of information on which to base decisions.  The e-referral system is to be rolled out gradually with ongoing improvements over time.  It is argued that it is how the system is applied rather than the technology itself which will make a difference.
(11th June)

The first of four pathfinder pilots is to start at the end of June in Blackburn with Darwen, with the others likely to start in September.  GPs are to contact patients individually to allow them to opt out.

A levy on tobacco companies to help fund efforts to reduce smoking is proposed by a group of 120 public health organisations in a five-year strategy document, ‘Smoking Still Kills’.  Smoking is said to cost the NHS £2bn a year, social care £1bn a year with almost £10bn of further costs to society.
Article by Peter Kellner, chair of the group that produced the report:

There is scope to save the lives of 2,000 babies a year based on comparisons with best performance in this country and overseas, according to a report, MBRRACE-UK, from a group of academics, clinicians and charities.  There are 6 still births per 1,000 in the UK compared to 4.3 in Sweden.  There is a variation from 5.4 to 7.1 between NHS areas.  Babies of black or black British ethnicity have a mortality rate of 9.8 deaths per 1,000.

The NHS was found at fault in deaths of, or serious injury to, 1316 new born babies in 2014, with over £1bn paid in compensation.

Diets tailored to how individuals respond to particular foods could help reduce obesity, improve diet and impact on conditions such as diabetes and heart disease, according to Israeli research, based on the responses of nearly 1,000 people over two years, to be presented at a conference.  The research found that the same foods can have very different effects in terms of glucose production between different people.

Agreement on the TTIP (Transatlantic Trade and Investment Partnership) is being delayed because of disagreements over food safety.

GPs will have to be recruited from overseas if the Government’s target of 5,000 more by 2020 is to be met according to ManpowerGroup Solutions, one of the largest recruiters of GPs in the country.

53% of public and voluntary sector workers are stressed ‘a lot’ or ‘all of the time’ according to a (self-selected) survey of over 3,700 public and voluntary sector workers by the Guardian.

A research report putting monetary values on the health benefits to tenants of housing association work, has been produced by the Affinity Sutton Housing Associations’ Charitable Trust and an LSE economist.

A report reviewing variations in Council Tax Support across England has been published by the JRF.


9th June 2015

Cities where more people are active have better health, better economic productivity, higher property values and better school performance according to a report from the University of California, for a conference in Bristol, and based on 500 previous studies covering 17 countries.  Schemes to promote walking and cycling had a particularly beneficial impact, with a return of £13 for every £1 invested.

The Welsh Government is proposing to ban e-cigarettes in workplaces and enclosed public spaces, as one of a number of health measures, on the grounds that they are a gateway to, and normalise, tobacco smoking.  Critics argue that there is no evidence that that is the case.  The bill could become law by 2017.

Violent crime against women is being understated in official statistics, particularly in cases where the assailant is known to the victim, because of a rule that limits the number of cases that can be reported by a single respondent to five, according to the Unesco Chair of Gender Research at Lancaster University.  The number of violent crimes increases by 60% if that cap is removed.

A two year pilot of a common heart failure treatment at home or a community clinic, has been deemed a success, and the British Heart Foundation which funded it, has now said it should be rolled out more widely.

A report on ‘Options for Integrated Commissioning’ of health and social care services is published by the King’s Fund.  It notes that there are around 400 local organisations responsible for commissioning different health and social care services.

Local authorities’ commissioning of sexual health services are described in nine case studies published by the LGA.

‘English Devolution: Local Solutions for a Healthy Nation’ is published by the LGA, drawing on the thoughts of councillors, Directors of Public Health, providers, commissioners, academics and others.

A report on the experience of black and minority ethnic patients in crisis mental health services is published by the Race Equality Foundation.


8th June 2015

People with mental health problems held in police cells as places of safety fell to 4,537 incidents last year, from 6,667 the year before, a drop of 32%, according to data compiled by the National Police Chiefs Council.

Deaths from rare and less common cancers are rising in total and as a proportion of the whole, with 2,700 more deaths from less common cancers in 2013 than 2010, according to a report from Cancer52 and Public Health England.  The reasons for the increase aren’t known, but it could be because of the aging population and because those cancers get less attention.  There are also more cases of negative patient experience for rarer cancers.

51 NHS Trusts were fined a total of £92m last year for missing targets, while 46 had not been fined at all (it was not clear whether or not they had missed targets) according to an investigation by the BBC’s You and Yours programme.  They sent requests to 164 trusts and received responses from 97.

Coverage of the national cardiovascular health check was 21% of the target population and identified 4.6% of patients as at high risk, according to DH research based on 509 GP practices in England.  There were also concerns about health inequalities, with lower take up in black African and Chinese groups.

More is needed to care for those people largely cured of cancer but continuing to live with symptoms or side effects of treatment Macmillan Cancer Support says.

An association between drinking sugar-sweetened drinks and non-alcoholic liver disease has been found by a study from Tufts University on 2,634 middle aged people, who had CT scans, which was published in the Journal of Hepatology.

Lower back pain is the biggest cause of years lived with disability in Britain and worldwide according to a study reported in the Lancet.


6th June 2015

Better management by hospitals of staffing and procurement could save the NHS hundreds of millions of pounds, according to a report by Lord Carter due to be published this week.  (See more detail 11th June)
(7th June)

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6th June 2015

Up to 700,000 people who opted out of having their data shared have not had their requests met, the HSCIC has admitted (in a letter sent in February).  The objections were raised during the lead up to the proposed launch of, which was subsequently delayed.  The CQC says it doesn’t have the resources or processes to deal with that level of objection.


5th June 2015

A 9 month delay in paying Personal Independence Payments to two people has been declared unlawful and unacceptable in the High Court.  There are currently over 78,000 people waiting to hear if they can receive PIP.

The CQC has been criticised for the way it gave a contract to McKinsey & Co without following proper procurement procedures.  A DH audit found that the consultancy had been given ‘exclusive access’ to the CQC’s ‘intelligent monitoring’ report and on another contract that they were given preferential treatment at the evaluation stage.


4th June 2015

Adult social services are to face £500m of cuts alongside £600m from increased demand and inflation making the equivalent of £1.1bn to be found over the next year, according to a report by the Association of Directors of Social Services based on a survey of 147 of the 151 relevant councils.  This is on top of £4.6bn cut since 2009-10, 31% of net real terms spending and 400,000 fewer people receiving social care support.  As well as reducing levels of care, the numbers helped, quality and reliability, it is argued there will be increased costs into the future and for other services, such as health.
Nearly half of respondents said that cuts so far had had little or not impact on services:

Funding for public health is to be cut by £200m as part of £3bn of cuts that Whitehall Departments have been told to find.  In the current year, the LGA has said councils will have to find £2.5bn savings after funding from the Government was cut by 8.5%.  [And as an aside, the sale of the stake in Royal Mail makes no long term difference to the deficit as it is a one-off, and arguably none to the national debt as it is an asset with a value through a future revenue stream or capital appreciation – which is presumably why other people will be prepared to buy the shares.  So while it releases cash, it is not a saving.  Just saying.]
(5th June)

Jeremy Hunt has said the NHS needs to save money by, amongst other things, better procurement.  He also announced a new scorecard for assessing CCGs based on how well care is delivered to each of five patient groups: older people; other people with long term conditions; people with mental health conditions; mothers and children; and the generally healthy.  CCGs will also be assessed on ‘resilience’ (e.g. to winter pressures) and ‘transformation’.

Two of the three 18 week referral to treatment targets are to be dropped, Jeremy Hunt has said.  They are the target that 90% of patients needing treatment are given it within 18 weeks and that 95% of those needing outpatient appointments should get them within that time.  The target that 92% of patients should be seen within 18 weeks will remain.  He also said that A&E, cancer and referral to treatment targets will be published at the same time once a month.

Mental health bed occupancy is at the highest level since 2010-11 at 89.5%, while the Royal College of Psychiatrists recommend 85% for effective care.  NHS Choices gives a breakdown by trusts which shows 10 Trusts reporting 100% occupancy.

50% of GPs are ‘at high risk of burnout’ according to a survey by Pulse magazine of 2,230 UK GPs.  The figure is 4 percentage points higher than its previous survey.  At the same time, funding is being cut for GPs’ occupational health schemes.

NICE’s work on safe staffing levels in hospitals is to stop, after NHS England said it would take over the work, with Jane Cummings, its chief nursing officer saying that in future staffing levels should look ‘beyond traditional professional boundaries’ and focus on patient outcomes rather than ratios.  The decision has been criticised by, amongst others, Robert Francis.
(11th June) Letter from Jane Cummings, England’s Chief Nursing Officer to nursing directors, CCGs and others:

Children of mothers who were depressed during pregnancy were three times as likely to become depressed, although there was no association with post-natal depression, according to a study of 103 mothers and their children born in 1987, of whom 35 were exposed to maternal depression during pregnancy.  There is no clear evidence for the reasons for the association.  The research was undertaken by King’s College London and published in the British Journal of Psychiatry.

64% of mental health patients smoke, compared to 18% of the general population according to Public Health England based on a survey of 105 care units.  This is thought to be one of the main reasons for the lower life expectancy of mental health patients.  PHE wants all mental health hospitals to be smoke free.

Britain has amongst the highest rates of drug use amongst young people in Europe, according to the European Monitoring Centre for Drugs and Drug Action.  However there is a long term downward trend in drug use.

A report, ‘Five Year Forward View: Time to Deliver’ has been published by the seven principal national health bodies.  It includes a number of initiatives already publicised but also more detail on other areas such as prevention, and outlines the governance arrangements through a NHS 5YFV Board.

Reports on economic, philosophical, psychological and sociological theories of poverty’ are published by the JRF.
(30th June) Comment piece on the psychological aspects:

A report, ‘Socioeconomic Inequality Of Access To Healthcare: Does Patients’ Choice Explain The Gradient?’ is published by York University’s Centre for Health Economics.


3rd June 2015

NHS regulators are to take over all the trusts in each of three regions with deep seated problems, Essex, North Cumbria and Northern, Eastern and Western Devon, in what is being called a ‘success regime’, Simon Stevens has said in a speech to the NHS Confederation.  The interventions will be undertaken by NHS England, the CQC, the Trust Development Authority and Monitor.  The aim is to make changes across ‘the whole system’.
The situation in mid-Essex:
Summary of the rest of the speech:
Stevens says more efforts are needed to combat obesity:
Video of the speech:

90% of NHS leaders believe that cuts to social care are directly affecting patient care in their organisations, according to a survey of over 300 leaders from 216 organisations, conducted by Populus.  The survey includes attitudes on finance, social care and future change.

The OECD argues for evening out cuts rather than front loading them, to avoid damaging economic growth, and says they shouldn’t be targeted at the poorest people.

5,900 children were being given emergency support by local authorities in 2012-13 under S27 of the 1989 Children Act according to a report by the University of Oxford’s Centre on Migration, Policy and Society.  Two thirds of the cases were waiting for decisions from the Home Office, of which 52% were ultimately given leave to remain, although they could have been waiting for two years for a decision.  The subsistence rates of support varied between authorities but were below welfare levels.  Changes to immigration rules meant there was a 19% increase in the number of families receiving emergency support, as they had ‘no recourse to public funds’ (NRPF).

The number of 13-19 year olds admitted to hospital with eating disorders has doubled in three years, from 915 to 1,815 between 2010-11 and 2013-14.

Many people go to A&E because they cannot access other services and many are advised to go there by other health providers according to a report by the Royal College of Emergency Medicine and the Patients’ Association, ‘Time to Act’, based on survey responses from 924 people between September 2014 and February 2015.  23% had contacted their GP before going to hospital and of those 55% had been unable to get an appointment that day.  The report also recommends co-locating GPs in A&Es.

Breast cancer screening could cut the risk of dying from the disease by 40% for women aged 50-69, according to the International Agency for Cancer Research, part of the WHO, who have reviewed the evidence, and published their conclusions in the New England Journal of Medicine.  However other experts said that this overstated the case and that there were other factors leading to the continuing fall in deaths from breast cancer.  There was a 40% reduced risk in those who attended screening, but 23% of all those who were invited.
(4th June)
(4th June)

Cancer has overtaken cardiovascular disease as the main cause of death at 29% to 28%, although not for women, according to analysis of Cardiovascular Disease Statistics 2014 published in the journal Heart.  Deaths from cardiovascular disease have fallen by more than 40% since 1960.

The effectiveness of the national health check programme is said to be questioned in an evaluation due to be published in the next few weeks.

There are two different phases of risk of readmission to hospital, one after 8 days which is more likely to be related to the original reason for hospitalisation, and the other after 30 days which was more likely to be related to a patient’s chronic illness, according to US research on 13,000 discharges involving 8,000 patients in 2009-10, published in Annals of Internal Medicine.

Guidance on how to spread innovation across the NHS is given in a paper from IPPR, ‘Improved Circulation: Unleashing Innovation across the NHS’, which argues that this is the single best way of closing the gap between demand and resources.


2nd June 2015

Jeremy Hunt has told the NHS to reduce the cost of spending on agency staff which has risen from £1.8bn to £3.3bn over the last 3 years.  He is to introduce maximum hourly rates for agency staff; cap the total that any Trust in financial trouble can spend on them; and ban agencies not on a new approved list.  However there has been criticism of the failure in planning to train and recruit the required number of permanent staff.
Background on the issue and profile of head of Health Education England, Ian Cumming:
Monitor strengthens its financial monitoring of NHS Foundation Trust finances including limits on the costs of employing agency staff.

The NHS could create a new role of ‘nurse associates’, between nurses and healthcare assistants, to help deal with growing workloads, Ian Cumming, head of HEE has said in an interview with the Guardian.

22% of care leavers in England are living in ‘unsuitable’ accommodation, such as bed and breakfasts, despite rules which say they should only be used in emergencies, with four local authorities having a half or less in suitable accommodation, according to official figures gathered by the BBC File on Four programme.

Alcohol related admissions to hospital for under 18s has continued to fall, although there has been a slight increase for adults, with a 2% rise for women (although there are still twice as many such admissions for men as women).
Local alcohol profiles for England, annual update, are published.

Being bullied at 13 was associated with twice the chance of depression for two years or more as an adult, according to a study of nearly 4,000 people in the Avon Longitudinal Study of Parents and Children, carried out by researchers from Oxford University, published in the BMJ.

Three tobacco firms have been ordered by a Canadian court to pay £8bn (C$15.5bn) in damages to nearly one million smokers in a class action suit on the basis that they failed to warn them of the health risks.  The companies have said they will appeal.

A Bill for opt-out organ donation in Scotland has been published, with support from all parties and a statement by the Scottish Government that they would see if a case could be made for it.

PHE’s 2015 local health profiles have been published. [Very handy summaries]

CCG Bulletin: Issue 85.  Includes: renewed support for CCGs on personal health budgets; CAMHS transformation plans, interim guidance; data on patient use of online services.


1st June 2015

30% of patients said it was not easy to get a GP appointment, 35% said they could not see the same doctor each time, 34% said their surgery did not offer online appointment bookings and 46% said they could not see a GP from their practice in the evenings or at weekends, in a survey of 3,315 patients by Ipsos MORI for a Monitor report, ‘Improving GP Services: commissioners and patient choice’.

The A&E 4 hour waiting time target has been met in England for the first time since September, with 95.1% of patients having been dealt with in the time in the week ending 24th May.

More than 8,000 more foster carers will be required this year, because of more children coming into care according to the Fostering Network.  There are currently 52,500 children living in foster families out of 63,000 in care.  A survey by the charity of 1,600 fostered children also found that 40% of teenagers were already on their third foster home since coming into care.

Office and sedentary workers should spend 4 hours a day on their feet, because of the increased risks of heart disease, cancer or diabetes from sitting, according to an ‘expert statement’ based on a summary of research commissioned by Public Health England and the Active Working community interest company published in the British Journal of Sports Medicine.  However PHE said that more research is needed before daily activity targets are recommended.
(2nd June)

The provision of free childcare for 3-4 year olds with working parents is to be doubled from 15-30 hours a week, the Prime Minister confirms.

The Prime Minister is said to have over-ruled proposals from Iain Duncan Smith to limit child benefit to the first two children.

More than a third of British adults would be prepared to volunteer to support the NHS according to a survey of 2,050 adults by ICM for the Royal Voluntary Service.
(2nd June)


31st May 2015

Action against ‘rip-off’ temp agencies and a war on obesity were two of the calls from Simon Stevens, CE of NHS England, speaking on the Andrew Marr show.  He said while it was hard for individual hospitals to take action on staffing agencies, the NHS collectively could take action and they would be doing.  Noting that 1 in 3 teenagers are drinking ‘high energy, sugary drinks’, he rather confusingly said he wanted to reach out to food producers who ‘can smell the coffee here’.

46 hospital trusts say they offer private hip and knee operations which could let patients have the operations in a week or two rather than waiting on the NHS waiting list, according to foi responses from 102 trusts received by the Mail on Sunday.  All of the trusts said that patients taking up the private option did not impact on the NHS waiting lists.


30th May 2015

Deaths from heatwaves could rise by between 130-1,700 per year in five years time from the current 2,000 a year, according to the current Heatwave Plan.  It also says hospitals need to do more to ensure there are cooler places, both for patients and medicines and it proposes the redesign of hospitals.
(22nd May)

160,000 patients have had to find a new GP surgery as 60 practices have closed over the last two years, according to foi responses received by Pulse magazine.
(1st June)


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29th May 2015

The banning of smoking in public buildings was associated with a 3.5% fall in admissions of under 15s to hospital with respiratory infections (about 11,000 children a year), according to research from Edinburgh, London and the Netherlands, published in the European Respiratory Journal.  The fall is estimated to have saved the NHS £17m a year.
400,000 more children would be classed as living in poverty if the money their parents spend on tobacco was taken into account according to an analysis from the University of Nottingham.

The proportion of deaths in those aged 35+ thought to be caused by smoking fell from 17% to 15%, from 95,000 to 78,000, between 2003 and 2013 according to figures from the HSCIC.

32% of 45-64 year olds are drinking to high-risk levels, compared to a 19% of 18-24 year olds according to a survey of 2,294 UK 18-75 year olds for the charity Drinkaware.  Those higher levels of drinking are associated with a greater risk of liver disease and cancer.

Advice for government action on mental health is proposed in a report by leading mental health charities and organisations.


28th May 2015

Delays by GPs in referring possible cancer patients for further tests may explain poorer survival rates in this country according to survey research on 2,795 GPs, asking them about hypothetical scenarios in phone interviews, in the UK, Australia, Canada, Norway, Sweden and Denmark by the International Cancer Benchmarking Partnership, funded by Cancer Research UK and published in BMJ Open.  While GPs in this country have access to certain tests, they have less access to MRI and CT scans or advice from specialists.

19 CCGs ended 2014-15 in deficit, while across all 211 CCGs there was a £151m underspend.

The Government’s plans for GP surgeries to open 7 days a week have been described as coming from cloud cuckoo land by Dr Maureen Baker, chair of the Royal College of GPs.  She suggested it might be better to invest those resources in the existing five day service.

Labour has said it is sympathetic to a cut in the benefit cap from £26k to £23k as long as it does not put children into poverty or increase homelessness.  Harriet Harman made the comments as acting Labour Leader in responding to the Queen’s Speech.

There are a number of barriers to recruiting care staff, including young people being attracted to the NHS which is seen as offering better terms and conditions, though there is forecast to be a need for 27% more care staff by 2022, according to the UK Commission for Employment and Skills.

The proportion of deaths due to cancer globally has increased from 12% to 15% between 1990 and 2013, with the ageing population and rising obesity thought to be behind the change as well as promotion of smoking in developing countries, according to the Global Burden of Disease Study looking at cancer, published in the journal JAMA Oncology.

The food poisoning bug campylobacter has been found in 73% of shop bought chickens despite efforts by some supermarkets to reduce the rate of infection, according to a study by the Food Standards Agency.  The bug causes about 280,000 cases of food poisoning a year, which can lead to further complications such as irritable bowel syndrome.  There are about 100 deaths a year from it.  The bug can be killed by proper cooking of the meat.

A proposed UN target to reduce premature mortality from non-communicable diseases discriminates against older people because it only applies to deaths of those under 70, leading medical experts have said in a letter to the Lancet.
(29th May)

More needs to be done to promote career progression routes in health and social care according to a report from the UK Commission for Employment and Skills.

Competition can improve hospitals’ management capacity according to ESRC funded research based on a survey of 100 hospitals and published data, by the Centre for Economic Performance and the Centre for Market and Public Organisation.  The report is: “The Impact of Competition on Management Quality: Evidence from Public Hospitals”.

A briefing paper on ‘Sugar and Health’ has been produced by the House of Commons library.


27th May 2015

The Queen’s Speech sets out proposed legislation for the new session of Parliament, including:
confirmation (but no bills) on increasing the health budget (to £8bn p.a. by 2020), implementing the five year forward view, ‘integrating healthcare and social care’ [presumably through the Better Care Fund], and ensuring the NHS works on a seven day basis
the extension of the right to buy to housing association tenants will proceed through a housing bill
a childcare bill will extend free child care for three to four year olds from 15 to 30 hours a week where ‘all’ parents work
an education and adoption bill will introduce regional adoption agencies, increase the number of academies and allow for intervention in ‘coasting’ schools
the full employment and welfare bill will implement welfare changes that it is estimated will save £1.5bn of the £15bn promised during the election campaign: reduction of the household benefit cap from £26k to £23k; a two year freeze on most working age benefits; the removal of automatic entitlement to housing support for 18-21 year olds; and the creation of duties to report on government policies such as the Troubled Families Initiative, employment and apprenticeships.
a cities and devolution bill will extend the sort of approach announced for Manchester to other groups of councils
the police and criminal justice bill will implement Theresa May’s promised changes to mental health (no children with mental health difficulties kept in police cells).  It could also make it a criminal offence for social workers to ‘wilfully neglect’ children by failing to act on child protection concerns
a blanket ban on ‘legal highs’ is to be implemented through a psychoactive substances bill
a public services ombudsman bill could merge the parliamentary and health service, local government and housing ombudsmen.
Commentary on how social care users are likely to be affected by changes, particularly those who are on benefits:
Councils may be forced to merge adoption services:
Possible jail for social workers for ‘wilful neglect’ of children:
Briefing for charities and voluntary organisations:
The Queen’s Speech:
Background briefing notes (103pp):

Plans to close inpatient facilities for people with learning disabilities, in the wake of the Winterbourne View scandal, are to start in two regions, the Midlands and East and North, before being rolled out to the rest of the country according to NHS England Board papers.

The South West Ambulance Service NHS FT is pulling out of the NHS 111 contract in Devon and Cornwall from the end of the financial year, having already lost the contract in Somerset.

Exposure by babies in the womb and up to two years to some sorts of air pollution is associated with a 1.5 times increase in autism according to research on 430 children (211 with autism spectrum disorder) who were interviewed about their exposure to different sorts of pollution.  The research was undertaken by the University of Pittsburgh and is due to be published in the journal Environmental Research.

A guide for CCGs on ‘Engaging the public in difficult decisions about health service change’ has been published by NHS Clinical Commissioners.


26th May 2015

Citizens Advice had a 39% increase in the number of people going to them because they were unable to pay court fines, making a total of over 46,000 people in 2014-15.  The single biggest debt issue they have seen has been council tax, with a 21% increase in the number of cases handled over the year, at a total of 193,000.

So far only about 10,000 people have registered with GP practices outside their area since this first became possible in January (for instance allowing commuters to register where they worked rather than where they lived) and this is said to be much less than the 6% of patients who had expressed an interest in changing their practice when the scheme was first proposed.

A second CQC Board member is leaving to join the government, this time Camilla Cavendish, Times columnist who is to be head of policy at 10 Downing Street.  (David Prior, Chair of the CQC was made a minister at the Department of Health).

There may be a tendency for patients over 80 to receive less intensive diagnosis and intervention according to an Australian study of over 11,000 patients undergoing surgery between 2009-12.

In Touch: Issue 4


25th May 2015

Boys aged 16-20 who were obese had twice the chance of developing bowel cancer by the age of 50, according to a study of 240,000 Swedish conscripts, followed up for 35 years by Harvard University and Orebro University Hospital in Sweden, published in a BMJ journal, ‘Gut’.
(26th May)

About a quarter of councils are using ‘Amazon-style’ e-markets to allow adult social care users with personal budgets or who are self-funding, to search for and buy care services, according to a report from the IPPR.
(23rd June 2015) blog evaluating the strength of evidence in the report:

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24th May 2015

The Government is considering consulting on a no-fault reporting system for pharmacies to increase the safety of prescribing.  Estimates for the proportion of prescribing errors range from 0.02% up to 3%.  There were 3 deaths linked to community pharmacies in 2014.


23rd May 2015

Different councils could be forced to merge their adoption services, with financial encouragement to do so on a regional basis, but with compulsion if they don’t do so within two years, in a schools and adoption bill to be included in the Queen’s Speech.


22nd May 2015

NHS providers of care ended the year with a £822m deficit (this includes hospitals, mental health, community and ambulance trusts), compared to £115m the previous year, according to figures from Monitor.  Foundation Trusts had a deficit of £349m.

More than 2 million children live in families which are spending less on food, clothing or heating as a result of real terms cuts in child-related benefits, with more than 4m households affected by below inflation rises in child benefit and child tax credit according to the End Child Poverty Coalition.

Two large tobacco companies have filed objections in the High Court to standardised packaging.  The two companies, Philip Morris International and British American Tobacco are claiming that the plans deprive them of property in the form of trademarks.  Other big tobacco companies are also thought likely to take action.

The CQC’s Inpatient Survey 2014 shows that 13% of hospital patients said there was no immediate response to the call bell, with 6% saying they had to wait for more than 5 minutes according to its annual survey of 59,000 patients.  They also found that 42% of patients were delayed in hospital despite being fit to leave.  The CQC said the survey results were broadly the same as last year.

Surveys of alcohol consumption typically miss the equivalent of three quarters of a bottle of wine per drinker a week, and this is partly because they ask about typical consumption but miss out special occasions, according to research by Cardiff, Bangor, Liverpool John Moores universities and the London School of Hygiene and Tropical Medicine, based on a random survey of over 6,000 people, published in BMC Medicine.  Surveys asking people what they consume typically account for only 63% of the alcohol actually sold in England.  However this study only brings that figure up to 79% meaning 22% is still unaccounted for.

Half a million people have taken up e-cigarettes in the last year, with a rise from 2.1m to 2.6m, most switching from ordinary cigarettes, according to Action on Smoking and Health (ASH) based on research by King’s College London.

Tesco says it will reduce the sugar content of its soft drinks by 5% a year.  The company said it had been reducing the sugar content since 2012, with a 30% reduction since then.

A Government minister says there could be a tax, based on the sugar content of foods if companies continue to sell foods with a high sugar content.  The minister was George Freeman, Life Sciences Minister, speaking at the Hay Festival.  However, the Prime Minister’s spokesman subsequently said this was not the right approach and said there were no plans to introduce a sugar tax.


21st May 2015

The prime minister’s seven day opening plan is a ‘surreal obsession’ which should be scrapped, according to the Chair of the BMA’s GP committee, Dr Chand Nagpaul, arguing that there aren’t enough GPs to cope with the existing demands and a third are intending to retire in the next five years.  He says there are 40m more appointments a year than five years ago, but a fall in the proportion of NHS funding for general practice.

The prime minister’s seven day proposals are ‘not credible’ according to Labour shadow health minister Andrew Gwynne.

740,000 households are living in privately rented homes that could harm their health, with a £1.3bn subsidy from housing benefit, according to a report from the CAB.  It says 16% of privately rented housing is unsafe, compared to 6% of socially rented housing.

20 times more people die in cold than hot weather, with mild variations causing more deaths than extreme weather, according to an analysis of 74 million deaths in 13 countries, including the UK, led by the London School of Hygiene and Tropical Medicine and published in the Lancet.  7.7% of deaths were due to non-optimal temperature with 7.3% linked to cold and 6.7% to moderate cold.  (Hot and cold were defined relative to the norm for the location).  However, the relative risk of dying increased at extreme temperatures (there are just fewer deaths because there are fewer days of extreme temperature).  It is suggested that more research is needed on the effects on particular, susceptible groups (e.g. old, young, unwell). [The NHS choices link below gives a comprehensive, accessible summary).

It is estimated that 73% of referrals from NHS111 to GPs are inappropriate according to an on-line, self-selected survey of 580 GPs by Pulse Magazine.

Devolution must extend to all areas of England, the LGA argues in a white paper in advance of the Cities Devolution Bill expected in next week’s Queen’s Speech.


20th May 2015

23% of deaths in 2013 were avoidable such as by better diet, activity or stopping smoking, according to figures from ONS on ‘avoidable mortality in England and Wales 2013’.  That is 114,740 deaths out of 506,790.  Coronary heart disease was the most common cause, at 17%, but for women it was lung cancer at 15%.  There has been a steady fall in avoidable deaths from about 32% in 2001 to 22% in 2013, although this levelled out between 2012 and 2013.

There could be an addition 71,000 deaths across Europe between 2020-29 because of ‘weak’ EU air pollution targets according to a study commissioned by Greenpeace and the European Environment Bureau.

Acute hospitals are being invited to submit expressions of interest for sharing services and resources to enhance their viability.  The new ‘vanguard’ sites will build on proposals in the Dalton review.  Proposals are to be submitted by the end of July, with the successful sites announced in September.

60% of those living in single parent households and 40% of those aged over 65 have experience poverty at least once between 2010 and 2013, according to statistics from ONS.  Persistent poverty (in relative income poverty in the current year and at least 2 out of the 3 preceding years) was 7.8% in 2013, half the overall poverty rate of 15.9% and lower than the EU average.

George Osborne has ordered Whitehall departments to identify the £13bn cuts promised in the Tory manifesto, with a view to announcing them in his 8th July budget.  These are to sit alongside the £12bn cut in welfare spending and £5bn increased revenue by reducing tax avoidance.

Theresa May promises £15m to help prevent people with mental health difficulties being kept in police cells, by providing suitable health based alternatives.  A new policing and sentencing bill is likely to make it illegal to detain children with mental health problems in police cells.|SCSC|SCDDB-2015-0521

Too many people end their lives in pain, distress and with a lack of dignity according to a report from the health service ombudsman, which details a number of individual cases.  The Ombudsman has investigated 265 cases in the last four years and has upheld 136 of them.  A separate report from King’s College London found that more people are dying in hospices, but it is still a very small proportion of the total (6%) and the gap between those in the least and most deprived areas is growing.,-ombudsman-service-report-finds

The 62 day cancer treatment target was missed in 2014-15 with 83.4% being treated against a target of 85%, though some cancers were much worse, such as lung cancer at 75%.  This is the highest number missing the target since records began in 2009.

The relaxation of the licensing laws 10 years ago did not lead to a predicted increase in binge drinking or violent crime according to a report from the Institute of Economic Affairs.

Children, and particularly girls, who were bullied are more likely to be obese in later life, with 26% of women who had been bullied being obese at 45, compared to 19% for those who hadn’t been bullied (the equivalent figures for men being 25% and 23.6%) according to a study on over 7,000 people born in 1958 conducted by King’s College London.

Transgender people are being treated as second class citizens with many having to wait for 6 years to transition, according to Healthwatch England.
(21st May)

A report, ‘The Practice of System Leadership’, based on interviews with 10 people, suggests starting with a ‘coalition of the willing’ and building outwards, and is published by the King’s Fund.

Increasing pressures on the NHS are hindering the ability to get involved in clinical research on cancer according to a report from the University of Birmingham.


19th May 2015

Ill health and stress amongst carers are increasing according to Carers UK’s annual survey reported in The State of Caring 2015 based on feedback from 4,500 carers.  80% of respondents said caring had had a negative impact on their health, and 55% have experienced depression as a result of their role.

GPs are being asked to ensure no patient goes to A&E because they couldn’t get a GP appointment, as one of 8 recommendations from Sir Bruce Keogh’s urgent and emergency care review.

The number of psychiatric bed days per patient per year has fallen by 10% since 2012-13 according to responses to foi requests by Healthwatch England which warns that some patients are being discharged too early with a consequent risk of harm.  There is concern that some social care services, such as ‘supported living environments’, day centres and support provided in people’s homes, are not regulated, which could put vulnerable people at risk.

97% of patients now potentially have access to their summary care record online NHS England has announced.

GPs spend 19% of their time on non-health issues (equivalent to £394m) according to responses to a survey commissioned by Citizens Advice (the national body of the CABx).

E-cigarettes do not help people stop smoking over a 3 or 6 month period, even though they do for a month, and so other methods should be tried given the uncertain health risks of e-cigarettes, according to a meta-analysis of 22 studies covering 2,223 people, by the University of Toronto, presented at a conference.
(18th May)

People are becoming obese or overweight at an earlier age with those born in the 1980s being up to three times more likely to be overweight or obese by the age of 10, than those born just after the war, with men become overweight by the age of 30 rather than 40 just after the war, according to analysis by UCL of 56,000 people born in Britain between 1946-2001 published in PLOS Medicine.  However, childhood obesity appears to be stabilising in the under 10’s.
(20th May)
(20th May)

Anxiety and depression have been linked with an increased risk of liver disease although the reasons for the link are unknown, according to research from the University of Edinburgh looking at data on 165,000 people, published in the journal Gastroenterology.
(21st May)

Key issues facing the new parliament, produced by the House of Commons Library, includes factual summaries on NHS funding and productivity, integrating health and social care, child poverty, mental health stigma and much more.

‘Understanding Everyday Help and Support’ is published by JRF, looking at how social context, biography and relationships shape the small, daily acts of kindness and help which make life liveable for some people.

Advice from 10 former secretaries of state for health comes in a new report from the Health Foundation, ‘Glaziers and Window Breakers’.
(28th May)
(Press release)
(Link to the publication)

Informed: Issue 33


18th May 2015

David Cameron promises the first proper 7 day a week health service in the world.  Norman Lamb says the changes can’t be made without more funding. The unions threaten to strike if the changes mean reduced payment for working unsocial hours.
(Useful background information)
Industry leaders say more funds and staffing will be needed to enable seven day working:
The speech:

Simon Stevens says the NHS must ‘pull out all the stops’ on prevention on issues like obesity and smoking (which accounts for half the inequality in life expectancy between rich and poor), as well as improving care (through integration and personalisation) and increasing efficiency (by the poorer performers learning from the best), to meet what he said is its most challenging period in its 67 years history.  He was speaking alongside the Prime Minister making his 7 day working announcement.
(19th May)

There have been at least 4,748 cases of sexual abuse against disabled adults in the last two years according to foi requests received by the BBC from 106 of the relevant 152 councils in England.  63% of the cases were against those with learning disabilities and 37% those with physical disabilities.

The UK is now the most unequal country in Europe in terms of wages and income distribution and is more unequal than the US, according to a report from the Dublin Foundation for Improvement of Living and Working Conditions.

A clinical trials company is bringing a judicial review against the Health Research Authority over its proposal that all drug trials should be registered in future, threatening the continuing success of the AllTrials campaign for transparency in clinical trials that seeks to make negative as well as positive results available.

Some of the chemicals used to flavour e-cigarettes could damage cells in the same way as tobacco according to research from the University of North Carolina presented at a US conference.

A programme tailoring diets to genetic profiles is being piloted by Enable East (a successor to the NHS Eastern Development Centre) with funding from the Big Lottery Fund.  The pilot involves testing the DNA of 56 people from Colchester.

Many migrants are not accessing NHS services because of the fear of arrest, language difficulties and not understanding the system, with consequent wider public health risks for instance as children are not vaccinated, according to research by charity Doctors of the World, which looked at the experiences of 22,000 people in Europe, 1,400 of them in London.  On average the foreign nationals had been living in the UK for 6.5 years.


17th May 2015

Cuts and changes to welfare are likely to lead to arrears, evictions and homelessness according to a report by consultants Grant Thornton, which surveyed English housing associations and local authorities.  A majority of respondents had seen a rise in average rent arrears over the last two years.

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

16th May 2015

The LGA has warned the Government that a further round of cuts would devastate local services, harm vulnerable people and have a knock on effect on other public services such as the NHS, in a letter to the Observer.

Cuts to social care could mean tens of thousands of people have to give up work to care for relatives, the Alzheimer’s Society is warning.

A third of people with permanent paralysis are given no help to get back into work according to research by the charity Back Up.


15th May 2015

The new Health ministerial team.

The number of cancelled operations in the first three months of the year was at its highest level since 2005, with a 15% increase over the previous year.  The number who were then not operated on within the prescribed 28 days, at 8.7%, was the highest since the first quarter of 2006.

Men aged 68-77 doing 30 minutes light to vigorous exercise 6 times a week lived on average five years longer, with a 40% reduced risk of dying, in a 11 year study of 5,700 men in Norway, conducted by Oslo University Hospital  and published in the British Journal of Sports Medicine.  They said that it was as beneficial as stopping smoking.  A separate study by the British Heart Foundation found that 44% of adults in the UK do no moderate exercise.
(14th May)

Britain’s beaches are the cleanest since records began, but tougher EU standards come into force this summer.


14th May 2015

There should be a new global fund to finance the development of antibiotics with financial incentives for pharmaceutical companies to develop new drugs, according to Jim O’Neill, appointed by the Government to lead a review on the subject.  A company might be paid $2-3bn to develop a new antibiotic that would then be sold on a not-for-profit basis.

The Royal College of GPs says the Health Check programme should be discontinued until there is evidence to support its use.  The scheme, promoted by PHE, offers five yearly health checks to those aged 40-74.

The Chancellor offers similar devolved powers to other cities as those going to Manchester, including control of public health, housing, transport, planning and policing, subject to them agreeing to have a directly elected mayor.
LGA’s response:

David Prior steps down as Chair of the CQC after being made an Under Secretary of State for Health in the new Government.

21% of overweight Britons thought their weight was normal, compared to 10% of overweight Italians and 16% of overweight French, while 36% of adults who were obese (BMI of more than 30) thought they were just overweight, according to a survey by Opinium of 14,000 adults across Europe, including 2,000 in this country, commissioned by the Association for the Study of Obesity.

Single mothers were found to have worse health in later life according to a study looking at 25,000 women in England, the US and 13 European countries led by Harvard, and involving US, Chinese, UK and German universities, and published in the Journal of Epidemiology and Community Health.  The nature of social support in the country was thought to be an influencing factor.
(15th May)

Peer support was valued by participants and increased their confidence, knowledge, connectedness and happiness, but more research is needed on the extent of its impact, how it works, for whom and under what circumstances, according to a literature review by National Voices and Nesta.

Patients’ choice of hospital reflected service improvements rather than mortality rates or readmissions but did not appear to lead to patients travelling much further for their surgery according to research on hip replacements by York University’s Centre for Health Economics.  However because of the size of the market studied, these choices could represent a large number of patients for the particular health provider.

The number of evictions of housing tenants was the highest for six years in the first quarter of 2015, with rising rents and cuts to benefits thought to be contributory factors.  The number of evictions, 11,000, was 8% higher than the previous year and 51% higher than five years ago.

It is claimed that private healthcare companies have a tax advantage over the NHS in being able to reclaim VAT on the cost of medicines, which NHS bodies can’t.  HMRC is quoted as saying that NHS trusts can’t reclaim the VAT on the cost of drugs but that the NHS is funded for their irrecoverable VAT under government funding arrangements.

Having a penalty plus reward to stop smoking was more effective than just a reward, according to US research where people signed up to either receive a $800 reward for stopping smoking for six months, or to pay a $150 deposit which they would lose if they failed to stop but which would be returned with a $650 reward if they succeeded.  More than half of those with the penalty quit, compared to 17% of those with just the reward.  [This is in line with other psychological findings on loss aversion.  There was some degree of self-selection in who went on which programme.]

The Children’s Worlds Study looks as happiness and wellbeing of children in 15 countries.


12th May 2015

The ‘responsibility deal’, where food companies voluntarily agreed to change their products and marketing to improve health, has not been successful, having had a limited effect on poor diets, according to research by the London School of Hygiene and Tropical Medicine which looked at changes resulting from the scheme.  They say that 37% of the pledged changes to tackle obesity would have happened anyway, and many of the proposals were ones which would have limited effect.

There has been a 46% increase in men aged 40-54 hospitalised after a stroke between 2000-2014, from 4,260 to 6,221, with an increase for women by 30%, according to NHS figures highlighted by the Stroke Association.  They suggest that obesity and sedentary lifestyles are key contributing factors.  The overall incidence of stroke has fallen from 142 to 116 per 100k between 1990 and 2010, largely because of the fall in number of smokers.  The number of deaths fell from 88k to 40k between 1990 and 2013.

There has been an increase in alcohol consumption in the UK since the 1990s, taking it from below to above the OECD average, from 10 to 10.6 litres of alcohol per person (equivalent to 115 bottles of wine), compared to the OECD average of 9.5 litres.  The OECD report said there were high rates of problem drinking among educated women.  Consumption is not evenly spread, with 20% of the population accounting for 60% of the consumption.
(1st May)

A list of medical tests and treatments which doctors will be advised against using is to be drawn up by the autumn, under direction from the Academy of Royal Colleges (which represents the 21 medical royal colleges of GPs, surgeons etc.).  This would aim to stop the use of such things as x-rays for back pain or antibiotics for flu, which do no good and could do harm.  This approach follows a similar schemes, the ‘Choosing Wisely’ initiative, in Canada and the USA.
(13th May)
(13th May)
(13th May)
(13th May)

‘Liaison and Diversion’ services, where mental health staff work with the police, are now operational in half the country, NHS England reports.

A pilot scheme offering £20k ‘golden hellos’ to GPs has not had the desired effect, so could be ended or revised.  The scheme, which ran in Leicester, with funding from NHS England, only managed to attract recruits to 3 of 16 GP practices.

A Mediterranean diet supplemented with either extra virgin olive oil or nuts was associated with either improved cognitive function or memory, respectively while those on a low fat diet had decreased memory and cognitive function, according to a randomised control trial on 334 people, of around 67 years of age, who followed one of three diets.  The research was led by the University of Barcelona.–providing-you-eat-extra-virgin-olive-oil-and-nuts-with-it-study-suggests-10243725.html

A useful summary of the policy issues facing health.


11th May 2015

Jeremy Hunt is reappointed as Secretary of State for Health.  He says his biggest priority is to make a step change in improving services outside hospitals.  Greg Clark replaces Eric Pickles as Secretary of State for Communities and Local Government.
(12th May)
(12th May)
(12th May)
(12th May)

Iain Duncan Smith is reappointed as Secretary of State for Work and Pensions, which includes the role to find £12bn of welfare savings promised during the election campaign.
(14th May) New ministerial team:

Obesity is being fuelled by the global tendency over a number of decades for unhealthy food to become cheaper while fruit and vegetables have become more expensive according to a report from the Overseas Development Institute.  In the UK, the price of an ice cream halved between 1980 and 2012, while that of fresh vegetables tripled.  The report looks particularly at Brazil, China, Korea and Mexico.

The prevalence of short sightedness appears to be increasing, affecting almost twice as many people in the 55-59 as the 25-29 age group (47% compared to 28%) according to research from King’s College London, looking at data from 60,000 people from 15 studies between 1990 and 2013 and published in the journal Ophthalmology.  There was also a higher prevalence amongst those who had completed higher education.

The Welsh Government is introducing a new eligibility test for social care, where people will be eligible for a care package if their needs ‘can and can only’ be met by social services.

A $10bn global R&D health fund to combat antimicrobial resistance, ebola and other neglected diseases has been called for by a group of international health experts.  Writing in the journal PLoS Medicine, they are calling for a publicly funded and controlled scheme.

CCG Bulletin: Issue 83.  Including, the new NHS e-referral system, that replaces ‘choose and book’, goes live on 15th June.

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

7th May 2015

23% of under fives are overweight or obese, the second highest figure in Europe, according to the WHO.

Parents of overweight children wrongly judged them to be ‘about right’  in a study, by researchers from New York and Shanghai, based on data about two groups of children over two time periods: 3,800 from 1988-94 and 3,200 from 2007-12.  Although the proportions making erroneous judgements were lower in the more recent group, the children were significantly more overweight.

Social workers experiencing role conflict, (when they are required to do things that conflict with their values), are more likely to suffer stress and burnout according to a literature review of over 300 studies by King’s College, London for the Professional Standards Authority.


6th May 2015

72% of social workers said meeting targets took precedence over meeting service users and 33% described their morale as low, according to a survey of 1,571 social workers (appears to be self-selection) by Liquid Personnel (recruitment consultants) and Professor Eileen Munro.  The percentage of those who had seen cuts in their teams were: 60% of administrative posts, 35% front line and 38% managerial posts (it is unclear what overlap there was, so what percentage overall had seen any sort of cuts).

60% of GPs had waiting times of more than a week, up from 54% last year, according to a (self-selecting) survey of 714 GPs by Pulse magazine.  The average waiting time has increased from 9 to 10 days.  The doctors generally thought waiting times were likely to get longer in the coming year.

The growth in obesity looks likely to continue with a prediction that 74% of men and 64% of women will be overweight by 2030, according to a WHO report.  The Netherlands is one exception where rates of those who are obese or overweight are expected to fall.

The European Commission has published revised proposals on the ‘investor-state dispute settlement’ provisions of the Transatlantic Trade and Investment Partnership.  (Those are the ‘private courts’ where companies could sue Governments for loss of profits and which is it feared could prevent renationalisation of health).  It is said that the new ‘concept paper’ increases member state’s rights to regulate on such things as public health and the environment.

IBM’s Watson supercomputer is being used to dramatically speed up data analysis to help treat cancer patients, with 14 hospitals in the US and Canada due to be signed up by the end of the year.

The NHS safety thermometer report for April 2014 to April 2015 is published by HSCIC.  (This measures harm from pressure ulcers, falls, urine infections (in patients with a catheter) and venous thromboembolism (VTE)).


5th May 2015

The UK has fewer doctors, nurses, hospital beds and scanners than the OECD average, according to a report by the Economist Intelligence Unit.  It ranks the UK as 27th out of 30 OECD countries for healthcare resources.  Labour is also claiming that a leaked NHS Providers’ document shows that NHS trusts could have a deficit of £1.86bn by the end of the year.

A rapid response home nursing service appears to have reduced GP call outs and led to a fall in emergency admissions in South Tees.  The community matrons can prescribe and put management plans in place for the patient.  There was a 3.9% fall in emergency admissions compared to a 3.9% rise nationally.

There has been a fall in living standards for the majority of the UK population, in the last 5 years, with increasing numbers unable to afford basic, everyday items or experiencing financial difficulties, according to data which has not yet been published as official statistics in this country but which has been made available to the European Statistical Office, analysed by ‘Poverty and Social Exclusion’, an ESRC funded collaboration between a number of universities and statistical bodies.
(1st May)

The UK has been ranked 24th in the world as a place for being a mother, below France (23), Greece (19), Australia (9) and Spain (7), according to Save the Children’s 16th annual State of the World’s Mothers report, with the risk of maternal death being twice as high as Belarus, Austria or Poland.  The index of 179 countries is based on UN data.

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

3rd May 2015

The parties’ promises for increased numbers of GPs are unachievable in the next parliament at the current rate of recruitment, so additional measures such as new incentives would be needed according to the Royal College of GPs.
(5th May)

While 84% of people say they are worried about skin cancer, 40% of people never check for signs of it, 72% say they have been sunburnt in the last year and 77% do not feel confident they would spot the signs of a melanoma, according to figures by the British Association of Dermatologists, released at the start of ‘sun awareness week’.  There are about 2,100 deaths a year from skin cancer.  [Over 1,000 people were surveyed, but at ‘national events’, so they may not be representative: for instance, these may be people who tend to go out more.]
(4th May)
(4th May)

64% of patients prefer the NHS over private providers when given a choice according to foi responses from CCGs published by the TUC and think tank False Economy.


2nd May 2015

A new list of approved suppliers of support services to the NHS is dominated by private providers, including Capita, KPMG, PwC, and UnitedHealth, it is reported.


1st May 2015

An awards scheme to identify innovative digital technology that makes it easier to live with chronic and acute health conditions has been launched by the NHS Confederation and four digital technology organisations.

Monitor publishes its business plan for 2015-16.


30th April 2015

The number of carers over 65 has risen by 25% in a decade while the number over 85 has doubled to over 87,000, according to research by Carers UK and Age UK using census figures and their own analysis.  They estimate the value of older carers as over £15bn a year.

The gap in life expectancy between rich and poor continues to widen, standing now at eight years for men and seven for women between the highest and lowest local authority areas, according to analysis of official data by Imperial College, published in The Lancet.  The study used new methodology which predicts people living longer than current estimates which could have implications for long term planning of health, social care, pensions, etc.

NHS GPs provided better out of hours services than private providers in terms of timeliness, confidence in doctors and overall care experience, according to a study of 900,000 responses to the 2012-13 GP Patient Survey by the University of Exeter Medical School published in the BMJ.  (Another study by Imperial College published last week, 24th April, came to similar conclusions for GP services in general).
(1st May)

The number of families relocated out of London rose by 77% in the year July 2013 – June 2014 from 783 to 1,388 placements according to documentation of figures from London boroughs seen by Inside Housing.

Over 200 children with mental health problems were held in police cells last year because there was no proper place of safety available for them.  The ‘Learning Disability Census’ providing local level data and experiences of inpatients with learning disabilities is published by the HSCIC.  Mind says that the distance some patients are from home is unacceptable.
(26th April)
(2nd May)

An Australian scheme to help 40 people escape homelessness was deemed successful in getting 75% into stable housing after three years, compared to 58% of a comparison group receiving ‘normal care’.  The scheme, based in Melbourne was estimated to make an overall saving of 17,000 Australian dollars per person, per year.

Being active for at least two minutes every hour was found to cut the risk of dying by a third, according to researchers from the University of Utah who analysed data from 3,243 participants in a US National Health and Nutrition Examination Survey who wore movement-sensing devices to measure their activity levels.  The results were published in the Clinical Journal of the American Society of Nephrology.


29th April 2015

Poverty, and particularly child poverty, has risen over the past two years, as welfare changes came into effect, with middle incomes starting to rise but lower incomes falling, according to estimates by the New Policy Institute.  They estimate that 29% of children are in relative poverty after housing costs and that the median weekly income of the poorest 10% has fallen from £174 to £160 over the last five years.  They have produced the estimates because official statistics for 2013-14 won’t be available until after the election, in June and those for 2014-15 by the following June.

Reliance on agency staffing in the NHS more than doubled between April 2012 and January 2015, and the trend seems to be continuing, with the risk of workforce pressures jeopardising the implementation of the Five Year Forward View, according to an analysis by the King’s Fund, ‘Workforce Planning in the NHS.’
(30th April) (Rgn)
(Press release)
(The publication)

The GP vacancy rate has risen from 6% to 9% in the last year according to a survey of 458 GPs by Pulse magazine, and it is now the highest in the four years that they have run the survey.

A series of recommendations for improving child health including linking a consultant paediatrician and a community children’s nurse with every GP practice and ensuring children referred to a paediatrician-led rapid access service should be seen within 24 hours, are made in a report ‘Facing the Future Together for Child Health’ from the Royal College of GPs, the Royal College of Paediatrics and Child Health and the Royal College of Nursing.

Drug prices are too high because of regulatory processes and pressures on NICE where there is an artificially high threshold for cost-effectiveness, according to an editorial by professors from the University of York health sciences team in the Royal Society of Medicine journal.

The IFS calls for a reform of the council tax system, including more bands and a revaluation of properties.

A National Autism Project has been set up, funded by entrepreneur and philanthropist Dame Stephanie Shirley, to create a more strategic approach to addressing the challenges of the condition, including the use of interactive technology.  Autism is estimated to cost £32bn a year, three times that of cancer and more than any other medical condition.

A biodegradable 3D printed implant has been used to save the life of a child with a potentially fatal condition for the first time in work by the University of Michigan.  The 3D printed splint prevents the throat from collapsing, expands with the growth of the child and is ultimately reabsorbed into the body.
(1st May)

A useful summary of what each of the parties are promising on health, local government and other public service areas.
(30th April) Feature article on the health issues in the election campaign and a brief summary of the parties’ positions:

The Well-being of Future Generations (Wales) Act 2015 becomes law, promoting wellbeing and sustainable development in Wales.


28th April 2015

A third of privately rented homes do not meet basic standards of health, safety and habitability, rough sleeping in London increased by a third between autumn 2013 and 2014, and the UK is in breach of UN human rights commitments because of the housing crisis, according to ‘Just Fair’, a consortium of charities including Crisis, Oxfam, Amnesty International, Save the Children and Unicef UK.  The research was largely funded by the JRF and designed to inform a UN audit of housing in England this autumn.

Cancer survival rates vary by up to 66% between different parts of the country, with five year survival rates for lung cancer varying from 7.2% to 12.1%, for prostate cancer from 71% to 86% (a difference of 22%), and for cervical cancer from 55% to 75% (a difference of 37%), according to figures from ONS.–sha-and-cancer-network/adults-followed-up-to-2013/stb—adults-diagnosed.html

Breastfeeding reduced the risk of mothers dying from the most common breast cancers by 25% and lowered the likelihood of it returning by 30%, according to self- reports from 1,636 women with breast cancer in a US study published in The Journal of the National Cancer Institute.

Children bullied by other children could be between 2 and 5 times more likely to suffer mental health problems later in life than those maltreated by adults, so attention should be given to all the factors affecting young people, according to research by the University of Warwick and Duke Medical Centre, involving 4,000 children in the UK and 1,400 in the US, studied over a number of years and published in The Lancet Psychiatry.  However the research relied on self-reports and the results from the UK cohort produced less of a difference than those from the US (twice, rather than five times, more likely to suffer depression).
(Link to full pdf of research)

Obesity in infants may be more influenced by parents, while that for adolescents by peers, suggesting different approaches may be needed for tackling the problem in the different age groups, according to research looking at changes in obesity rates since the 1980s, led by the University of Exeter and published in the International Journal of Obesity.

Lower pollution in the eighth month of pregnancy was associated with higher birthweights, in a ‘natural experiment’, involving an analysis of 84,000 births in four districts in Beijing, before, during and after strict pollution controls were instituted for the Olympic games.  The babies were on average 24 grams heavier than in 2007 and 2009 when the air pollution controls were not as strict.


27th April 2015

Two thirds of the world’s population, 5bn people, have no access to safe surgery and a third of deaths worldwide in 2010 were from conditions treatable by surgery, according to research from 25 experts who spent a year and a half gathering evidence from 100 countries, published in The Lancet.  This is double the previous estimates which only looked at whether surgery was available, not whether it was accessible or affordable.

Over 400,000 diabetics are not getting the annual foot checks which could save them from amputation, according to Diabetes UK.  This is 13% of those with Type 2 and 28% of those with Type 1 diabetes.  [There are several thousand limb amputations a year and around 50% of amputations occur in people with diabetes.]

The NHS could save ‘millions’ if all of those who wanted to could die at home, by providing the necessary social support, according to Marie Curie.  In 2013, 85% of those who died in hospital had said they wanted to die at home.

‘Physician associates’ can do some of the existing work of GPs just as effectively and for lower cost according to analysis of same day appointments by over 12,000 patients in 12 GP practices.  The research was undertaken by Kingston University and St George’s University, London and published in the British Journal of General Practice.

£3m is to be spent on promoting running in Birmingham, to tackle obesity, by Birmingham City Council and Sport England, with an aim to get 5,000 inactive people started and 15,000 who do some exercise to do more.

The amount of calories did not determine weight gain but foods with a high glycemic load (which increase blood sugar) were associated with putting on weight, so that foods such as nuts, chicken, seafood and yoghurt helped people reduce weight while red meats, carbohydrates, refined grains, starches and sugar did the reverse, according to an analysis of data from previous studies on 120,000 US health professionals, based on self-reported questionnaires, over 16 years by Tufts University in Boston, published in the American Journal of Clinical Nutrition.

A report, ‘Economic Cost of the Health Impact of Air Pollution in Europe: Clean air, health and wealth’ is published by the WHO.


26th April 2015

GPs are advised to draw up end-of-life plans for all over 75 year olds, including whether they would want a ‘do not resuscitate’ order, under new NHS guidelines according to the Daily Mail.  [I have not been able to find the source of these guidelines.]

There would have been a cut to hospitals equivalent to £2bn over five years if reductions in tariffs identified in the 698 procedures which were examined also applied to all 4,500 treatments, according to research by the think tank False Economy commissioned by the TUC and Unison.

There was a week’s delay in diagnosing bowel cancer for those patients who saw their regular GP, but no difference for lung or breast cancer, according to a study of the records of 18,500 patients between 2000 and 2009 by the University of Bristol and Cancer Research UK published in the British Journal of General Practice.
(27th April)


25th April 2015

Paramedics took 28% more days off for stress-related illness in 2014 than 2012 according to foi responses from 9 of the 10 NHS regional ambulance services.  This is thought to reflect increasing, pressured workloads with little opportunity for respite.

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

25th April 2015

Labour highlight the high proportion of recent health contracts that have been let to the private sector, with £3.5bn of £9.6bn contracts (37%) let last year going to the private sector according to the NHS Support Federation, and 40% of CCG contracts going to the private sector as against 41% to NHS bodies according to foi responses.  Labour have said they will reinstate the 2% limit that NHS hospitals can earn from private patients, which was raised to 49% by the 2012 Health and Social Care Act.  For the average trust only about 1% of income comes from private patients.   [The Guardian article says these figures question the Government claims that only 6% of the NHS budget goes to private firms but I can’t see any evidence to support that.  The Government says there has been an increase from 4% to 6%, which means that while the overall proportion is still low, that still represents an increase of 50%.]


24th April 2015

Allowing non-NHS providers to provide GP services has not led to better care and may even have led to it worsening according to research by Imperial College published in the Journal of the Royal Society of Medicine which found that those on APMS contracts (Alternative Provider of Medical Services) performed significantly worse than other providers on 13 of 17 indicators in each year from 2008/9 to 2012/13.

115 of 224 care companies investigated by HMRC were not paying the minimum wage, to nearly 7,000 workers according to the results of an foi request reported in a Guardian article by Liz Kendall, Shadow Care Minister and Dave Prentis, general secretary of Unison.

A ‘fuel bank’ scheme offering £49 vouchers for two weeks’ free emergency electricity is being piloted in 21 areas.  It is being run by nPower and poverty charities including the Trussell Trust.

Chinese scientists have made genetic modifications to human embryos for the first time, in a procedure which would be illegal in the UK.  They used non-viable IVF embryos and tried to change the genetic code relating to a rare blood disease.  Concerns have been expressed about the ethical implications of such research.

Anxiety in children has both genetic and behavioural causes according to a study involving nearly 1,000 families where the parents were either identical or non-identical twins, by researchers from King’s College London and published in the American Journal of Psychiatry.


23rd April 2015

The NHS is unlikely to make the £22bn efficiency savings of the £30bn identified as required in the Five Year Forward View, by 2020 and on which the Tory and Lib-Dem commitments to £8bn are based, according to the King’s Fund based on a survey of NHS Finance Directors.  Of FDs of NHS Trusts, 69 of 93 (74%) said there was a high or very high risk of not achieving the £22bn, while for CCG’s the figure was 27 out of 40 (68%).  The report also said that the £8bn would be needed before 2020.

Labour will have to increase its spending on health if it is to meet its promises on the NHS while the Conservatives are unlikely to be able to find their promised efficiency savings, according to an analysis of the election manifestos by the IFS.  It estimates that real terms spending on the NHS would increase by £4.2bn a year under labour but £8bn under the Conservatives.
(Article mainly the financial proposals as a whole)

Voluntary sector organisations are having limited involvement with the local health and wellbeing system such as Health and Wellbeing Boards and joint strategic needs analyses, according to a survey of 720 charities published by the NACVA (National Association for Voluntary and Community Action).


22nd April 2015

Food bank use has increased by 19% in the last year to over 1m uses (equivalent to 500,000 people if each person used one twice) according to figures from the Trussell Trust based on its 445 food banks.  In 2009-10, 41,000 people were given three days food from the then 56 food banks.  A Conservative Party spokesman is quoted as saying: “Increased use of food banks is partially because the last Labour government didn’t let jobcentres direct people to them when they were in need of food.”

Labour promises cancer diagnosis equipment in GPs’ surgeries in every town with an investment of £150m every year from 2016-17.

A fall in binge drinking is said to be behind fewer numbers injured in serious violence according to a study of data from 117 emergency departments, minor injury units and walk-in centres, by Cardiff University.  A reduction in violence against children could be partly due to better safeguarding, it is also suggested.

67% of 5-11 year olds did not meet fitness standards in running, jumping and throwing, with between 32% and 36% deemed to be at an adequate level of fitness according to testing of 10,000 children by company Fit for Sport.

The CQC has revised Hinchingbrooke’s inspection rating from ‘inadequate’ to ‘requires improvement’, but it remains in special measures.
(23rd April) (Rgn)
(£ Rgn)

The Law Commission is likely to propose simpler Deprivation of Liberty Safeguards procedures to ease pressures on professionals whilst still protecting human rights according to comments made at a conference.  It is to launch a consultation on a new system in July after it was asked by the Government last year to draw up proposals for reform.


21st April 2015

Plans to ration access to care for financial or efficiency reasons were being considered by 39% of CCGs according to a survey of 67 (out of 211 / 209) CCGs by the Health Service Journal.  [There are now 209 CCGs, because of mergers, but I am not clear how many there were at the time of the survey.]
(22nd April)

Mindfulness based cognitive therapy was found to be as effective as medication for preventing relapse for people recovering from major bouts of depression, according to a randomised controlled trial of 424 adults from the South West of England, led by the University of Oxford and published in The Lancet.

Labour says its promised £2.5bn funding for the NHS is just a ‘downpayment’.  Milliband also promises a GP in every A&E by this winter.

Many hospitals appear to be ‘gaming’ the reporting of performance data because of the way they collect figures (such as mortality data) or by changing how and when they provide care, according to a report from Dr. Foster.
(22nd April)

Twice as many GPs think the introduction of CCGs has worsened patient care than those who said it had improved, at 37% to 18%, according to a survey by Pulse magazine of 592 GPs.


20th April 2015

Labour aims to get 1,000 additional nurses into training this year, if elected, as part of the aim to recruit 20,000 more nurses by 2020.  Malcolm Grant, Chair of NHS England calls for no repeat of the top down reorganisation.
(21st April)
(22nd April) (Rgn)

The SNP says it would seek to increase UK spending on the NHS by £24bn by 2020/21, £9.5bn above inflation, as they launched their manifesto.  They promise more help to carers and a reversal of the coalition’s welfare cuts.

A quarter of people with Parkinson’s have had their symptoms mistaken for drunkenness and 32% said they had been stared at when they displayed symptoms, often making them feel intimated (36% of those who had experienced negative reactions) according to a survey of 2,140 people by Parkinson’s UK.

There has been a 7% increase in the number of 11-13 year old girls reporting emotional problems, according to a comparison of two surveys of 1,600 pupils in 2009 and 2014 according to research from University College London reported in the Journal of Adolescent Health.  There was no increase in problems amongst boys.

There has been an increase in GP recorded depression amongst men since the 2008 financial crash, with an overall increase of 4% between 2008-13 which followed a fall of 15% between 2003-08 (with the only statistically significant change being amongst men), according to research led by the University of Southampton looking at data from 142 practices and published in the Journal of Affective Disorders.

A new safe staffing indicator is to be introduced by NHS England into hospitals this summer, with a red-amber-green rating based on such things as: sickness absence, training, rate of appraisals, and views of staffing from national staff and patient surveys.

15 local Healthwatch’s have set up websites to monitor and review GP practices, including ‘Trip Advisor’ style ratings.  [Judging by the comments on the Pulse website, this feedback is not welcomed by GPs.]


19th April 2015

There have been calls for under 4 year olds to be given free vitamins because of an increase in the number of cases of rickets with the Chief Medical Officer, Dame Sally Davies reported to have ordered a review into it.  There were 833 hospital admissions for the condition in 2012-13.
(£ Subscription)

The ability of CCGs to monitor private health providers is questioned in a report from the Centre for Health and Public Interest, which received survey responses from 181 of 211 CCGs and found that 60% did not record the number of site visits they undertook, 12% undertook no site visits.
(20th April)


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

18th April 2015

Six different demographic types of obese people have been identified and different approaches are needed to help each of them, based on data from more than 4,000 people in Yorkshire aged 18-85 collected in 2010-12 in research led by Sheffield University, reported in the Journal of Public Health.  The six types are: heavy drinking men; young healthy women; unhappy and anxious middle aged; affluent and healthy older people; physically sick but happy older people; and those with the poorest health.  However the work is criticised as not indicating whether these characteristics caused people to become overweight and as not saying whether a particular intervention would be helpful.


17th April 2015

What the party manifestos would mean for councils:

The election manifestos’ implications for health; comment from the King’s Fund.

Briefing on the manifestos from the Nuffield Trust.

The parties proposals for social work.

The Government’s austerity measures are having a profoundly disturbing impact on people’s psychological wellbeing, according to 400 counsellors, psychotherapists and other mental health experts in a letter to the Guardian.  There is criticism of the proposals to link social security benefits to ‘state therapy’, which is described as damaging and professionally unethical (e.g. because it is therapy without consent).
The letter:

Building a sustainable social care workforce should be a priority, the new president of ADASS, Ray Jones, who succeeds David Pearson, has said.

Later Life Newsletter 66 


16th April 2015

Former NHS boss Sir David Nicholson has said it will be difficult to meet the £22bn savings arising from the Five Year Forward View and there is a risk of managers being held to blame if it is not achieved.  He criticised politicians for not facing up to the substantial financial problems of the English NHS.  He said Labour should sign up to offering the additional £8bn a year the Tories and Lib Dems had agreed to and that the money was needed earlier than 2020.
(Analysis and comment):

The National Health Action Party launches its manifesto.  The party is fielding a dozen candidates at the election.

The NHS Confederation welcomes elements of the party manifestos but criticises the arbitrary targets for increasing staff numbers and the lack of honesty over the financial pressures on the NHS and calls for more attention to social care and calls for more stability.

Diagnoses of dementia have increased by 24% since GPs were offered £55 for each diagnosis at the end of September.  It is now estimated that 63% of those with dementia have been diagnosed, close to the Government’s 67% target.
(17th April):

A guide to the Enhanced Tariff Option for 2015-16, for providers and commissioners is published by NHS England.


15th April 2015

BBC’s guide to the health and care policies of the parties:!issue=health!party=!nation=uk

The Lib-Dem manifesto is launched, promising to:
– increase spending on the English NHS by £8bn a year by 2020
– increase spending by £500m a year on mental health care by 2016-17
– align mental health waiting time standards with those for physical health
– pool health and social care budgets locally by 2018 and launch a fundamental review of health and social care funding this year
– keep rural GP practices open by co-locating them with pharmacies, libraries and post offices
– promote evidence based social prescribing
– combine the public health, adult social care and health outcome frameworks into a single national wellbeing outcomes framework
– introduce a statutory code of conduct and care workers’ suitability register
King’s Fund comment: Notes that the promised £8bn funding for the English NHS won’t be available until later in the Parliament.  Like the two main parties they don’t address social care funding.  They have led the way in getting mental health onto the agenda.

The UKIP election manifesto is published promising to:
– spend £12bn on the English NHS by 2020 (i.e. £2.4bn a year)
– fund 20,000 more nurses, 8,000 more GPs and 3,000 more midwives
– invest £1.5bn in mental health and dementia over five years
– end the use of the Private Finance Initiative in the NHS
– end hospital parking charges
– end ‘health tourism’
– replace Monitor and the CQC with ‘county health boards’
– increase spending on social care by £1.2bn each year bringing it back to 2010 levels
– abolish 15 minute care visits
– seek wholesale reform of child protection services

34% of GPs plan to retire in the next five years according to a poll of 15,560 for the BMA by the market research company ICM.  53% said their workload was generally manageable but heavy at times, 37% said it was unmanageable and 10% said it was generally manageable or ‘low’.

Few non-smoking 11-16 year olds have become regular users of e-cigarettes, with 12% of 11-16 year olds having tried e-cigarettes but only 1.5% using them at least once a month, and the odds of being a regular e-cigarette user are 100 times higher for current smokers than non-smokers with a fifth of regular smokers using e-cigarettes, according to analysis of a representative sample of over 10,000 10-16 year olds in Wales, by Cardiff University, published in BMJ Open.–but-few-of-those-who-try-them-become-regular-users-10179570.html
(16th April):

What is described as an ‘aggressive’ hedge fund has bought a large stake in Circle, the private health provider, leading to a comment that this indicates they think there is money to be made from the NHS.

Having depression was associated with an 83% greater risk of developing dementia, while having diabetes was associated with a 20% greater risk, in research led by the University of Washington based on data on 2.4m Danish people aged 50 or over and published in the journal JAMA Psychiatry.  Having both depression and Type 2 diabetes was linked with a 117% greater risk of developing dementia.

More than £42m has been cut from councils’ sport and leisure budgets since 2010 according to figures collected by the BBC.


14th April 2015

The Tories launch their election manifesto.  Promises include:
– “spend at least an additional £8bn by 2020 over and above inflation” on the English NHS [this doesn’t sound the same as the £8bn a year by 2020 envisaged in the Five Year Forward View although the plans are described as implementing it]
– the right to a named GP
– same day GP appointments for over 75s
– seven day access to GPs, 8am to 8pm
– integration of health and social care through the Better Care Fund including piloting new approaches to joined up services between homes, clinics and hospitals
– enforcing new mental health access and waiting time standards
– access to mental health support for women during and after pregnancy
– extra funding for primary care and diabetes prevention
– the creation of regional adoption agencies
– overall cut to government spending of £30bn by 2020
(15th April)
(17th April) Coercing patients with addictions or who are obese into treatment could turn GPs into ‘inspectors’ and ‘probation officers’ and would affect doctor patient relationships:
Comment from the King’s Fund: the £8bn is welcome but finding the productivity savings will be a herculean effort and notes the manifesto is silent on the unprecedented challenges facing social care.

The Green Party launches its manifesto with promises to:
– increase the NHS budget by £12bn a year and then 1.2% annually after that
– ensure 11% of the NHS budget to be allocated to primary care, as the Royal College of GPs and the BMA’s General Practitioner Committee have asked for
– provide free dentistry, chiropody and prescriptions
– provide free social care for older people
– repeal the Health and Social Care Act and restrict the role of private firms in health
– increase the carer’s allowance by 50%
– make a national investment in evidence based parenting programmes
– initiate a UK strategy to tackle violence against women
Full manifesto at a glance:

A report on ‘Asset Based Approaches in Health Care’, titled ‘Heads, Hands and Heart’, summarising the theory and evidence behind asset based approaches in health, care and wellbeing and describing six case studies is published by the Health Foundation.

The forthcoming European agenda is set out in a briefing from the NHS Confederation European Office, looking at its priorities and work areas, including EU laws affecting data sharing, revisions of the European Working Time Directive, and the Transatlantic Trade and Investment Partnership.

Informed: Issue 32


13th April 2015

Labour launch their election manifesto, including promises to:
– repeal the Health and Social Care Act and make the NHS the ‘preferred provider’
– cap profits for private firms from NHS contracts
i- ntegrate health and social care through local, bottom-up agreements, with Health and Wellbeing Boards supported to become ‘a vehicle for system leadership’
– raise £2.5bn a year for a ‘Time to Care’ fund from a mansion tax
– recruit 8,000 more GPs, 20,000 more nurses and 3,000 more midwives (allowing for one-to-one care for women giving birth)
– guarantee GP appointments within 48 hours
– guarantee cancer tests within a week
– join up services from home to hospital
– give mental health the same priority as physical health and increase the proportion of the mental health budget spent on CAMHS
– take action on high strength, low cost alcohol
– set maximum permitted levels of sugar, salt and fat in children’s food
– avoid extreme cuts to social care
– end 15 minute social care visits
– recruit 5,000 new care workers
– ban the use of zero hours contracts
– devolve £30bn of resources to English cities and regions
(14th April)
Briefing from the All Party Parliamentary Health Group:
Comment from the King’s Fund: a positive vision but hard to see how they could dismantle the Health and Social Care Act without disruptive structural change; question whether Health and Wellbeing Boards could play the leadership role envisaged; failure to promise £8bn a year funding leaves a gap at the heart of its plans; although they identify social care as a challenge, there is no commitment to increase funding.
The health manifesto (pdf, 19 pages):

17% of women subsequently diagnosed with breast cancer waited a month before seeing their GP according to a YouGov poll for Breast Cancer Aware.  [I think that’s what it means: what the press release actually says is, “Nearly a fifth (17%) of women who have been diagnosed with breast cancer after spotting a potential symptom wait over a month before seeing their GP”.]  409 people were surveyed, of whom 403 were women [the discrepancy is not explained.]

The proportion of research funding for dementia and stroke is much less than the proportionate costs of those diseases compared to cancer according to research from the health economics research centre at Oxford University published in BMJ Open.  For every £10 of the costs of each disease, £1.09 was spent on cancer research, 65p on coronary heart disease and 7p on dementia.  The proportion of government spending has fallen on cancer and risen for dementia and stroke but charitable donations have not matched that pattern.

Patients could be asked to show passports or other proof that they are UK residents before being admitted to hospital under the new rules to tighten up access to health services by people from abroad.  This does not apply to GP or emergency care.  Visitors from outside the EU now have to pay 150% of the cost of their treatment.


12th April 2015

There could be a million elderly people lacking basic social care according to Age UK.

A collection of essays on early, preventive action, ‘One Hundred Days for Early Action: Time for Government to put prevention first’ is published by the Community Links led Early Action Taskforce.
(Press release):


11th April 2015

There was a 28% reduction in the number of community nurses between 2010-14, a fall of 3,300 despite an increase in the number of nurses in total according to a report from the Royal College of Nurses, ‘The Fragile Frontline’.  There were also reductions of 4,000 mental health nurses, and 1,500 learning disability nurses since May 2010.  The RCN is calling for more nurses to be trained.
(12th April)

Labour promises 3,000 extra midwives and one-to-one maternity care.


10th April 2015

George Osborne commits to providing the £8bn p.a. real terms spending increase requested for the English NHS and to meet the full £30bn funding gap through extra spending and savings.  [I thought he’d already said this earlier in the week].
(13th April) Osborne promises same day appointments for over 75’s, but this was criticised by GPs as being simplistic and risking distorting clinical priorities:

The design of NHS Citizen is introduced by NHS England.  This is a system through which the NHS England Board can engage with issues raised by citizens.  It appears to be a largely online process for gathering issues directly from members of the public and from established bodies such as Healthwatch and the third sector and debating them online.  There is an online summary of the discussions then prioritisation of 10 topics to go to a citizens’ jury, which further prioritises it to 5.  These are put to a biannual, three day meeting of a citizens’ assembly, in which the NHS England Board participates for the final half day.  [Comment: this looks like an excellent, well designed system. It is complicated – but I don’t think that’s a problem: it’s appropriate for the purpose.  The problem is that I couldn’t find a succinct description of what it is – you have to search through a lot of web pages to find out.]
This systems diagram gives a good initial idea of what it is all about and the other links on the page help understand the detail:

Stroke patients had twice the risk of attempting suicide, particularly within the first two years after the stroke, according to a Swedish study involving over 200,000 patients who had had a stroke between 2001 and 2012 and published in the journal Neurology.  However, those born outside Europe had half the risk of attempting suicide, suggesting there were cultural and religious factors involved.

A briefing on future resources, competition and organisation in the NHS is produced by the LSE’s Centre for Economic Performance (it is 11 pages).

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

10th April 2015

People who are underweight in middle age have a higher risk of getting dementia when they are older, contradicting previous research, according to a study of the records of 2m people in the UK, conducted by the London School of Hygiene and Tropical Medicine, published in the journal the Lancet Diabetes and Endocrinology.  However this is not an argument for putting on weight because, as the lead author told the Guardian, “you may not live long enough to benefit because you are at higher risk from other conditions.”


9th April 2015

The Lib-Dems are promising to increase the use of technology in the NHS, including making it paperless to be funded by the sale of surplus land which should raise £250m.  The money would go into a one-off transformation fund of the sort the Five Year Forward View said was needed.

Performance on starting consultant led treatment within 18 weeks of referral is the worst for almost seven years according to February’s figures which showed 87% meeting the deadline against a 90% target.  The average waiting time for treatment is now 10 weeks.

Britain has been ranked 27th in the world in terms of health and wellness despite being the fifth richest nation, according an index of social progress.  It was pushed down the rankings because of high obesity levels.  The index is based on 52 indicators enabling it to rank 133 countries on their social and environmental performance.
Press release (pdf):

Switching between antibiotics in a particular sequence was found to be a more effective way of killing a bug in the laboratory than conventional approaches and could enable the use of antibiotics thought to be no longer effective and help combat drug resistance, according to research by Exeter University published in PLoS Biology.

The coalition government has made limited progress in reducing health inequalities despite enshrining the requirement to address it in legislation, according to an assessment by the King’s Fund, which concludes that, the lack of a coherent strategy and the translation of that into implementation means that the initial rhetoric has not been lived up to.

93% of GPs said their workload was affecting the care they could provide with 37% saying it was unmanageable.  94% of GPs did not want their practice to open at weekends and 63% said they would not want their surgery to join a group of others, to allow such opening in a survey of 15,560 GPs by the BMA.  51% said practices should offer some extended opening.  67% said they would like the standard 10 minute appointment time to be longer so they could provide better care.

The NHS could save £180m a year by reducing its carbon emissions according to a report from the NAO.

GPs prescribed sun creams with a total value of £13m alongside prescriptions for toothpaste, multi-vitamins and other over products available over the counter, according to figures from HSCIC.  The cost of all prescribed items rose by 3% last year to £8.9bn, although this excludes income from prescription charges.

A briefing on personal budgets in Mental Health is published by the NHS Confederation and Think Local Act Personal.


8th April 2015

The high rates of food bank use have been in areas with the highest rates of benefit sanctions, unemployment and cuts in central welfare spending according to research by Oxford University using figures from the Trussell Trust, the largest provider of food banks.  (The associations were statistically significant at the 95% level).  The number of local authority areas with food banks rose from 29 in 2009-10 to 251 in 2013-14.  There is a statistically significant association between that rise and cuts to local authority spending and central welfare spending.

The NHS is expected to have overspent by £600m by the end of the financial year, particularly because of the cost of agency staff, according to a report by the Health Foundation, ‘Hospital Finances and Productivity: in a crucial condition?’  The report also said productivity had been much lower than necessary to meet long term plans.
Blog, with analysis:

End of life care needs a major overhaul according to research from the LSE which said that 100,000 people a year do not get palliative care, although they would benefit from it.  Only 53% of frontline staff think patients’ palliative care needs are being adequately met, according to a survey, also commissioned by Marie Curie, conducted by Ipsos MORI of 500 people.

The NHS Safety Thermometer Report March 2014 to March 2015 is published by HSCIC.  This measures harms from pressure ulcers, falls, urinary tract infections and venous thromboemolisms.


7th April 2015

The latest English quarterly A&E waiting time targets are the worst in ten years at 91.8% treated or discharged within 4 hours.  This is a fall from 92.6% in the previous quarter, to December 2014.  In hospital A&E’s only 87.5% were dealt with in the target time.  There were similarly poor results in the other UK nations.

Jeremy Hunt says the Tories would provide the £8bn identified in the Five Year Forward View as being required by 2020, or however much is needed, whether more or less than that.

Life expectancy for women aged 65, 75, 85 and 95 fell in 2012 compared to the previous year, the first such fall in 17 years according to a report by Public Health England.  There was a fall for men aged 85 and 95.  PHE said it was too soon to say whether this was just a ‘blip’ or a trend, however others suggested this could be the ‘canary in the coalmine’ and said there should be an investigation into possible causes such as cuts in social care.

The cost of treating British visitors to Europe is five times what the NHS pays for treating Europeans here, questioning some of the arguments used on ‘health tourism’, according to figures from DH obtained through foi requests.  There is some question as to how accurate the figures are, and whether costs are fully recovered in this country.

More than 140 doctors have written an open letter criticising the Government’s record on the NHS, accusing it of funding cuts, broken promises and destructive legislation.
The letter:
(8th April)

There has been inconsistency between Government departments in how effectively they have published performance information according to a report by the Institute for Government.
(2nd April)

A toolkit for commissioners to help reduce poor inpatient care has been published by NHS England.  It is a 27 page pdf document, designed to be used with patients, carers and providers, providing advice on what to look for and where to find data, with many short case studies and lots of links to other resources.

Short, anonymised summaries of complaints investigations have been published by the Parliamentary and Health Services Ombudsman.  This is the fourth in a series of such digests.

Informed: Issue 31.  (Including: new policies published on Never Events and Serious Incident Frameworks)

CCG Bulletin: Issue 81.  (With items including: new framework to assure CCGs, mental health taskforce launched, change in the number of CCGs (there are now 209).)


6th April 2015

Skin cancer amongst pensioners is seven times more prevalent now than in the 1970’s with about 5,700 older people diagnosed with melanoma each year now compared to 600 cases a year in the 1970s according to figures collected by Cancer Research UK.  About 2,100 people die from it each year.  The increase is thought to be because of the boom in package holidays abroad in the 1970s.

There could be as many as 80,000 deaths from a drug resistant bacterial blood infection according to the latest National Risk Register of Civil Emergencies, highlighting the importance of antimicrobial resistance (AMR).
(7th April)

Making a greater proportion of exercise vigorous rather than moderate was found to have a greater impact on reducing mortality according to Australian research on 218,000 45-75 years which took self-reports of exercise for one week then compared it to mortality over 6.5 years.  Of the 7,400 people who died, there was a steady reduction from 8.3% of those who did no moderate to vigorous physical activity through to 2.6% of those who did 300 minutes or more a week.  The research was published in JAMA Internal Medicine.  The results call into question existing advice which suggests that vigorous exercise is exactly equivalent to moderate exercise done for twice as long.

Soft drinks manufacturers should reduce the sugar in their products the LGA says. Its research found that some fizzy drinks cans contained twice the recommended daily sugar limit.  It is calling on a proportion of taxes on unhealthy food and drinks to be used for preventive work.

A systematic review of weight loss plans finds evidence for the effectiveness of two after twelve months, Weight Watchers and Jenny Craig, compared to people dieting on their own, but generally finds a limited amount of evidence.  The researchers, from John Hopkins University, reviewed 4,200 studies but found only a few dozen using properly controlled clinical trials.  From these, they examined 11 programmes in detail.  The research was published in the Annals of Internal Medicine.

It is illegal for newsagents and corner shops to display cigarettes from today.


5th April 2015

69% of teachers said they had seen children coming to school hungry and 24% said they had brought in food for hungry pupils while 80% said pupils were arriving at school in inappropriate clothing for the weather conditions, according to a NASUWT survey of 2,452 teachers.  [There is no indication that this was undertaken by a polling company or that it was a representative sample.]

There is reported to be pressure for a new levy on tobacco companies to recognise the harm their product does, analogous to the ‘polluter pays’ principle.  A new law banning newsagents from displaying tobacco products comes into force on 6th April.
(Analysis and comment)

Only 8% of GPs think that the standard 10 minute consultation is long enough, 93% say their heavy workload has had a negative impact on the quality of patient services and 94% do not support seven day working, in a BMA survey of nearly 16,000 GPs.


4th April 2015

The proportion of nurses recruited from abroad has risen from 11% to 29% between 2009-11 and 2014-15, while training places fell by nearly 40% over four years, with just over 20,000 places in 2010-11 for about 54,000 UK applicants.

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

4th April 2015

85% of people think the NHS should be protected from cuts with 59% supporting tax rises to pay for it and only 16% favouring charging for services although 61% would support £10 fines for missed appointments, according to an Ipsos MORI survey of 1800 people.

The Lib-Dems commit to an additional £2.5bn spending on social care over the next Parliament.


2nd April 2015

Fast food outlets have been increasing more in deprived than well-off areas according to a study looking at changes in Norfolk between 1990-2008, by the University of Cambridge published in the journal Health and Place.  It found that the number of takeaway outlets rose by 45% over the period equivalent to 2.6 to 3.8 per 100k residents, with the rise being 4.6 to 6.5 (43%) in the areas of highest deprivation and 1.6 to 2.1 (30%) in the areas of least deprivation.
[I find the statistics a little confusing and can’t find the original article]

Fatalities within 30 days of children’s heart surgery have fallen by a half between 2000 and 2009, from 4.3% to 2.6% of cases, according to research published in the online journal Open Heart.

The Government says there are too few referrals to independent mental capacity advocates (IMCA) in safeguarding cases, in its annual review on the IMCA service, a point it has also made in the previous two reports.

An international drug company has been accused of trying to ‘scupper’ trials of a drug to treat the eye condition wet AMD, which is much cheaper than the existing alternative.  The claim is made in the BMJ.

A nurse developed ‘barometer’ to assess organisational culture could be rolled out more widely across the NHS according to a recent conference report.

A review of evidence on service reconfiguration in the NHS finds that there is little evidence that the concentration of acute general hospital services and investment in community services will generate the hoped for level of savings.  The review is by researchers from the King’s Fund and the Nuffield Trust published by NIHR.

Research on NHS commissioning practice and health systems governance is published by NIHR.

The NHS should train more permanent staff to reduce the use of agency and locum staff to save money and improve safety according to a report from the think tank Civitas.

A report recommending a more market orientated health system, with comparisons to other European countries is published by the Institute of Economic Affairs.


1st April 2015

Ofsted’s ‘crude’ single inspection process has been criticised by the LGA, ADCS and Solace who say it is flawed and not conducive to improvement.  They say it should be replaced by a ‘portfolio approach’ with an initial, unannounced ‘front door’ inspection, followed if necessary by a wider, multi-agency inspection with a narrative replacing the existing scoring.

Opening GP surgeries at weekends reduced A&E attendance by 8% in a study of 34 London GP practices according to research by Sussex University reported to the Royal Economic Society Conference.  The average cost of an A&E visit is estimated at £114 while a GP appointment is £25.

10% of people trying to get a GP appointment could not get one, equivalent to 34m appointments, according to a study based on figures from the GP Patient survey, led by researchers from Imperial College and New York University and published in the BMJ.  It is also reported in the BMJ that there is a lack of evidence of what impact Labour and Conservative promises to increase access to GPs will have.

29% of GP training places remain unfilled after the first round of recruitment, Pulse reports.  There are likely to be three rounds.
(6th April)

The number of GPs who trained abroad has increased by 11% over ten years and now stands at 22% of the workforce, according to figures from the HSCIC.

There is still too much variation in the health and care people receive according to the CQC’s equality information report for 2014, ‘Equal Measures’.

Councils are planning to increase the number of social workers by an average of 6.4% to meet the needs of the Care Act according to workforce plans obtained from 90 authorities obtained through foi requests by Community Care magazine.  30% of councils planned no increase.

Most of the provisions of the Care Act came into force on 1st April.  In Scotland, health and care budgets are being merged, with the Public Bodies (Joint Working) Act.

The Care Act, despite bringing ‘bold’ changes is built on sand because of a lack of funding, according to a coalition of leading charities, the Care and Support Alliance.

A comprehensive list of health and care measures coming into effect on 1st April is produced by the NHS Confederation.

Changes in regulations and responsibilities from 1st April, including ‘fundamental standards’, duty of candour, requirement to display ratings, new enforcement policy, and market oversight to monitor the risk if large, ‘difficult to replace’ providers of adult social care were to close is published by the CQC.
(27th March)

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