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2015 Q4 October-December

Health and Wellbeing Policy Update: October-December 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 a weekly email you can contact me ‘webmaster at equwell dot org dot uk’ (replacing ‘dot’ and ‘at’ with the respective signs).

23 December 2015

The Scottish Government’s plan for a minimum alcohol price is in breach of EU free-trade laws, the European Court of Justice has ruled, saying that it would only be justified if it was more proportionate and effective than using general taxation, which would then allow retailers to set their own prices and compete with each other.  It returned the case to Scotland’s civil courts for a final ruling.

Labour says the Government’s promise of extra health spending is unravelling, since the £3.8bn for next year will largely be taken up dealing with the predicted £2.2bn Trusts’ deficit and additional pension contributions of £1.1bn (because of the abolition of the lower rate of employer’s national insurance contribution for those opted out of the second state pension).  The claims were confirmed in comments by the King’s Fund’s chief economist, John Appleby to the Radio 4 Today programme.

EU wide restrictions on e-cigarettes do not break European law according to the Advocate General in response to a challenge by manufacturers.  The final court judgement is expected next year and although it will not automatically follow this opinion, most judgements do endorse those opinions.

Online comparison of care homes is now possible on the My NHS part of the NHS Choices website.  As well as key information such as location, contact details and services on offer, further information includes CQC inspection results and user reviews and star ratings.
(You need to scroll down the page then choose ‘Care Homes’ from ‘choose a category of service’)

A new measure of avoidable deaths for individual health trusts in England will involve a self-assessment but the exact form of the measure has yet to be determined, according to a letter from Sir Bruce Keogh, NHS England Medical Director, to all trusts last week.  The Health Secretary had previously promised that the measure would be in place by April.

The UK paid out almost 15 times more to other European countries for healthcare than it received under reciprocal arrangements last year according to figures from the Department of Health.  It paid out £660m to other countries in the European Economic Area and received back £43m.  It is suggested that the imbalance is largely because of British pensioners retiring abroad under EU free movement rules.


22 December 2015

Health planning guidance for the next five years has been published by NHS England and the other bodies who produced the Five Year Forward View: NHS Improvement, the CQC, PHE, HEE and NICE.  The plan aims for a quarter of the population to have access to some seven day care in acute hospitals by May 2017. It sets out nine ‘must dos’ for each local area, including a return to ‘financial balance’ by the end of the 2016-17 financial year and meeting key targets such as the A&E four hour wait and ambulance response times.  All NHS organisations are asked to produce two plans: a five year ‘Sustainability and Transformation Plan’ for the health and care system; and a one year organisational plan. [Comment: this looks very worthwhile, but how can you have a health and care system plan produced just by health organisations?  Isn’t the Joint Health and Wellbeing Strategy the vehicle for this?]
Press release:

Care for homeless people in A&E was generally good but fundamental standards were not being met in a number of cases, according to an audit looking at 22 trusts over a two week period in winter, including 294 homeless people,  published by the Royal College of Emergency Medicine and The Faculty for Homeless and Inclusion Health.  Of the 146 presenting because of a drug or alcohol problem, only a quarter were referred for specialist assessment.  Of the 44 where a mental health problem was recorded, 55% were shown as having a risk assessment and referred to a specialist team.  About half were not registered with a GP and in 85% of those cases no further advice or information was given about registration.

Nurses tend to feel more stressed from being undervalued and not in control than from the actual tasks they carry out according to research on 100 nurses at a large teaching hospital in Scotland which continuously monitored heart rate and activity levels and asked about tasks and stress every 90 minutes over two work shifts.  The research was published in the Annals of Behavioural Medicine.

Seven NHS trusts made more than £3m from parking charges in 2014-15, according to foi responses to the Press Association from 90 trusts, with half of them making at least £1m a year.  Many of the trusts said they use the money for patient care or for maintaining the car parks or grounds, but some are locked into PFI deals with the money going to private contractors.


21 December 2015

Bacteria resistant to the antibiotic usually used as the last resort, colistin, have been found in the UK, in three farms and in samples of human infections.  Such resistance was found in China last month.  Public Health England said the current risk is low but is being kept under ongoing review.  They said the organisms could be killed by cooking food properly and they are responsive to other antibiotics.

Avoidable benefit delays are putting people at risk of hunger and losing their home according to the House of Commons Work and Pensions select committee.  It expressed concerns that under universal credit some people will have to wait up to six weeks for their first benefit cheque.  It was said that sufficient data had not been made available to hold the DWP to account and that if it was not being collected, the Government was ‘making policy decisions in the dark.’

Nine out of ten hospital trusts in England are not meeting their safe staffing targets with 92% of the 225 acute trusts not having the planned number of nurses during the day on the measurement day in August and 81% not having enough at night, according to analysis by the Health Service Journal.

The DWP has admitted some people on universal credit will lose money from next April due to changes to work allowances, but have suggested they recoup the losses by working longer hours.  About 500,000 people will be on universal credit by April, but it is not known how many of those claim the work allowance.

Alcohol related activity is putting increasing strains on hospitals in England, with inpatient admissions specific to alcohol having risen by 64% in the 9 years to 2013-14 and A&E attendance due to alcohol poisoning having doubled in the 6 years to 2013-14 (from 73 to 149 per 100k of population) according to an analysis by the Nuffield Trust.

Funding for community pharmacy is to be cut by 6% next year, whilst at the same time asking for a greater contribution to local health.

Another 52 CCGs will be able to commission GP services from April 2016, having been given the authorisation by NHS England.

The funding formula for GP practices is likely to be changed giving more funding to deprived areas.

Jeremy Hunt says free wi-fi is to be provided in all NHS buildings. [This appears to be confirmation of the item appearing on 8/12/15 from NHS England about increased use of on-line facilities.]


20 December 2015

Only 15% (209 of 1,436) of deaths of inpatients with learning disabilities in England have been investigated by NHS hospital trusts according to figures obtained by the Guardian in response to foi requests.  Of such deaths classed as unexpected, 36% (100 of 275) were investigated.  The CQC is already committed to reviewing investigations of death.  The foi responses also revealed a discrepancy with the Southern Health NHS Foundation Trust, which reported 67 unexpected deaths of which it had investigated 67, while the recent audit by the firm Mazars (which was leaked to the BBC) found 93.

A stay in hospital can make you more vulnerable to further illness, unpublished research from Loyola University Medical Centre in Illinois, looking at readmission rates for hernia patients, suggests.  [This is a feature rather than a news item.]  This seems to support hypotheses published in several leading medical journals by Yale Professor, Dr Harlan Krumholz, suggesting it is the cumulative result of stressors and de-conditioning such as: sleep deprivation, poor nutrition, staying in bed, cognitive overload and emotional stress.  This leads to ideas on how hospitals could be made healthier places.


18 December 2015

An estimated 86% of patients were seen in A&E within four hours compared to the target of 95%, in the week ending 4th December, according to figures from the Royal College of Emergency Medicine based on data submitted by 40 Trusts from across the UK (a fifth of the total).  However 33 out of 40 trusts, covering 86% of the population had increased bed numbers and delayed transfers of care had fallen to the lowest level since the beginning of October.
The weekly report (pdf):

11% of available GP training places will remain unfilled this year, with a total of 2,769 recruited, 98 more than the previous year, compared to the Government target of 3,250 trainees a year by August 2016.  More places remained unfilled in the north east and midlands than the south east.

Nurses should remain on the national shortage occupational list and be exempt from immigration controls when the position is reviewed in February according to a report from the House of Commons Home Affairs Select Committee, reporting on the effectiveness of the immigration cap.  The high salary thresholds in the cap could have created a crisis for nurse recruitment, ‘effectively crippling the NHS over winter’, the committee said.

The increasing use of ‘legal highs’ in prisons is putting presure on ambulance services according to a study by the chief inspector of prisons.

France is to introduce ‘plain’ cigarette packaging from May 2016 after legislation was passed with conservative opposition.


17 December 2015

Local government funding is to be cut by 6.7% between 2016-20, frontloaded into the first two years, the DCLG has announced.  There is to be an option of a four year settlement.  Despite the Communities Secretary saying that the settlement “makes local councils fully responsible to local people for their financing”, the Government is to maintain the ‘2% council tax threshold’ (in addition to the 2% precept for social care).  The Better Care Fund increase is to be distributed to councils according to local need, to help compensate councils unable to raise enough from the new 2% precept.
Councils warn that the cuts will increase pressure on already stretched services:
Press release:
Consultation on the finance settlement:
Spreadsheet with details for each local authority:
Provisional local government finance report (technical document) (63pp):

Funding for GPs is to be increased by 4% for each of the next five years, NHS England has said, which will mean a 25% increase on current spending by 2021.  It is also updating the formula used to allocate funding to practices.  Every CCG is to get extra funding next year with adjustments made so that those who need it get more.  CCGs are expected to increase their spending on mental health in line with the increase in their budgets.

Half of England’s population should be covered by new models of care integrating primary and secondary care by 2020, this year’s DH mandate to NHS England says.  Other targets include: full seven day working in hospitals and all patients having acess to routine evening and weekend GP appointments; a measurable reduction in emergency admissions by 2020; measuring the quality of, and access to, GPs; no patient waiting for more than 28 days for a cancer diagnosis or all clear; a reduction in childhood obesity; and an increase in the number of patients getting a dementia diagnosis within six weeks.  There were over 127,000 responses to the consultation on the Mandate, compared to about 150 in previous years and 3% were in favour of seven day services.
Response to consultation on the Mandate:
The Mandate:

Three quarters of people affected by the bedroom tax say they have had to cut back on food, 46% had cut back on heating, 33% on travel and 42% on leisure, according to an independent evaluation from the Cambridge Centre for Housing and Planning Research and Ipsos MORI, published by the DWP.  It found that 78% of those still affected by the policy after two years were regularly running out of money by the end of the week or month.  Only one in nine had moved to another property and only 5% of those affected had found other work.
Assessment of the removal of the ‘spare room subsidy’ (this is by CooperGibson Research, so not clear if it is the same as that referred to in the Guardian article)

Responsibility for attendance allowance for over 65s is to pass from the DWP to local councils in what is reported to be one of the biggest reallocations of public resources in 25 years.  The benefit is non-means tested for people over 65 who need help and is currently paid to 1.5m people.

Health and social care are experiencing a decade long funding squeeze which is not sustainable, according to a briefing on the spending review produced jointly by the King’s Fund, Health Foundation and Nuffield Trust.  They note that the Government has changed the definition of health spending in their announcements (looking only at NHS England rather than the whole of the Department of Health) and taking the definition which has always been used before, there will be a real terms increase in health spending of 0.9% a year, almost exactly the same as in the previous parliament.  Much of the new money will go into meeting the deficits of service providers and additional pension costs, with little left for investing in new models of care.

Jeremy Hunt has criticised the Southern NHS Foundation Trust in a written statement to the House of Commons on the independent report which said the Trust had failed to properly investigate the deaths of people with mental health problems or learning disabilities.  The CQC is to undertake a focussed inspection of Southern Health in the new year and a wider review into the investigation of deaths in a sample of trusts throughout the country.
Press release from Monitor, TDA and the CQC:
Link to the reports:

The number of homeless families being housed in B&Bs is at the highest level for 12 years according to Government figures.  There has been a large rise in the proportion who were previously living in private rented accommodation, from 11% in 2009-10 to 31% in the four months to September.

The single biggest thing needed to make Britain more equal is to improve teaching in disadvantaged areas according to Alan Milburn, chairman of the social mobility commission, in the commission’s latest report.

A new role of ‘nursing associate’ is to be created, bridging the gap between healthcare support workers and registered nurses, and providing a route for those wishing to become a registered nurse, the Department of Health has announced.  Up to 1,000 nursing associates could be trained from 2016.
(Rgn) the new role is cautiously welcomed by the unions:
(18/12/15) (Rgn)  There are important considerations as to whether the role should be regulated:

A five fold variation in survival rates 30 days after being admitted for an emergency operation between NHS Trusts has been found in research showing a 1.6% risk of dying in the best trusts compared to 8% in the worst, published in the British Journal of Anaesthesia.  7% of the difference between death rates could be attributed to differing staffing levels.  The research looked at 156 Trusts using data from nearly 300,000 patients over the five years from 2005-10 and found that 14 had significantly higher than expected death rates and in 9 they were significantly lower.  The research also showed higher mortality rates for weekend admissions after accounting for differences in staffing levels.
(18/12/15) (Rgn)

Guidelines to reduce loneliness and maintain independence and mental wellbeing among older people have been published by NICE.
Press release:
The guidelines:

Folic acid should be added to bread to reduce the number of birth defects, such as spina bifida, as it is in many other countries, according to a study published in the Archives of Disease in Childhood which found that such a policy could have reduced the number of ‘neural tube defect’ pregnancies in the UK by 2,014 over 21 years.

Research on the impact of children’s centres has been published by DfE.

Research on how local authorities support children who return home from care has been published by DfE.

A draft Cycling and Walking Investment Strategy is to be produced for consultation by spring 2016. The Government is required to produce such a strategy under the Infrastructure Act 2015.


16 December 2015

At least a third of care home residents are affected by malnutrition, and people arriving underweight and malnourished were more likely to get worse, according to an analysis of four surveys that took place between 2007 and 2011, involving 474 care homes and 3,971 residents, by the charitable association BAPEN.  The surveys were carried out with the British Dietetic Association and Royal College of Nurses and supported by the Government and chief nurses.
Press release:

70%-90% of some cancers are caused by lifestyle and environmental, rather than genetic factors according to research using four different forms of analysis by researchers at Stony Brook University, New York state published in the journal Nature.  This contradicts research published in January (1st) suggesting that the rate of cell division explains most of the risk with environmental factors only accounting for a third. Factors contributing to cancer include tobacco, alcohol, diet, lack of exercise, exposure to sunlight and viruses, stress and pollution.  Environmental factors are more important for some cancers than others.  Since the rate of some cancers has been steadily increasing, this can’t be explained by purely genetic factors.  Similarly when people migrate from low to higher cancer areas, their risk of developing cancer increases.

Financial problems in the NHS are becoming endemic according to the NAO which says the current situation is unsustainable and that there is limited evidence for the savings plans in the Five Year Forward View.  NHS Trusts are expected to overspend by over £2.2bn this year.  The report said that DH, NHS England and Monitor do not have a plan to stabilise the situation.
Press release and link to report:

New NICE guidance on end-of-life care proposes an individualised approach tailored to the needs of the individual patient, and a move away from a tick box culture.  The new guidance is a move away from the criticised Liverpool Care Pathway.  Snap decisions should not be made, and junior doctors should consult more experienced specialists.  People in the last few days of life should be offered fluids.
Press release:
The guidance:

Part of the promised additional NHS funding (£1.8bn out of £3.8bn) is to be used as a transformation fund, to be allocated to hospitals meeting a series of conditions, including: agreeing plans to reduce deficits and break even within a reasonable timescale; reducing agency spend; agreeing plans to meet targets; and setting out plans to achieve seven day services by 2020.  There are to be ‘sanctions’ ‘to ensure hospitals comply with the measures.’

Results from the Health Survey 2014 have been published covering a wide range of health data. Those drinking more than lower risk levels are likely to be older and better off. 13% of the population have some degree of hearing loss and it is higher in men, with 50% of men over the age of 65 having some hearing loss and over a quarter of men over 55 who think they hear well actually have a hearing loss.  17% of people over 16 had given unpaid care in the last month to someone with physical or mental health needs.  24% of older men and 33% of older women needed help with some activity of daily living.  The research is carried out for the HSCIC by NatCen Social Research and UCL, and involved interviews with 8,795 adults and 2,185 children.
Press release:
Summary and links to documents:

GPs in the UK are the most stressed amongst the wealthiest nations, with a fall in the proportion saying their health system worked well from nearly half in 2012 to 22% in 2015, according to a survey by the American based Commonwealth Fund, of GPs in Austria, Canada, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland, the UK and the U.S.  In the UK, 1,001 GPs were surveyed.
International profiles of healthcare systems:

Nurses are feeling increasingly under pressure, with 80% saying the pressure had increased in the last year, 65% saying care activities had had to be left undone at the end of their last shift due to lack of time and 53% reporting a reduction in permanent staffing in the last year, according to a survey by Nursing Times of 950 of its readers.

The Mid-Staffordshire Trust has been fined £500,000 for errors linked to the deaths of four patients at Stafford Hospital.  The Trust no longer runs the hospital, exists only as a legal entity and has no funds, so the fine and costs will be paid by the Department of Health.

A review of perinatal deaths is recommended for 21 NHS Trusts and boards that have higher than average stillbirth and newborn death rates, by an inquiry by a panel of experts led by the University of Leicester (MBRRACE-UK, ‘Mothers and Babies: Reducing Risk Through Audits and Confidential Enquiries Across the UK).

The BMA has suggested longer GP appointments than 10 minutes should be allowed for more complex patients, in comments by Dr Chaand Nagpaul, Chair of the BMA’s GP Committee to the Health Select Committee.  Increasing the length of some appointments could mean other patients having to wait longer for an appointment.

A community interest company focussing on prevention and improving health is being set up by the local NHS Trust, county council and university in Northamptonshire.  Income will come from the NHS and up to 20% from trading.

[not policy news as such, but an interesting example of a whole person approach to prevention].


15 December 2015

A health devolution deal for nine London councils has been agreed by the Department of Health, which includes five councils sharing buildings and facilities with the NHS and Hackney combining health and social care budgets.

A CQC maternity survey of 20,000 women shows improved services but continuing areas of concern, with the CQC press release highlighting a series of improved statistics but the Mail online headline claiming: “The dismal state of maternity services laid bare: Thousands of women left terrified and alone during childbirth, subjected to forceps and given poor breastfeeding advice.”  Improvements since 2013 included an increase from 35% to 41% in being given a choice of giving birth in a midwife-led unit; an increase from 59% to 62% in always being given the information they needed and an increase from 85% to 87% of those who said they were treated with dignity and respect.  In the 8 years since 2007 there was an increase from 42% to 63% of those saying they were given active support and encouragement about feeding their baby.  However there was an increase since 2013 from 19% to 22% in the use of styrups.  Only 64% said they were able to get the attention of staff when they needed it.

More should be done to boost the uptake of bowel cancer screening to improve survival rates, according to the latest bowel cancer audit.  Survival rates after 90 days have improved over the last two years from 94% to 96%.

Alcohol is a factor in more than half the incidents Scottish ambulance crews attend at weekends and nearly half of calls on weekday evenings, according to figures from an internal staff survey.  It is not something that is recorded in formal monitoring systems.

Larger GP practices should be able to self-monitor and have fewer inspections, the CQC’s Chief Inspector of General Practice has said in comments to the House of Commons Health select commitee.  He, himself is a partner in such a practice.

Local authorities should have more local tax raising powers including retaining stamp duty tax revenue, which amounted to £10bn in 2014-15, according to the Centre for Cities.  It says that in most other countries, local government has more tax raising powers.  Devolving land and property tax as well as business rates would give local authorities responsibility for 41% of their spending, compared to 19% at present.

The results of the Learning Disability Census have been published by HSCIC.


14 December 2015

Plans to take failing children’s services out of the local authority’s control have been announced by the Government.  If the services were not able to improve within 6 months, they would be given to other, high performing councils, children’s charities or teams of experts to manage.  This follows a statement by the Prime Minister on 11th September that he wanted to break up state monopolies, including chidlren’s services.  Over £100m is to be invested in attracting ‘high-calibre’ graduates into social work.  A new ‘What Works’ centre is to be set up to spread good practice in social work.  Ofsted found that 19 of 74 children’s services inspected between February 2014 and September 2015 were ‘inadequate’.
(15/12/15) Feature and comment:
Press release:

General practice has ‘failed as a profession’ according to the CQC’s Chief Inspector of General Practice, Prof Steve Field, who said, in an interview with the Mail, that he was at times ashamed to be a GP when he saw the standard of care at some practices.  The comments were called ‘baffling and offensive’ by Dr Maureen Baker, Chair of the Royal College of GPs.  The BMA’s GP committee calls on Prof Field to resign and says he has lost the confidence of the profession.  Jeremy Hunt defends the ‘courage and expertise’ of Field.

A scheme to develop the role of care workers and create a career ladder has been cancelled after £178,000 of funding was withdrawn by the UK Commission for Employment and Skills following cuts in the autumn spending reivew.  The scheme aimed to help meet the challenge of a shortage of nurses in care homes.

Shropshire CCG has been put into special measures, the first CCG to have such intervention.  It is forecasting a £10.3m deficit this year.  NHS England is also intervening in East Surrey CCG.

There has been a large rise in the number of newborn babies taken into care from 802 in 2008 to 2,018 in 2013 according to research from the University of Lancaster published in the British Journal of Social Work.  Mothers rarely get any professional help and often end up returning to court, it said.
Press release:

A shortage of school nurses and threats to the number of health visitors could damage early years care according to the Unite union.  It says cuts to Public Health could lead to a fall in the number of health visitors, while there are only 1,200 school nurses, compared to 2,500 in 2004.

78% of students said they experienced mental health issues in the last year, with 33% saying they had suicidal thoughts according to a survey by the National Union of Students for the All Party Parliamentary Group on Students.  1,093 students were surveyed between November and December [but it is not clear how they were selected and therefore how representative the survey was.]

A Scottish computer system for NHS 24 has been criticised for being late and over budget by the Scottish Parliament’s Public Audit Committee.  Although an earlier review had described it as an exemplar of good practice, it now appears that key parts of the contract were not copied over to the final version and no-one had read it before it went out to tender.

The Department of Health Permanent Secretary, Dame Una O’Brien is to leave her post at the end of April 2016.


12 December 2015

The future for adult social care services in England looks bleak and government proposals for ensuring it has enough funds do little more than paper over the cracks, according to a report from the International Longevity Centre.  The areas with the highest concentrations of older people and unpaid carers would be the least able to raise additional funds through the new 2% council tax precept.

Trainee nurses and midwives are to march in protest at the ending of student bursaries and their replacement with loans on 9th January.

A ‘closed culture within the NHS’ has been criticised by a doctor independently reviewing the death of a three year old boy at Stafford Hospital in 2014.  The doctor, a consultant paediatrician, said that two different trusts responded in the same, closed, unhelpful manner and that he found himself in the same position as the parents, ‘On the outside, unable to find a way in to ask simple questions.’  The local CCG has said it is prepared to act on behalf of the parents to secure a second inquest.


11 December 2015

Winter pressures on the NHS were illustrated in the first of the weekly performance reports which will now be published through till the end of February.  They show that 12 Trusts had no beds available from 4-6 December and another 30 had fewer than 10 available.  Emergency departments had to be closed on 23 occasions.  There has been criticism that the reports show much less information than previous years and the usual explanatory notes and official responses have not been provided.–2

The CQC is not an effective regulator according to the Public Accounts Committee, which criticises it for a lack of detail, inconsistency and taking too long to produce reports.  The inspection programmes for hospitals, primary care and adult social care services in England are all behind schedule, with staff shortages a contributory factor, it says.  It also said that it needs to demonstrate how it will cope with planned funding cuts of 25-40%.  The Committee does also acknowledge that the CQC has made substantial progress since its previous report in 2012.
Press release:
The report (pdf)

Women’s health and the risks of obesity are the focus of the Chief Medical Officer’s annual report which warns of the dangers for both women and their babies of obesity in pregnancy, and suggests that obesity should be included in national risk planning.  The report also looks at a range of other women’s health issues including the menopause and health in later life, including incontinence.  It calls for better treatment for ovarian cancer, with survival rates among the lowest of developed countries.
The food industry is on notice that unless it takes action, a sugar tax could be an option, Sally Davies says in an interview on the report:
Press release:

The number of children going missing from foster care increased by nearly a fifth last year to 17,175, according to Ofsted’s annual report on foster care in England.

Poorer children are nearly three times more likely to be obese, with 7.9% of the poorest quintile obese at the age of eleven compared to 2.9% of the richest quintile, according to research by UCL and the LSE using data from 20,000 families in the Millennium Cohort Study, published in the European Journal of Public Health.  Diet was more important for weight in early years while activity became more important later on.

Proposals for regulations on advertising e-cigarttes have been published which will translate into law an EU directive.

Changes to the Deprivation of Liberty Safeguards (DoLs) proposed by the Law Commission are too complex and costly the Department of Health has said in its response to the proposals.  The Law Commission is due to publish its final proposals at the end of 2016.


10 December 2015

A number of NHS targets have been missed and the number of delayed discharges is the highest since records began in 2010, at a third higher than that year, according to the latest monthly release of performance data, for Ocobter. The number who were fit to go but could not leave was 5,328 in October, almost 50% more than the previous month.  The ambulance response time target of 75% of the most serious calls answered in eight minutes has been missed for the fifth month in a row.  The A&E four hour target has been missed for the 13th time in 14 months.  The targets of six weeks for diagnostic tests and 62 days for cancer treatment to start, were also missed, the latter for the 18th month in a row.

Four of the world’s largest tobacco companies have begun legal action against the Government over its plain packaging regulations which come into force in May 2016.  The four companies are: Philip Morris International; British American Tobacco; Imperial Tobacco; and Japan Tobacco International.  The companies say the new rules will destroy their property rights and make the products indistinguishable from each other.

Hunger is now a fact of life in Britain’s poorer communities with structural factors such as low wages, unstable employment and benefit delays, being a significant cause of problems, according to the All Party Parliamentary Group on Hunger.  Prompt payment of benefits and tax credit alongside a less harsh benefits sanctions regime could halve the number of people reliant on emergency food parcels, it says.  The report was supported by the Archbishop of Canterbury who, in a foreword, said Government policies on poverty and welfare have left too many people unable to feed their families.

Investors are being invited to purchase UK care home rooms on a buy-to-let basis with a guaranteed rental income of 10%, according to an investigation by the Bureau of Investigative Journalism focussing on the MBi group, which is registered to run three care homes in the North of England.  A number of concerns have been expressed about the company.

Reasons for the annual A&E crisis are analysed in a briefing from the Nuffield Trust which argues that although 41% of additional funding has gone towards more staff and beds, this is not enough to tackle the underlying shortage of 14,000 beds.  Instead, what is needed is to focus on the 3.6% of, mainly elderly, patients who account for 37% of time in NHS beds.
(11/12/15) Feature:

49% of GPs say they would be prepared to resign en masse in protest at the rising pressure on practices from lack of funding and the continuous paperwork, according to a survey of 922 GPs by Pulse magazine.

There should be an independent system for investigating the deaths of mental health patients detained in hospitals under the Mental Health Act, according to the CQC in its report, ‘Monitoring the Mental Health Act 2014/15’.  There was concern that service providers had not informed the CQC of the death of a detained patient within the required timescales in 45% of cases.  There were 227 deaths of people detained under the Act during the year, the majority, 182, from natural causes.

NHS England and others are asking for less restrictive freedom of information legislation because of the burden that answering requests places on them.

A new NICE quality standard recommends that pregnant women should be informed of the local risk of giving birth in hospital, at home or in a midwife centre, to enable them to make a more informed decision about where to have their baby.  It also says that women at low risk of complications should not have unnecessary procdures such as electronic monitoring of the baby’s heart or medicines to speed up labour.
(11/12/15) (Rgn)

The Labour led Welsh Government has backed a proposal for a tax on sugary drinks which a Plaid Cymru motion called for in the next administration after elections next year.  If agreed by the Welsh Assembly, the tax would still have to be approved by the UK Parliament.

An analysis of trends from inpatient surveys over nine years has been published by the King’s Fund and the Picker Institute Europe and shows only modest improvements in patient experience.

A briefing on antimicrobial resistance has been produced by Public Health England.
Press release:


09 December 2015

Four leading health and care bodies are warning of a crisis in social care funding and asking for emergency talks with the Government, claiming that the Chancellor’s recent proposals leave a funding gap and put vulnerable people at risk. They warn of an increasing number of care home closures and are asking what happened to the £6bn saved from delaying the introduction of the promised care cap.  The four are: the Association of Directors of Adult Social Services; the Care and Support Alliance (representing more than 75 charities); the Care Providers Alliance (representing independent providers); and the NHS Confederation.

The Southern mental health trust failed to properly investigate the unexpected deaths of over 1,000 people since 2011, according to a leaked report from an investigation commissioned by NHS England.  The Southern Health NHS Foundation Trust covers Hampshire, Dorset, Wiltshire, Oxfordshire and Buckinghamshire.  Investigations were particularly unlikely for mental health patients over 65 and for those with a learning disability.  Even where investigations were undertaken they were often of poor quality and late.  In nearly two thirds of investigations, there was no family involvement.  The final report has not yet been published.  The Trust says that while they had had one or more contacts with the patients in the previous twelve months, in almost all cases they were not the main provider of care.
(10/12/15) Jeremy Hunt response:
Trust CE apologies:

Over a quarter of doctors in training have some symptoms of depression according to a systematic review and meta-analysis of 54 studies from 1963 to 2015, involving over 17,000 people, by US and UK researchers, published in the Journal of the American Medical Association.

Being happy doesn’t make you live longer, and being unhappy doesn’t shorten life, contrary to previous research, according to analysis of data from the UK Million Women study, which recruited women over 50 between 1996 and 2001 and has followed them up ever since, and was published in the Lancet.  The analysis found that when adjusted for self-rated health, treatment for various illnesses, and factors such as smoking, deprivation and body mass, those who said they were unhappy were no more likely to die earlier than those who had said they were happy.  It is suggested that ill health causes unhappiness, but unhappiness itself has no direct effect on mortality (but may incline you to live more unhealthily).  Other experts disputed the conclusions.

Healthy life expectancy has increased over the last 20 years according to an analysis of identical surveys from 1991 and 2011 with 15,000 responses from people in Cambridge, Newcastle and Nottingham published in The Lancet.  There was an increase, over that 20 year period, of 4 years for men and 3 for women in the time they enjoyed perceived good health; there were 4 more years without cognitive impairment; and 2.6 more years without disability for men and half a year more for women.  However the time spent with milder disability increased over the period.

Obesity in Scotland has become the norm to the point where it is making people ill according to a report from Food Standards Scotland.

A report on ‘Transforming Local Services Through Digital’ has been published by the LGA.


08 December 2015

The global use of antibiotics in agriculture needs to be reduced because of its role in increasing bacterial resistance, according to the latest report from the review chaired by Jim O’Neill, set up by David Cameron.  A review of the evidence found that 100 out of 139 (72%) of studies found there was a link between resistance in relation to animals and humans and only 5% claimed there was no link.  The report proposes that each country should have a limit on antibiotic use in food production and suggests a ban on the use of certain antibiotics because of their importance for human health.

Half of perinatal suicides amongst women could be prevented by better care according to the ‘Confidential Enquiry into Maternal Deaths’ from the University of Oxford which studied all 101 suicides by women in pregnancy or a year after birth between 2009-13.  Only 15% had contact with specialist perinatal mental health services.

Tests on 51 brands of flavoured e-cigarette found that 47 had at least one of three chemicals harmful to health, including one, diacetyl, linked to an incurable condition called ‘popcorn lung’, which was found in 39 of the brands (but in some at only small concentrations) according to researchers from the Harvard TH Chan School of Public Health and reported in the journal Environmental Health Perspectives.

An official survey of 120,000 fifteen year olds has found that twice as many girls were victims of cyber bullying as boys, twice as many girls as boys reported low levels of life satisfaction and 46% of girls thought they were too fat, compared to 23% of boys.  The survey, which covers a wide range of health and wellbeing issues, including general health, life satisfaction, physical activity, diet, bullying, smoking, alcohol, drugs and other risky behaviours, was commissioned from Ipsos MORI by the HSCIC.  Children from better off households were more likely (70%) to have tried alcohol compared to about half from more deprived households with the better off 15 year olds twice as likely to be regular drinkers.

Three quarters of doctors said they had seen treatment rationed in their area in the last year, in a survey of 749 doctors (536 hospital doctors and 213 GPs), conducted for the Guardian by the company Binley’s OnMedica.  86% of respondents said rationing was occuring for financial reasons, 39% to manage demand and 28% because the evidence for particular treatments had changed.

The bedroom tax is creating emotional distress and material hardship for children and harming their learning, according to a small scale exploratory study involving in depth interviews with 14 parents and 40 representatives from 20 schools, housing associations and community groups by Manchester University.

People want to play a bigger role in looking after their own health according to a report from Healthwatch England.

Unhealthy behaviours accounted for 31% of mortality, according to an analysis of seven risk factors – smoking, alcohol, diet, physical inactivity, prolonged sitting, sleeping fewer then 7 hours or sleeping more than 9 hours a night – in an Australian study of 231,000 people over 6 years, published in PLOS Medicine.  The combinations having the strongest association with all-cause mortality were: physical inactivity, prolonged sitting and/or long sleep duration; and combinations involving smoking and high alcohol intake.

The Welsh Government has stepped back from its proposal to ban e-cigarettes in all public places, and will only ban them in schools, eating places and on public transport.  The changes will be made through amendments to the Public Health Bill.

More universal credit claimants, (71%), found jobs within nine months than those on jobseeker’s allowance, (63%), according to Government research.  Of those working less than 30 hours a week, 86% of universal credit claimants were actively seeking more work, compared with 38% of JSA claimants.  The research also says that univeral credit claimants spend 50% more time looking for jobs than JSA claimants.  There are currently about 150,000 people on universal credit (significantly behind original projections), mainly single people without children.

GPs should encourage patients to go online to book appointments and repeat prescriptions, according to a report by Baroness Martha Lane Fox for NHS England, to be considered by the National Information Board.  She also proposes that every NHS building should have free wi-fi.

The Welsh Government is to increase spending on the NHS by 4.1% but cut funding for local government by 2% next year.


07 December 2015

NHS Trust investigations into errors causing serious harm are not ‘consistent, reliable or transparent’ and are’ too quick to absolve staff’, with complainants facing a ‘wall of silence’, according to a report from the Parliamentary and Health Service Ombudsman.  In only half (52%) of cases of avoidable harm and death which involved a clinician carrying out a review was the clinician independent of the events complained about.  The review of unresolved complaints brought to the Ombudsman found that in 73% of cases where there were clear failings, the hospital’s earlier investigation had found none.

GPs who prescribe fewer antibiotics tend to get a worse satisfaction rating, according to research by King’s College, London, based on data including the 2012 GP patient survey, published in the British Journal of General Practice.  A 25% reduction of antibiotic prescribing was associated with a fall of 3-6 percentage points in national satisfaction scores.

Nearly a third of new mothers with postnatal depression do not seek medical advice according to a survey of 700 mothers by website Mumsnet and ITV Lunchtime News.  The main reasons given were that they did not think the symptoms were bad enough, they were worried a diagnosis would raise concerns about their ability to look after the child, and a feeling they were letting their family down.

74% of CCG GP leads are male, despite the fact that 52% of practising GPs are female, and CCGs should do more to address the gender imbalance according to NHS Clinical Commissioners

The number of people waiting for treatment by the Welsh NHS has risen by 10% in three years, according to a report from the Royal College of Surgeons, ‘The State of Surgery in Wales’.

Checking the migration status of patients takes doctors just a minute or two for each plus about 30 minutes a month to process the data, according to the Department of Health based on a pilot study.


06 December 2015

The range of indicators published in weekly updates of NHS England’s winter performance is to be reduced, to exclude figures on A&E waiting times, ambulance delays outside hospitals, the number of patients left on trolleys for more than four hours and last minute cancellation of operations.  The weekly reports will also now run to the end of February rather than March as in previous years.  There is to be a fuller report on a monthly basis, throughout the year.

Doctors will be able to prescribe e-cigarettes from 2016 after one of the devices has been granted a licence by the UK drugs regulator, the Government has confirmed.  It is reported that they did not want to publicise the change too much, for fear of generating demand which could not be met.

The 2% council tax precept for social care will widen the gap in available funds between richer and poorer areas, according to a report from the King’s Fund.  They also query how likely it is to raise the £2bn predicted by the Government, since that depends, amongst other things, on all local authorities levying it.  The report estimates that by the end of the parliament, the proportion of GDP spent on social care will have fallen from 1.9% in 2009 to 0.9%, the lowest level since 2001.

Employers should make it easier for the menopause to be discussed at work so that any appropriate adjustments, such as flexible working, can be made, according the Chief Medical Officer.  About a quarter of female employees had discussed their symptoms with their manager but three quarters would want their manager to be aware that the menopause could be an occupational health issue.
Critics say it is wrong to single out menopausal women

The proposed new CQC chairman does not have sufficient frontline NHS experience according to a forthcoming report from the Health Select Committee on the appointment of Peter Wyman, who is a longstanding Conservative Party member and formerly worked for PricewaterhouseCoopers and advised John Major’s government on tax and deregulation.

More charges for medical services for people from outside the European Economic Area are being proposed by the Government in a consultation which will run until 6th March.  As well as paying for ambulances and A&E care as already proposed, it is now being suggested they should pay for primary care services such as blood tests, prescriptions, dental treatment and physiotherapy.  There was resistance from the RCGPs and BMA to losing the principle of care free at the point of need and of GPs having to determine who would be eligible.


05 December 2015

The proportion of junior doctors staying in the NHS after their first two years’ foundation training has fallen to its lowest level ever, 52%, down from 71% in 2011.  Instead of working to become GPs or specialists, more are going into academia, becoming locums or pursuing other careers.

More than 2,000 mental health patients a month are being sent out of area, with over 500 going more than thirty miles, because of a lack of local beds, according to figures from the HSCIC, which have been collected since April at the initiative of the then minister, Norman Lamb.


04 December 2015

Bacteria resistant to all forms of antibiotics have been found in Europe for the first time, with a patient in Denmark infected with an untreatable form of salmonella and the discovery of untreatable bacteria in five samples of chicken imported from China via Germany.

A third of pensioner households are living on less than £300 a week and around 750,000 are having to choose between eating and heating, according to a survey of 1,000 over 65 year olds by the charity Independent Age.

Women who have breastfed their baby are 23% less likely to develop diabetes over a 24 year period, while their babies were 18% less likely to develop it, according to a study of the records of 335,000 babies born over a 24 year period, by the University of Manitoba in Canada, presented at an international conference.  The mechanism for the effect is not known, but it is thought likely to be because breast feeding uses up excess fat and sugar and helps prevent obesity.

The UK is paying less for its cancer drugs than many other high income countries according to analysis of the published prices of 31 cancer drugs in 2013, in 18 high income countries (16 in Europe plus Australia and New Zealand), published in The Lancet Oncology.

A report giving “a systematic overview of the NHS’s failures, inadequacies and structural problems” has been published by the Institute of Economic Affairs.


03 December 2015

Councils could be forced to take unaccompanied children seeking asylum if a voluntary scheme to promote dispersal is not effective.  Nearly 1,000 unaccompanied children are living in Kent, which is trying to get other local authorities to share the burden.  Arrangements for transferring responsibility for the children between local authorities was included in an amendment to the Immigration Bill.

Exposure to organophosphate pesticides was as damaging to children as passive smoking according to a long term study of 279 children living in California’s Salinas Valley, published in the journal Thorax.

New drug and alcohol statistics show fewer younger people accessing specialist substance misuse services while the adults accessing them are increasingly aged 40 or over.  Over 97% start treatment within three weeks.  The figures are from Public Health England.

Three quarters of CCGs have applied to be in the diabetes screening programme, with 66 bids, many by a number of partners, involving 168 CCGs and 132 local authorities.  The programme, which involves identifying people at risk of diabetes and referring them for lifestyle change interventions, is run by NHS England, Public Health England and Diabetes UK.  It was launched in March 2015 and originally involved seven ‘demonstrator’ sites.

Eight million patients are signed up for online access to appointments and repeat prescriptions with 10 million GP appointments expected to be booked online by the end of the financial year, according to NHS England.  More needed to be done to make best use of the technology, they said.

Families of patients in the Four Seasons care homes in Northern Ireland warn that the impending closures may kill many of the elderly people. Alliance Party member in the Northern Ireland Assembly, Chris Lyttle, is asking Jeremy Hunt to intervene and suggests that the decision to shut the homes with 12 weeks notice may indicate that the private sector should not be involved in caring for such people.

About 420,000 people worldwide die each year from food poisoning according to a report from the WHO.

An association has been found between high proportions of non-UK educated nurses in a hospital and decreased patient ratings of the hospital, suggesting that recruiting more nurses from abroad may negatively impact on quality of care, according to a study based on survey responses from 12,506 patients in 31 hospitals and 3,000 nurses, and published in BMJ Open.

Smaller portion sizes are recommended as a way of tackling obesity in a BMJ article, based on an analysis of 61 previous studies involving 6,711 participants.  Portion sizes are believed to have increased over recent decades.

Carers will be eligible for NHS parking concessions subject to local decision, after the Department of Health amended a technical memorandum on best practice in car-park management and sustainable transport.  A private members’ bill that would have exempted carers from hospital car parking charges was talked out on 30th October 2015.

NHS England has announced three senior appointments. Matthew Swindells, who has considerable NHS, Government and private sector experience will replace Dame Barbara Hakin as National Director for Commission Operations and Information.  Pauline Philip is being seconded from a trust where she is chief executive to be the National Urgent and Emergency Care Director.  Anu Singh has been appointed Director of Patient and Public Participation and Insight from Staffordshire County Council where she was Head of Business Improvement.

A briefing on what effect debt can have on people’s mental and physical health has been published by the Picker Institute Europe.


02 December 2015

The delay in implementing the cap on care costs (of £72k) until 2020 could leave some older people unable to cope with the unlimited expenses, the Public Accounts Committee has said.  They are asking for a firm timetable for its implementation to be drawn up.  They also warned about the risks of ‘cost shunting’ and the financial burdens of new responsibilities on local authorities not being properly assessed.  The committee is concerned that “carers and the people they care for may not get the services they need because of continuing reductions to local authority budgets and demand for care being so uncertain.”

Treatment of type 2 diabetes should be tailored to the individual needs of patients, the latest NICE guidance on the subject recommends, with targets applied on a case by case basis.
(This magazine is aimed at professionals and this article has a lot of technical detail):3
The guidance:

30% of families are not able to support older people when they leave hospital according to a report from Royal Voluntary Service, assisted by the King’s Fund.  It found that families often rally when someone goes into hospital but then find it difficult to provide ongoing, longer term support, with many living too far away.  28% of families had concerns about care post-discharge and more, 19%, were worried about premature discharge than the 3% worried about delayed discharge.
‘External contributor’ rather than news article:

The Government is to cut its funding for support to disabled students in higher education, expecting the universities to cover the costs instead.

A toolkit for professionals caring for children with mental health problems has been launched, which encourages the involvement of parents and carers.


01 December 2015

The junior doctors’ strike was called off on the evening before, which was too late for many cancelled appointments to be reinstated.  The talks had been taking place through ACAS.  The other two planned days of strikes, and the threat by Jeremy Hunt to impose a new contract, have only been suspended temporarily, to give time in the next few weeks for a deal to be agreed.

Consent for organ donation in Wales switches to presumed consent from today, 1st December 2015, for all those over 18 who have lived in Wales for a year, with people having to explicitly opt out.  The Welsh Government says it could increase the number of organs available by 25%.  So far, 34% of the population (over 1 million people) have opted in and 3% (86,000) have opted out.

The UK will have the worst pensions and highest retirement age of any developed economy according to the OECD, with the average value of private and public pensions adding up to 38% of salary compared, for instance, to 80% in Spain and Italy and 90% in the Netherlands and Austria.  It was suggested that people in the UK are not healthy enough to keep working until their late 60s, with the state pension age due to rise to 67 by 2028 and to 68 after that.

NICE have produced guidance to help prevent people with social care needs staying in hospital unnecessarily, including the recommendation that hospitals should appoint a single person responsible for co-ordinating an individual’s discharge.  This person should be the main point of contact for the patient, their family and health and social care practitioners.  They should agree a discharge plan taking account of social and emotional wellbeing as well as the practicalities of daily life.  A key focus is to maintain good communications between health and social care professionals.  There should be continuing contact with the patient after discharge by a community based multi-disciplinary team.
Press release:
The guidance:

Children in long term foster or kinship care have better educational results than those in other forms of care, such as residential care or remaining with the birth families while in need, according to research by the Rees Centre of the University of Oxford and University of Bristol.  Longer and more stable placements were associated with better results.

A special meeting of GPs’ representatives is to be held on 30th January 2016, to discuss the future of the GP contract and ‘what actions are needed to ensure GPs can deliver a safe and sustainable service.’  This is a conference of local management committees (LMCs) called by the GPs Committee of the BMA.  (It was reported by Pulse Magazine on 20/11/15 that the conference was to take place).

Women with breast cancer who were also depressed were 45% more likely to die according to a study following 77,173 cancer patients for 10 years by King’s College, London.  It was suspected that those who were depressed were likely to have a less healthy lifestyle and to not accept treatment.

Guidance on preventing suicides in public places has been published by Public Health England.

A model mapping the range of drivers of depression using systems dynamics has been produced by researchers from Michigan State University and MIT, based on an analysis of nearly 600 articles, and published in Psychological Medicine.


30 November 2015

A tax on sugar has been backed by the Health Select Committee in its report on childhood obesity, ‘Brave and Bold Action’.  They also propose restrictions on marketing and promoting unhealthy foods, clearer labelling of products showing sugar content in teaspoons and a drive to force industry to reduce the sugar content of foods, as happened with salt.
The report

55% of parents have never spoken to their children about stress, anxiety or depression according to a survey of over 1,100 parents of children between 6 and 18 by market research company Opinion Matters, on behalf of the Time to Change campaign, being run by Mind and Rethink Mental Illness.

73% of GPs said they were involved in some sort of collaborative working such as networks or federations with other GP practices, in survey responses from 982 GPs and practice representatives and 94 CCGs, in research by the Nuffield Trust and Royal College of GPs for NHS England.

A new pressure group on obesity, the Obesity Stakeholder Group, has been formed by 19 organisations, including medical royal colleges, the Faculty of Public Health, the Obesity Forum and a number of charities.  They have set out ten priorities they would like to see addressed in the Government’s forthcoming childhood obesity strategy including a sugar tax, restrictions on marketing unhealthy food, industry action and the promotion of active travel.

Action on Sugar has published an obesity plan setting out a 6 point plan it is asking the Government to take up.

A review of Scotland’s out of hours health services says that in future patients will need to see their GP first if they need urgent care. It proposes a system of multi-disciplinary teams working in ‘resource hubs’ across the country with patients being dealt with by any of a number of health professionals, and online or on the phone as well as face to face.

It is claimed that patient safety is at risk in small private hospitals by anti-privatisation think tank the Centre for Health and Public Interest, in a report based on analysis of 15 CQC inspections from each of the six main private chains.  The private chains disputed the claims.

The CQC is consulting on its access to person medical records in its inspections.

A new role of associate nurse at band 4, is to be introduced with a government consultation in the next few weeks, the Nursing Times reports.  It is not yet clear whether the new role will be regulated by the Nursing and Midwifery Council.

A report on ‘Disability and Domestic Abuse: risk, impacts and response’ has been published by Public Health England.


29 November 2015

Almost three quarters of people advised by NHS 111 to go to hospital did not need emergency treatment, according to a study by Cambridge University published in BMJ Open, involving an assessment of 1,474 cases in Cambridgeshire with a review of the cases by a GP.  In 400 cases (27%) it was judged that the person should have been sent to hospital, 667 could have been seen by an out of hours GP and 407 required no treatment at all.


28 November 2015

The new 2% adult social care precept will allow wealthier areas to raise their social care bugets by three times as much as poorer areas, and home care services in deprived areas will have to be scrapped for all but those in the most desperate need, according to the LGA.


27 November 2015

A&E waiting times are getting worse having fallen from 92% of patients seen within four hours at the start of October to 88% in the week ending 13th November, according to figures submitted to the Royal College of Emergency Medicine.  Although obtained from only a fifth of trusts, the College says the figures should reflect the national picture.

More people are struggling to get through to a GP on the phone with 27% of people saying it was not easy to reach their GP practice on the phone in 2014-15, compared with 19% in 2011-12, according to a report from the NAO.  There was a slight fall in the proportion who were usually able to see their preferred GP from 66% to 60% over the same period.  Those able to get an appointment fell slightly from 91% to 89% over those three years.  The NAO also said the government was trying to increase access without fully understanding current demand or capacity.  It said the Government lacks the data to know whether the promised 5,000 extra GPs will help extend access or manage demand.
There was a growing reliance on nursing and other staff rather than GPs. (Rgn)

A petition calling on the Government to retain student burseries for nurses has been signed by over 100,000 people, enough to make it eligible for debate in parliament.  In a survey by Unison of 2,000 nurses, 91% said they wouldn’t have chosen to study nursing without a bursary.
(Rgn) the debate is to be held on 11th January 2016:

Children admitted to hospital in Scotland at the weekend were no more likely to die than those admitted during the week according to a study analysing half a million admissions between 2000 and 2013 and finding 251 deaths on weekdays and 84 at the weekend.  This is a different result from the ‘weekend effect’ identified in recent studies for adults and births in England.

The latest Marmot health inequalities indicators show  more people falling into poverty and ill health despite increasing numbers finding work. The number of households unable to afford an acceptable standard of living has risen from 19.1% in 2008-09 to 24.4% in 2012-13.  The number reporting work related illness increased by nearly 10% from 3,640 per 100k in 2011-12 to 4,000 per 100k in 2013-14.  There has been a small increase in the expected number of years people will spend in ill health.
Press release (pdf):

The London ambulance service has been put into special measures following a rating of ‘Inadequate’ by the CQC, partly because of its preparedness for an emergency response.  There was also a shortage of frontline staff, poor response times and a demoralised workforce.  However changes were happening under a new Chief Executive.  The CQC said the staff were ‘overwhelmingly dedicated, hardworking and compassioniate’.  This is the first ambulance trust to be put in special measures.

NICE guidelines on multiple pregnancies are only being met in full by 10-18% of UK maternity units according to a report, including the results of a survey of 1,400 parents, by the Twins and Multiple Births Association and the NCT, and performance varied considerably across the country.  About 3% of pregnancies in the UK are multiple pregnancies.

There is an association between resting heart rate and premature mortality, with a rate of more than 80 beats per minutes meaning you are 45% more likely to die in the next 20 years, according to a meta-analysis using 46 previous studies involving 1.2m people published in the Canadian Medical Association Journal.


26 November 2015

The spending review will produce more poor families who are worse off than those of today, with 2.6m working families  worse off in 2020 by £1,600 a year, while 1.9m would be better off by £1,400, compared to what their benefits would be under the current system, although this would apply to new claimants and those with changed circumstances, rather than individual families losing out, according to analysis by the IFS and the Resolution Foundation.

Iain Duncan Smith unlawfully discriminated against disabled people by not exempting their carers from the benefit cap, according to a high court ruling.  The court said that the two carers who brought the case were caring for more than 35 hours a week and were therefore effectively in work.  It was noted that if the cap forced such carers into employment it would lead to increased costs to the state.  The benefit cap affects about 1,400 people in receipt of a carer’s allowance.
Feature and comment:

Obesity amongst reception year children is at its lowest ever level but the gap in obesity levels between the most and least deprived areas is increasing, according to figures from the HSCIC.  9.1% of reception year children were obese in 2014-15, compared to 9.9% in 2006-7.  However obesity amongst year 6 children has increased from 17.5 to 19.1% over the same period.  Obesity for year 6 children was twice as much in deprived as affluent areas, at 25.0% to 11.5%, which was a wider gap than the previous year, 2013-14, when it was 24.7% to 13.1%

A reduced sugar diet made food taste sweeter but did not lead to a preference for less sweet food, as was the case with salt, suggesting that a gradual withdrawal of sugar from diets may not work in the same way that approach has for salt, according to a randomised controlled trial where one group had 40% of their calories from sugar replaced by fats, proteins and carbohydrates.

There has been the largest number of new cases of HIV in Europe since records began in the 1980s, with 142,000 reported last year, according to the WHO.  The increase is largely due to a doubling of cases in the last decade in Eastern Europe as a result mainly of heterosexual transmission and injected drug use.

Proposals for reducing air pollution reporting requirements on local authorities have been produced for consultation by Defra.  The proposals would reduce the number of pollutants on which authorities have to report and require them to produce only one annual improvement report.


25 November 2015

The additional £3.8bn for the NHS confirmed in the spending review is offset by a 25% reduction in the rest of the DH budget. There will be cuts to Public Health England and Health Education England.  £1.5bn is to be added to the Better Care Fund by 2020.  Public health grants to local authorities are to be cut by 3.9% a year in real terms.  The Government is to consult on whether central funding for public health should stop entirely.  The wider health budget, beyond that given to the NHS, is to be cut by 20% over the next five years.  The share of UK GDP for publicly funded health is to fall from 7.3% (below the European average) in 2015-16 to 6.7% in 2020-21.

Central government grants to local authorities are to be abolished but they will be able to keep all of their business rates.  The grant was worth £18bn in 2013-14, while business rates are expected to bring in £11.5bn by 2020.  It is estimated that overall funding to local authorities will fall by 6.7% [though there seem to be widely differing views from different parties].  Councils are to be allowed to keep 100% of receipts from sales of assets.

Councils will be able to raise a 2% precept on council tax, to be spent exclusively on adult social care.  However it is suggested this will not meet the shortfall with rising demand, and it will favour better off areas with a higher council tax base rather than poorer areas that need it most.

There are plans to integrate health and social care by 2020 with local areas having to come up with a plan to do so by 2017.  It will be up to local areas implement the integration.  Possible models include ‘accountable care organisations’, devolution deals and lead commissioners.
Changes department by department:
The departmental settlements:
Nurses will have to take out loans for their tuition rather than receiving bursaries:
The spending reivew and local government:
Councils are facing a £4.1bn gap in their budgets:
Institute for Government blog:
(26/11/15) Feature and analysis on the effects on local government:
Reaction to replacing nursing burseries with loans:
Implications for adult social care:
Government press releases:
The full spending review document:
The statement and supporting documents

There was a 151% rise in excess winter deaths last year, the biggest year-on-year rise since 1967/68, thought to be due in part to the reduced efficiency of the flu vaccine because of the mutation of the virus.  The number of excess deaths, 43,900 was the highest since 1999.–provisional–and-2013-14–final-/index.html

The funding crisis for care homes has not been properly addressed in the autumn statement and it could lead to providers going bust, according to Care England and other industry leaders.

Nurses pay has fallen by 9.6% in real terms since 2008 according to an analysis by the Royal College of Nursing.

The Government has agreed to talks at ACAS in the junior doctors’ dispute.

Many NHS trusts are not carrying out three yearly DBS checks, despite this being a recommendation following the Jimmy Saville scandal.

Visa applications for nurses from outside the European Economic Area rose by 209% in a year, from 733 between April-July 2014 to 2,264 in the same period this year according to the Migration Advisory Committee.

GPs have a duty to tell the DVLA about patients who continue to drive when they are medically unfit, according to draft guidance from the GMC which says it has heard from GPs who are anxious about reporting patients.  This is part of a wider consultation on confidentiality.  Final guidance is expected to be published in late 2016.


24 November 2015

Only 3 out of 16 CCG pilot areas have committed to continuing with seven day GP access according to Pulse Magazine.

Up to 85% of child abuse is not discovered by police and other professionals, according to a report by the Office of the Children’s Commissioner
Links to the report:

Babies born in English hospitals at the weekend have a slightly higher risk of dying within seven days than those born in the rest of the week, with a rate of 7.3 deaths per 1,000 at the weekend compared to 6.4 during the week, equivalent to 770 more deaths per year, according to research by Imperial College looking at 1.3m births between 2010-12 and published in the British Medical Journal.  On average there are 4,500 deaths a year from 675,000 births. The highest number of deaths within seven days occurred with Thursday births, the day of the highest number of deliveries.  No link was found with the number of consultants, but the study did not look at any relationship between mortality and the number of other staff such as nurses or midwives on duty.  The authors of the paper say that a number of different factors could have influenced the outcomes.

The current system of bursaries for nurse training should be replaced by loans according to the think tank Civitas.  [Which, interestingly, is what the Chancellor is thinking of doing in his autumn statement this week].  It is said that this should free up more spaces for those currently wanting to train when there are limited places available.

There is a big variation in recovery rates from mental health disorders across the country, ranging from 19% to 69% in different CCGs, according to figures from the HSCIC.  The waiting time from referral to entering treatment varied from 7 to 124 days.

Seven care homes are to be closed in Northern Ireland by Four Seasons Health Care, Britain’s largest care home operator, as it says they are loss making and no longer viable.  Four Seasons is owned by private equity company Terra Firma.

Researchers call on the Government to release data which could shed light on any link between work capability assessments (WCAs) and increased suicides. Researchers identified an association between increases in WCAs and suicide (16/11/15) but this was dismissed by DWP on the grounds that there was no evidence on whether those who had committed suicide had been subject to a WCA.  The researchers are now saying that the DWP has the relevant data and they asking them to release it.
Letter from the researchers:

A mechanism by which loneliness increases the risk of illness has been shown in research in which white blood cells were found to be more likely to cause inflamation and less likely to fight infection in lonely humans and macaque monkeys.  The research was published in the Proceedings of the National Academy of Sciences.


23 November 2015

An additional £3.8bn for the NHS in England in 2016-17 has been agreed as part of the spending review, so front-loading the £8.4bn promised by 2021.  It is a 3.7% increase on the £101bn front line-budget (or 3.2% on the full £116bn health budget). This has been welcomed by Simon Stevens as enabling the NHS to meet immediate pressures and to invest to produce the £22bn efficiencies said to be needed by 2020, as well as delivering a seven day service by the same date.  Changes to other parts of health, such as nurse training and public health have not yet been announced.

There were over 2,000 cases of malnutrition in 43 hospital trusts in a year, a rise of 259 over three years ago according to responses to foi requests made by a Birmingham University student.

GPs are feeling so overworked that 88% fear missing symptons during a consultation according to an online survey by ComRes for the Royal College of GPs, of 504 GPs, weighted to be representative.  It also found that 99% said workloads had risen, 94% said fatigue has inreased and 97% thought morale had worsened over the last five years.  29% had sought help for work related stress in the last two years.  One in ten say they are so overworked and disillusioned that they will quit in the next year.

The global response to the Ebola outbreak was too slow and lacked leadership, according to a review by an independent panel of experts initiated by the London School of Hygiene and Tropical Medicine and Harvard University.  It says that the WHO was too slow to declare an international public health emergency.  The report makes 10 recommendations to improve responses to future outbreaks.

The Government’s cuts to the size of the state have held back economic growth while straining public services and undermining social stability according to a report from the TUC, commissioned by the Fabian Society.
Press release:
Link to report:

Sir Bruce Keogh has been accused of making a politicised and disrespectful intervention in the junior doctors’ dispute when he (the medical director of NHS England) asked for confirmation that doctors would respond to a Paris style terrorist attack.  A letter, signed by 3,000 junior doctors, says the question was unnecessary and was asked for political motives.  They also question whether he was in collusion with Jeremy Hunt in writing an academic paper earlier in the year which said that 11,000 more people die who are admitted to hospitals at weekends, which has been widely used by politicians.

The findings of an annual survey of the views of children living in homes and foster care and adults who support them, have been published by Ofsted.  Amongst other things it says that adults working with children in care would like more training.

A cap on NHS spending on agency staff comes into force on 23rd November 2015, meaning that by April 2016, NHS trusts will not be able to pay over 55% more per shift than they would for a permanent member of staff.

A report, ‘Monitoring Poverty and Social Exclusion 2015’ has been published by the Joseph Rowntree Foundation.

An annual review of statistics on poverty and social exclusion has been published, showing that while the proportion in poverty has not changed much over the last decade, there has been a shift to more in-work poverty, a shift from poverty in the social rented to privately rented sector and also more poverty amongst younger people aged 16-24.  The report was commissioned from the New Policy Institute by the Joseph Rowntree Foundation.


22 November 2015

Over 600 junior doctors have signed a letter to Jeremy Hunt asking him to enter into talks via ACAS to avoid the planned strikes in December.


21 November 2015

The U shape of happiness over the life course has been confirmed in research tracking 50,000 adults in Australia, Britain and Germany throughout their lives and due to be published in the Economic Journal.  This is said to be different from previous research in tracking people over their lifetimes, in a number of different countries.  The research suggests that the dip in happiness in mid-life is not due to having children, since it affects childless people too.

A new digitial currency where users can create value by walking is being launched in the UK and a small number of other countries.  Users would be able to exchange the currency earned for US dollars or spend them with sports retailers, health insurance firms, environmental groups or whoever signs up for the scheme.  The aim is to encourage walking in developed countries and provide income in developing countries.


20 November 2015

The English NHS deficit was £1.6bn in the first half of the year, £358m worse than expected, and providers were struggling to meet a number of national standards, according to Monitor and the Trust Development authority.  It has been suggested that hospitals could run out of cash to pay staff.  Delayed discharges from hospitals and the use of agency staff were thought to have significantly contributed to the problems.  190 out of 241 providers had a deficit in the second quarter of the year.  Providers made 2.8% savings.

There is a prospect for a way of avoiding the ‘antimicrobial apocolypse’ based on an approach which kills a narrower range of bacteria using bacteriocins, which are protein antibiotics produced by bacteria to kill closely related species.  These were demonstrated in a workshop in Beijing last month.
(Feature article)

Permission for local authorities to levy a new 2% precept specifically for social care is likely to be announced in next week’s autumn statement as a way of tackling the social care funding crisis.

The BMA’s GP Committee (GPC) is calling a special meeting early in the new year, to discuss what action is needed to maintain a safe and sustainable general practice, after pressure from GPs because of the increasing demands on them.

The difference in the number of years people can expect to live in good health is almost 17 years between the most and least deprived areas, with average healthy life expectancy being 64 years, according to a report from ONS.  The difference for disability-free life expectancy is about 14 years, while for total life it was 8 years.–england/inequality-in-health-expectancies-using-imd-2015-small-area-deprivation-scores–2009-13/stb-he.html

More investment is needed to beat TB globally, with the Stop TB Partnership, which includes the WHO, saying £36bn is needed.  The UK has the highest TB rates in Western Europe.

GPs will have to register people living in their area but unable to provide proof of a permanent address, such as people who are homeless or those staying with friends, for instance to escape domestic violence, in a clarification of regulations from NHS England.

The Treasury is pushing for cuts to non-NHS health spending, such as public health, in next week’s spending reivew, the BBC understands.


19 November 2015

The discovery of bacteria resistant to all drugs, including that of last resort, colistin, has increased the risk of an ‘antibiotic apocalypse’ according to research reported in The Lancet Infectious Diseases.  The significance of the discovery, in patients and livestock in China, is that the mutation is easily shared between other bactieria, via a mobile gene, so is likely to spread widely.

Junior doctors have voted by 98% for strike action. The first walk out is to be on 1st December.  The BMA and Labour have both asked for ACAS to be involved in negotiations and that has been supported by the Academy of Royal Colleges, but so far rejected by Jeremy Hunt though not ruled out entirely.
Hospitals are not legally allowed to employ locums to replace striking doctors:
Pressure for arbitration:

Proposals to streamline cancer drugs approvals through NICE and the Cancer Drugs Fund have been published for a 12 week consultation by NHS England.  There would be quicker access to drugs, with NICE issuing an interim funding decision on the day a drug receives a safety licence.  The Cancer Drugs Fund would be changed into a testing ground for new drugs, making promising drugs available for two years, within which time data would be collected to determine whether they should continue to be made available. The changes would mean that NICE makes all decisions about new drugs.  The new arrangements are due to start by next April.

Deaths from liver disease are likely to increase as a result of changes in the summer budget which reduced the rate of duty and removed the ‘escalator’ by which duty continued to rise, according to a report from the Lancet medical journal commission on liver disease.  It says that deaths from liver disease quadrupled between 1980 and 2013 as a result of government policies making it more affordable as well as longer pub opening hours and a greater number of off-licences.  There has been a drop in deaths after the introduction of the 2% above inflation duty escalator in 2008.  More needs to be done to ensure specialist medical support is available more widely.

Six out of ten stillbirths is potentially avoidable if there had been better care, according to a detailed study of 85 stillbirths, led by the University of Leicester.  There are 3,600 stillbirths in the UK each year, one of the highest rates in Europe, and it is estimated that 600 of these could be avoided.

Talks are taking place between care home owners and council leaders about the risk of a large number of providers pulling out of the market.  Those represented at the talks will include the LGA, Care England, Carers UK and Age UK.

A judge’s rulling on deprivation of liberty safeguards for children is likely to increase children’s social care workloads. If a local authority has a child in their care, they must consider whether they are really free to leave, and if not they cannot consent to the deprivation of liberty themselves but must apply to the court.  It is unlikely the parents would be able to consent in such cases.  Deprivation of liberty safeguard assessments have already increased the workload of adult social care after the Cheshire West court ruling.

Survival rates for most cancers continue to improve but they still lag behind much of Europe, according to figures from ONS.

Jeremy Hunt has been criticised for making misleading claims about weekend hospital care, in saying that in only 10% of hospitals are patients seen by a senior doctor within 14 hours at weekends.  Experts say that the actual figures are for the whole week rather than weekends and that the position may not be clear because of small sample sizes.  It is estimated that across the whole week, all hospitals and all specialities, 79% see a consultant within 14 hours.

A report on district councils’ contribution to public health by the King’s Fund, commissioned by the District Councils’ Network, has been published.
Press release:
The report:


18 November 2015

A built-in delay of 42 days in paying universal credit is leaving many vulnerable people without money and unable to pay bills, according to a survey by Citizens Advice of 350 who had presented to 16 of their offices with benefit problems (so were not representative).

Children are waiting for an average of two months for mental health assessments, with wide variations across the country, from a week to six months, according to a study of 35 NHS mental health trusts by the NSPCC.

A mapping of the premature mortality amongst people with mental health problems has been published by the Open Public Services Network of the RSA, based on publically open but not easily accessible data.  Premature mortality is said to be particularly worrying in a quarter of areas.  Overall, premature mortality is 2.4 times higher than the general population.
The report:

Pet owners are being urged by Public Health England to use antibiotics as directed because of the increasing drug resistance and the ability of antibiotic resistant bacteria to pass between humans and animals.  In 2013, 418 tonnes of antibiotics were given to animals while 531 tonnes were given to people.

The planned tax credit cuts will affect poorer regions more than the better off ones according to an analysis by the TUC.

The NHS is heading for a bigger deficit than the £2bn so far predicted and it is unlikely to meet the £22bn savings identified in the Five Year Forward View and anticipated by the Government’s promised additional £8bn a year by 2020, according to a survey of 200 NHS finance directors by the Healthcare Financial Management Association.

A big surge in the prescription of antibiotics in the winter, possibly inappropriately, has been found in an analysis of statistics by Antibiotic Research UK for the BBC.  It also shows substantial variations in prescribing between different areas.

Too few people are getting the advocacy they are entitled to under the Care Act.


17 November 2015

Two more combined authorities are to be set up in the Liverpool city region and the West Midlands, with more devolved control over transport.  Neither deal involves health and social care like the Manchester arrangement.  Both will have to accept elected mayors for the regions and both will have over £30m a year ‘invesment funding’ for the next 30 years, though this is a small proportion of the cuts made to local authority funding in those areas.

The GMC is calling for more powers to check the competence and medical skills of doctors from Europe, to match its powers for assessing doctors from the rest of the world.


16 November 2015

An association between the work capability assessment and 590 suicides and 725,000 additional antidepressant prescriptions has been identified in research which looked at rates of increase of reassessments and subsequent rises in aspects of mental health in different parts of the country.  The research considered, and was able to discount, other possible explanations such as unemployment, wages, levels of deprivation and cuts to services.  The research, from the Universities of Liverpool and Oxford, looked at data from 149 local authority areas and was published in the Journal of Epidemiology and Community Health.

The use of ‘antibiotics of last resort’ has increased significantly in the last five years, an indication of the growing problem of antimicrobial resistance, but also a possible contributor to resistance, according to a report from Public Health England.  The number of infections from drug resistant bugs has risen by a fifth since 2010.
The report:

There are widespread misconceptions about antimicrobial resistance, according to a global survey by the WHO, as it launches a campaign to raise awareness.

Industry bodies have called for new funding for antibiotic research, possibly in some sort of insurance-style scheme, in a letter to the Financial Times.

More babies are being born to women over 35 than under 25, at 21% to 20%, for the first time since such records started in 1938, according to figures from ONS.  There are also fewer women having children at all–england-and-wales


15 November 2015

Nearly half (44%) of those who had been bullied experienced mental health problems such as anxiety or depression according to a survey of 1,496 young people aged 16-25 by OnePoll for the anti-bullying alliance and National Children’s Bureau.  Separate figures, from DfE found that playground bullying and violence in schools has fallen in the last ten years from 36% saying they had experienced some form of bullying in the last 12 months, compared to 41% in the 2005 survey.


14 November 2015

The number of adults with diabetes in the UK has risen by 65% in 10 year to 3.5m people, according to the British Heart Foundation.  There has been a 3.5% increase in the last year.  Diabetes kills around 20,000 people a year and takes about a tenth of the NHS budget.


13 November 2015

A drive to reduce the number of stillbirths and neonatal deaths has been launched by Jeremy Hunt, including publishing data at trust level and a £4m fund for new equipment.  The UK has one of the highest rates of stillbirths in Europe.

Homeopathy on the NHS could be banned depending on the outcome of a consultation which is to be held in 2016, according to a Government minister.  It is thought that the NHS spends about £4m a year on homeopathy.


12 November 2015

The number of benefit sanctions against people with mental health problems has increased by 600% in four years from 2,507 in 2011-12 to 19,259 in 2014-15, according to an analysis of DWP figures by the Independent and Mind.

The English NHS has missed key targets and the number of people whose transfer from hospital has been delayed, though they are fit to be discharged, is the highest since 2010 when records started, according to figures for September.  Targets were also missed on being seen in A&E within 4 hours, access to cancer treatment, diagnostic tests and ambulance response times.

The suicide rate increased in the early years of the recession with 878 more men taking their own lives than would have been expected if the downward trend had continued, according to research from Bristol, Manchester and Oxford Universities funded by the National Institute for Health Research.  Debt, austerity measures and unemployment may be amongst the factors involved in the rise.

Cuts to adult mental health services in England have started to impact on the quality of services, with less than 20% of people feeling they received appropriate support in a crisis, according to a briefing from the King’s Fund.  According to one charity, disappearing services are putting lives at risk.  The Government said the amount of money available for mental health overall had increased.
Press release:
The report:

NICE publishes guidance on diagnosing and managing the menopause which recommends offering hormone replacement therapy, while being aware of the risk of increased breast cancer, and giving women more opportunities to discuss the options and choose for themselves.
(13/11/15) Two academics say the advice is biassed and misleading and downplays the risk of breast cancer from HRT:

Jeremy Hunt condemns junior doctors for proposed three days of strikes, to be held on 1st, 8th and 16th December, if approved by the strike ballot, the results of which are to be announced on 19th November.

A report on Place-Based Systems of Care, which argues for collaboration in local areas to meet growing health demands, is published by the King’s Fund.
(16/11/15) Blog:
The publication:


11 November 2015

There is little evidence to support the claim that the Troubled Families Programme has been a success, according to a report from a Durham University academic for the Centre for Crime and Justice Studies.  Foi requests by the Guardian found that only 79,000 (out of 120,000) families were ‘turned around’ by a family intervention.  Over 8,000 families had not received any kind of family intervention, rather imporvement was identified from data-matching exercises.  The almost exact match between the predicted number of ‘troubled families’ and those claimed to have been helped was said to be ‘hard to believe’.

There could be a loss of almost 10% (37,000) care home beds within five years because of a developing shortfall in funding, according to a report from the ResPublica think tank.  This would cost the NHS £3bn a year if they were to take on the care.

CCGs awarded 437 contracts worth £2.4bn to organisations in which CCG Board members had an interest, such as ownership or working in them, according to an investigation by the BMJ and the Times.  There were varying ways of dealing with such conflicts of interest, (such as leaving the room for the discussion or remaining but not voting).

David Cameron criticises his local council for its cuts and offers access to his advisers in a letter obtained by the Oxford Mail.  A shadow Cabinet Office minister has written to Sir Jeremy Heywood questionning whether he has broken the ministerial code by not keeping separate his roles as prime minister and constituency MP.


10 November 2015

Child poverty, deprivation and unemployment are the three determinants most closely correlated with health, according to a study by Grant Thornton UK LLP, using a health and wellbeing index with 33 health determinants.  The report also identifies which areas (mostly in London) are performing above their expected level.

About 40% of new mothers experience mental health problems during or after pregnancy with their first child, but only 46% considered seeking support from a healthcare professional, according to a survey of 2,000 new parents by YouGov for the Royal College of Nursing.

A RSPH report on child obesity recommends that parents of overweight children should be given healthy food vouchers to enable them to buy more fruit and vegetables.  The Royal Society of Public Health report also calls for more physical activity in primary schools, restrictions on junk food advertising, a sugar tax and for companies to reformulate their products to reduce the sugar, fat and salt content.
(10/11/14) (Feature article):


09 November 2015

Local authorities are spending only 1.1% of their public health budgets on mental health according to an analysis by Mind, based on responses to foi requests from 131 of the 152 relevant local authorities.  In the reporting of public health spending there is no specific cateogry for mental health and it is included under ‘miscellaneous’.  It is estimated that mental health problems cost local authorities £21bn a year.

Cancers are the leading cause of death in England and Wales, when all forms are combined, accounting for nearly a third of deaths, according to figures from the ONS.  When the different sorts of cancers were counted separately, the leading causes of death for men were: coronary disease (14.8%); dementia and Alzheimer’s (7.0%); lung cancer (6.9%); chronic lower respiratory diseases (5.9%); and stroke (5.8%).  For women it was: dementia and Alzheimer’s (13.4%); coronary disease (9.4%); stroke (7.8%); chronic lower respiratory diseases (5.6%); and influenza and pneumonia (5.5%).  Just over 500,000 deaths were recorded in England and Wales in 2014.

The Health and Wellbeing Systems Bulletin for November has been published by the LGA.

A report on giving children the best healthy start in life and the role of local authorities who have taken over commissioning responsibilities for under-fives, has been published by the LGA.


07 November 2015

Voluntary action by the alcohol industry under the ‘responsibility deal’ has been a failure in having had little effect while allowing resistance to more effective policies according to an assessment by the Institute of Alcohol Studies (which is independent of alcohol companies).  Overall consumption of alcohol has fallen slightly but admissions to hospital and alcohol related deaths continue to rise.  The report says that on the other hand, drinks firms have made progress with not advertising within 100 metres of schools, and products carrying warnings abour safe drinking guidelines, drinking during pregnancy and the number of units contained.


06 November 2015

81% of patients are happy with their current GP opening hours according to an analysis of the views of 881,183 patients gathered in the 2014 General Practice Patients’ Survey, analysed by East Anglia and Oxford Universities and published in the Journal of General Practice.  14.5% of respondents said weekend opening would make it easier for them to see a doctor.


05 November 2015

Britain has the fourth highest infant mortality rate of all Western countries, linked to high child poverty levels, a lack of investment in healthcare and inequality, according to research by Bournemouth University.

A report recommending a strategic approach to reducing inactivity including putting a personal trainer in every doctor’s surgery and job centre has been launched by the not-for-profit organisation ukactive.  Lack of activity is estimated to cause 37,000 premature deaths annually and cost the economy £20bn a year.

Premature babies may be missing out on health checks with 46% having no record of the two year check-up which they should receive, according to a report by the Royal College of Paediatrics and Child Health based on data on 86,000 babies requiring specialist care born in England and Wales in 2014.


04 November 2015

The UK’s spending on health is lower than the OECD average and would need an additional 47,700 nurses and 26,500 doctors at a cost of £5bn a year to reach the average.  The OECD report compared healthcare across 34 countries.  The UK performed below average in terms of obesity, smoking and alcohol consumption. It was also behind in relation to strokes and cancer.  It performed well in relation to waiting times for key treatments and ensuring everyone had access to services.

North-south inequality in life expactancy has been increasing with babies born in parts of London expected to live 9 years longer than those born in Blackpool, according to ONS figures.

The NHS Trust that ran Stafford Hospital has pleaded guilty to four deaths between 2005-14. Charges were brought by the HSE.  The Trust remains as a legal entity but a new trust now runs the hospital.

Two thirds (67%) of GPs would support a sugar tax according to a poll by Pulse magazine of 878 GPs.

There is to be a re-organisation of the health system in Northern Ireland, with Trusts reporting directly to the Department of Health rather than via the Health and Social Care Board.  A panel of experts is to decide on the detail of the changes.

Increasing the number of steps taken each day reduced mortality according to a study of 3,000 over-59 year old Australians over 15 years by the George Institute for Global Health and the Menzies Research Institute in Tasmania.  Steps were measured using pedometers.  Increasing the number of steps from 1,000 to 3,000 over five days in the week reduced the mortality risk by 12%.

NICE have produced guidelines for the social care of older people with multiple long term conditions. Among the recommendations are that older people should have a named care co-ordinator.  The guidelines are used by the CQC in its inspections.
Press release:
The guidance:


03 November 2015

Jeremy Hunt offers an increase of 11% in junior doctors’ basic pay but no change in the overall pay bill, as part of the dispute over a new contract.  He was criticised for releasing the offer through the media rather than directly to the junior doctors’ representatives.

Computerised brain training games of 10 minutes at a time led to better cognitive scores at 3 and 6 months according to research  involving nearly 7,000 over 50 year olds, randomly assigned to an intervention or control group, by King’s College, London and involving the BBC, Alzheimer’s Society and the Medical Research Council, and published in the journal JAMDA.
involving nearly 7,000 over 50 year olds, randomly assigned to an intervention or control grouphttp:// involving nearly 7,000 over 50 year olds, randomly assigned to an intervention or control group


02 November 2015

Britain’s biggest care home provider, Four Seasons Health Care, could run out of cash next year, according to credit ratings agency S&P.  Four Seasons said it was dealing with the problems and there would be no effect on the quality of care of their residents.

Almost 2,000 people with cancer live in deprived areas and face financial hardship since for 4 out of 5 cancer sufferers there is an additional cost of £570 a month for things such as additional heating or special clothes to deal with body changes, according to analysis by Macmillan Cancer Support and PHE’s Cancer Intelligence Network.

A campaign for mental health to be treated as seriously as other illnesses, with more funding, has been launched with a letter from over 200 high profile celebrities and others including Norman Lamb, Alistair Campbell and Andrew Mitchell.

The (voluntary) living wage has been increased by 40p outside London, to £8.25 an hour and by 25p in London to £9.40 an hour by the living wage foundation, so increasing the gap with George Osborne’s ‘national living wage’ of £7.20 per hour for adults, coming into force in April 2016.


31 October 2015

The UK has been ranked as the 21st healthiest country, with the top five spots taken respectively by Singapore, Italy, Australia, Switzerland and Japan, according to the Bloomberg rankings, calculated by subtracting a risk from a health score.

The legal duty on doctors, nurses, midwives and teachers to report cases of FGM came into force on 31st October 2015.


30 October 2015

The availability of GP surgeries on Saturday afternoons and Sundays has not proved popular with the public, although extended hours during the week and Saturday morning provision has attracted more attendance according to a review of 20 pilot schemes covering 1,100 practices and 7.5m patients, by consultancy Mott Macdonald.  £50m was initally provided for the PM’s Challenge Fund for the pilots, with a further £100m added in September 2014 for what is now called the Prime Minister’s GP Access Fund.

The number of beds for people with learning disabilities and autism is to be halved (from its current 2,600) and the largest NHS hospital for people with learning disabilities, Calderstones in Lancashire, is to be closed, as part of the process of moving from hospital to community care following the Winterbourne View scandal.  A £45m fund is being established to support the changes, with NHS funds providing ‘dowries’ for people who have been in hospital for more than five years.

A majority of housing associations are to be reclassified as public bodies following a decision by the ONS based on the implications of 2008 legislation, with the application of the decision to be backdated to 2008.  The National Housing Federation expressed concern that this could lead to reduced ability of associations to borrow, since this would increase government debt, but the Government said it would make no material difference and that it would bring forward measures to allow associations to become private bodies again as soon as possible.

A private member’s bill to exempt carers from hospital car parking charges has been blocked by Tory MPs who spoke for so long that the debate ran out of time.
(Official guidance has been updated to include carers as an explicit group eligible for the provision of concessions)


29 October 2015

CCGs are to be subject to CQC inspections and ratings from next June, Jeremy Hunt has said, with separate scores for each of six services: cancer, dementia, maternity, mental health, diabetes and learning disabilities.  He has also said he wants to reduce bureaucracy, such as rearrangement of outpatient appointments having to be re-referred by GPs.

Specialist orthopaedic hospitals in England face cuts in their funding due to changes in nationally determined tariffs.  The changes mean the NHS will save money on contracts with the private sector for knee and hip operations, and other trusts will be able to spread these losses across all treatment areas, but specialist orthopaedic centres will not have that option.

The number of people in prison who have died or been injured is at the highest level for ten years according to statistics published by the Ministry of Justice.

E-cigarette users were more likely to drink problematically, with a link between e-cigarette use and alcohol consumption, according to a study looking at the habits of 1,400 people, published in the journal Addictive Behaviours.  It is suggested that nicotine counters the tendency of alcohol to make you sleepy, so people consume both together, so when switching to e-cigarettes rather than quitting entirely, the drinking continues.  The study also found more women than men using e-cigarettes socially.

Jeremy Hunt says a minority of doctors may lose money from the proposed new contract, with  those working more than 56 hours a week affected.  He is said to have angered many junior doctors by using the term ‘danger money’ in relation to those working longer hours, saying it was an NHS colloquialism, but this has been generally refuted.


28 October 2015

A survey of sexual abuse survivors found less than a half felt listened to, believed or respected by health and social services.  Researchers from University Campus Suffolk surveyed 400 adults who had experienced sexual abuse as children.

The CQC could move to a system of co-regulation of GP practices, with those that have already been rated ‘good’ or ‘outstanding’ to develop their own systems of self-evaluation that they would then report to the CQC.  The suggestion is made in a CQC discussion paper.

There is unacceptable variation in the speed of cancer diagnosis and if all parts of the country were as good as the best, 20,000 cases could have been spotted earlier, according to Cancer Research UK.  There was also variation between dignosis rates for different types of cancers so an area might do well for one type but poorly for another.

The Government is trialling having job advisers in food banks to help with issues to do with benefits and finding work.
Analysis and comment:

The Government announces a review into children’s residential care, to be led by Sir Martin Narey.

Watching television increased the risk of death from any cause, with 3-4 hours per day increasing the risk by 15% and watching more than 7 hours a day increasing it by 47%, according to a study on 221,000 people aged 40-71 by the US National Cancer Institute, published in the American Journal of Preventive Medicine.

TB and HIV are the two infectious diseases killing most people worldwide, at about 1.1m to 1.2m each, according to the WHO.

A report on social isolation by the Scottish Parliament’s Equal Opportunities Committee says that the Scottish government should develop a national strategy to deal with the problem.

Jeremy Hunt has now said that no junior doctors will lose money under the proposed new contract. The BMA welcomed the shift in position but wanted to know more details.


27 October 2015

The causes of the north-south divide are illustrated by the fact that 5 year olds lag behind their peers in the south, with the proportion of children from deprived families reaching a good standard of development (with measures including personal development, language skills and maths) being 47% in the north of England compared to 59% in London, according to a report from IPPR North, ‘The State of the North 2015’, which looks at the future of the ‘northern powerhouse’.

Malnutrition has increased by over 50% in four years, from 4,883 cases in the period August 2010 to July 2011, compared with 7,366 in the same period 2014-15, according to  figures from the HSCIC.  There were also increases in some other diseases common in the Victorian era such as scurvy, scarlet fever, cholera and whooping cough (although the number of cases of TB, measles, typhoid and rickets have fallen).  There has also been an increase in gout.

Rates of TB are higher in parts of London than Iraq or Rwanda, with the rate in Newham being 107 cases per 100,000 population, compared with 69 for Rwanda, 45 for Iraq and 13 for the UK as a whole, according to a report from the London Assembly.  A third of boroughs had rates over 40 per 100,000.

EU reforms liberalising the sugar market could lead to greater marketing of foods high in sugar, as sucrose and fructose become relatively cheaper, so damaging other efforts to reduce sugar consumptions, according to an article in the British Medical Journal.  Under the reforms, Europe’s sugar beet producers will lose the protection of the common agricultural policy.  The Government is supporting the changes because of the benefits to UK producers.

Healthwatch England’s second annual report highlights the risk to vulnerable people using state funded services which are not subject to CQC inspection and where the means of making compalints are unclear.  The report also highlights difficulties accessing dental services, difficulties accessing gender identity services and poor continuity of care for vulnerable people discharged from hospital.


26 October 2015

Stopping drinking by a month reduced blood pressure and cholesterol, reducing liver damage by 12.5% and resistance to insulin by 28%, according to research by UCL on 100 men and women in the 40’s who took part in the ‘dry January’ campaign.  It is not yet known whether drinking returned to previous levels at the end of the month or whether the health benefits were sustained.  The research has not yet been peer reviewed or published.

An appeal for the NHS to be exempted from the TTIP has been signed by leaders of most of the main political party leaders, including Labour, the SNP, UKIP, the Greens, Plaid Cymru, the Democratic Unionist Party and Sinn Fein.  The Conservatives have refused and there has been no reply from the Liberal Democrats.  The Transatlantic Trade and Investment Partnership is currently being negotiated to free up trade between the EU and U.S.A.  It would allow foreign companies to sue central or local governments for loss of business in court outside national judicial systems.

Processed meats such as bacon, sausages and ham cause cancer, according to the WHO.  It has placed them in the top category alongside such things as tobacco, alcohol and arsenic.  However, that doesn’t mean they are as bad for you, just that there is the same level of evidence of some harmful effect.  Red meat has been put in the second from top category.  Eating 50g of processed meat daily increases the chances of getting colorectal cancer by 18%, which for a man would mean an increase from 6 in 100 to a chance of 7 in 100. It is not suggested that these meats should necessarily be avoided altogether. The decision was made following a review of the evidence by a panel of 22 international experts.
Background and explanation:
Q&A from the WHO:

53% of police officers’ time is spent dealing with drink related crime and 75% of police officers and 50% of ambulance staff say they have been injured while handling drink related crimes, according to a survey of nearly 5,000 police officers, ambulance staff, firefighters and NHS medical staff by the charity the Institute of Alcohol Studies.

The NHS is short of 2,600 midwives and demand is increasing as more women have babies later, requiring more care according to a report by the Royal College of Midwives.  At the same time the average age of the workforce is increasing.

53% of police officers’ time is spent dealing with drink related crime and 75% of police officers and 50% of ambulance staff say they have been injured while handling drink related crimes, according to a survey of nearly 5,000 police officers, ambulance staff, firefighters and NHS medical staff by the charity the Institute of Alcohol Studies.

The NHS is short of 2,600 midwives and demand is increasing as more women have babies later, requiring more care according to a report by the Royal College of Midwives.  At the same time the average age of the workforce is increasing.
(27/10/15) (Rgn):

High consumption of fruit and vegetables by people in their 20’s reduced the risk of blocked arteries in their 40’s by 25%, according to a study of 2,506 people by the Minneapolis Heart Institute, published in the journal Circulation.

The introduction of a new system for revalidating nurses and midwives could be delayed for two years because of DH’s concern abou the costs for struggling trusts, according to the Nursing Times.

But DH later said it will go ahead as planned next year.
(30/10/15) (Rgn)


25 October 2015

Sir Bruce Keogh confirms that it is not possible to say how many of the excess weekend deaths are preventable but stops short of criticising Jeremy Hunt for saying that there are 11,000 excess deaths annually as a result of inadequate cover at weekends.  However Keogh, the NHS Medical Director does say that there is an avoidable ‘weekend effect’ which if addressed could save lives.

Some supermarket ready meals contain 13 teaspoons of sugar according to a study by Action on Sugar and the Sunday Telegraph.


24 October 2015

53% of people are in favour of a sugar tax according to a ComRes survey of a representative sample of 2,191 British adults.  Other proposals from experts include a gradual reformulation of foods to reduce sugar, overseen by an independent body such as a re-established Food Standards Agency, or a ban on marketing all unhealthy foods.

The NHS has spent at least £7m in the last 5 years on adapting services and equipment for obese patients, according to foi responses obtained by Sky News.


23 October 2015

Detentions under the Mental Health Act rose by almost 10% last year 2014-15 according to figures from HSCIC.  The number of  people subject to the Act increased by 6.7% to 25,117, but the number of detentions was higher as the same person could be detained several times.  It is suggested this is indicative of services struggling and people not receiving help until crisis point.  Overall, 1.85m people were in contact with mental health and learning disability services at some point in the year.  HSCIC has also published the Mental Health Bulletin, Annual report 2014-15.
Press release:
Mental Health Bulletin: Annual Report 2014-15:

NHS Trusts will be able to breach the new agency staffing restrictions if there is a risk of patient safety, Monitor has confirmed in an address to a nursing conference.

The Chancellor is being urged to reverse the £200m cuts to public health and not introduce any further cuts, by eleven leading health bodies including the Academy of Medical Royal Colleges, the Royal College of Nursing, the NHS Confederation,  the Faculty of Public Health and the LGA. The Faculty of Public Health estimates that the cuts will cost the NHS at least £1bn in future years.  The letter also says it is misleading to describe the cuts as non-NHS, since they have a direct impact on the NHS and many services delivered through public health spending fund clinical NHS care.

Cancer patients could lose up to £120 a month due to the welfare cuts, the charity Macmillan has said.  Those in the Work Related Activity Group will have payments designed to cover costs associated with the condition (such clothing to cover swellings or colostomy bags) cut from £102 to £73 a week.  DWP said only a small proportion of cancer sufferers would be affected [so that’s all right then.]

Processed meats like bacon and sausages are expected to be added to a list of carcinogens by the WHO.  They are expected to be put onto the highest of five categories with red meat the category below that.

The quality of treatment for heroin users is threatened by shrinking resources and disruptive procurement processes, according to a report from the Advisory Council on the Misuse of Drugs.  The report calls for protection of investment in drug treatment and the implementation of a national quality improvement programme.

The legislation to ban new psychoactive substances is being rushed, with ministers not working properly with their own expert drug advisers, according to the Home Affairs select committee.

The UK and China are establishing a fund to tackle anti-microbial resistance, which it is hoped will attact £1bn of investment. [I can’t see any mention of either government committing any money themselves to the fund.]

New diagnostic tools that can quickly determine if antibiotics are necessary are needed to tackle the crisis of antimicrobial resistance, according to the latest report of the review by Lord Jim O’Neill into the problem.  He proposes subsidies for developers of new tests, paid for from an international fund.


22 October 2015

A tax on sugar is one of a number of recommendations in the delayed PHE report which has now been published. Other recommendations include: reducing price promotions in supermarkets; reduce advertising of high sugar food and drink; reduce sugar content and portion sizes in everyday food and drink; promote healthier provision of food by public services; and continue to raise awareness.  It says that if sugar was cut to recommended levels in 10 yearsit could save 4,100 lives and £480m a year to the NHS [p.14 of the report. It is not easy to make sense of those figures it also says that 68,300 lives could be saved over 25 years which would only be an average of 2,732 lives a year.  One of the news reports estimates that sugary drinks are implicated in the loss of 1,316 lives a year in the UK.]
Cameron under pressure to back a sugar tax:
Background and analysis:
More background:
Press release:
The report:

The NHS in Scotland is facing substantial problems and declining quality because of cuts in budgets according to Audit Scotland.  It said 7 of 9 performance targets had been missed, with funding having fallen by 0.7% in real terms over the last six years.

The Government has launched a campaign to reduce the stigma of mental health in children which will use social media, school visits and a new ‘Youth Mental Health Hub’ as part of the NHS Choices website.  The Government has also commissioned a new survey of children’s mental health, the first of its kind since 2004.  However there were £35m of cuts to mental health services last year.

The new Physician Associates should be regulated the General Medical Council has said, although it is thought the Government favours voluntary registration.

Statistics on the characteristics of children assessed by children’s social services in 2014-15, published by the Department of Education, show that fewer referrals are passing the ‘child in need’ threshold but also a rise in child protection investigations and child protection plans

The BMJ has accused Jeremy Hunt of misrepresenting findings on deaths rates published in the journal when he says that the 11,000 deaths are ‘excess’ and blaming them on staffing at weekends.  The report on which the claims are made says it would be rash and misleading to claim the deaths could have been avoided.  Health Minister Ben Gummer, replying on behalf of Jeremy Hunt said there was ‘significant independent clinical evidence’ of increased mortality in hospitals at weekends linked to reduced clinical cover.


21 October 2015

Hospitals are to be given an indication of how much they ought to be able to save by Lord Carter who has been tasked by the Government to identify efficiency savings in the NHS.  The figures will be based on variations in spending identified in Lord Carter’s work with 22 hospitals, now broken down by speciality.  Overall the review says £5bn could be saved by reducing unnecessary variation between hospitals.  He is also to produce clearer guidance on safe staffing levels, providing safe ranges which would provide ‘air cover’ for trusts facing inspection.

A million older people struggling with everyday tasks are being left to fend for themselves, up from 800,000 in 2010 according to Age UK.  They say there are 3 million people over 65 needing care, with 850,000 helped by their local councils and just over a million paying for care or relying on friends and family.  The charity says the lack of support at home has increased admissions to hospitals for a range of conditions.

The new price caps on agency staff could bring significant patient risks according to an impact assessment by Monitor.  There is also a risk of increasing pay costs if there was an increased use of overtime, but overall they predict annual savings of £370m.

Health and care provision for older people is under severe stress leading to poorer outcomes according to a report analysing the current state of the health and care system by Age UK.

Local authorities cannot show they are providing the support to carers they should be under the Care Act, with only 13% (17 of 132 contacted) saying they are working to identify carers and few providing any details of a prevention strategy, according to foi requests made to 147 councils by the Carers’ Trust.

There has been ‘no notable improvement’ in mental health care outside hospitals, according to an annual CQC-led survey of 13,000 people.  The survey was conducted between September and November 2014.  There were small increases in the proportion of people who felt they had had a poor experience, weren’t listened to or were not treated with dignity and respect.

The risk of death or complications from diabetes have reduced but there are still around 22,000 avoidable deaths a year from diabetes related causes, according to a progress report by the National Audit Office.

People in middle age can delay or prevent dementia, disability and frailty in later life by adopting healthier lifestyles, such as stopping smoking, being more active, reducing alcohol consumption, improving diet and maintaining a healthy weight, according to guidance from NICE.

The latest survey results of patients’ experience of community mental health services, part of the ‘overall patient experience scores’, bringing together the results of different surveys, have been published by NHS England.  They show small reductions in the scores compared to previous years.

A consultation on payment arrangements for NHS mental health services has been launched by NHS England and Monitor.  The consultation is aimed at commissioners and providers and is suggesting one of two options: capitation or payment based on a year of care or episode of treatment, with an element linked to outcome measures under either approach.

A strike ballot of junior doctors is to last for two weeks from 5th November, the BMA has said.

Male managers and professionals now have a life expectancy greater than the average woman, at 82.5 years compared to 82.4 years for women, with life expectancy between the sexes having narrowed over the last 30 years, according to figures from ONS.

The Health and Wellbeing System Bulletin has been published by the LGA.


20 October 2015

The decade to 2020 is likely to see the largest sustained fall in the NHS’s share of GDP since 1951 according to the King’s Fund, talking to the BBC.

Local authorities are failing in their Care Act duty to offer ‘choice and control’ since they are not providing sufficient information about rights and care options, according to a study by the Living Strategy Group, published by the In-Control charity.  It included a survey of 399 people which found 30% felt they had experienced a reduction in choice and control.

21% of young people have indications of depression or anxiety according to the latest wellbeing figures from ONS.  The proportion expressing high or very high levels of satisfaction has increased slightly to 83%.  18% report high levels of anxiety and 16% medium levels.

Children spending more than three hours a day on social media were twice as likely to suffer mental health problems, with 27% of those spending 3 or more hours on a normal school day scoring high on ‘difficulties’ that suggest mental health problems, according to figures from ONS.  For those spending up to 3 hours a day the figure was 11% and for those spending no time on social media the figure was 12%. About 8% of children spend more than three hours a day on social media (11% of girls and 5% of boys).

Teachers, doctors and nurses will have a legal duty to report cases of female genital mutilation from 31st October. The law was passed earlier in the year, but the starting date has just been announced.  Teachers and health and social care professionals will have to report ‘visually confirmed’ or ‘verbally disclosed’ cases of girls under 18 to the police within a month or face disciplinary or regulatory action.

Public Health England are backing a sugar tax in a report whose publication they have been criticised for delaying, it was confirmed in hearings before the Health Select Committee.  Evidence was presented to the committee by Dr Alison Tedstone, chief nutritionist at PHE.

A guide on ‘Contingency Planning for Provider Failure’ in adult social care, ‘Care and Continuity’, has been published by the LGIU.


19 October 2015

Benefit delays are creating hardship and debt and putting charities under unsustainable pressure according to evidence from over 60 bodies to an inquiry on benefit delivery by the House of Commons Work and Pensions Select Committee, starting on 21st October.

Neonatal services providing care for sick and premature babies are understaffed, with 64% of neonatal units not havng enough nurses and 70% of intensive care units have unsafe numbers of babies (more than 80% occupancy) according to a report from the charity Bliss.

The number of moles on an arm indicates a higher risk of skin cancer because it correlates with the number of moles on the body overall, and so could be an easy way for doctors to assess risk, according to research from King’s College London and others, published in the British Journal of Dermatology.  The research involved 3,000 female twins over eight years and more then 400 men and women with melanoma.  It found that 11 moles on their right arm indicated a nine times likelihood of 100 on the body as a whole which meant there was five times the risk of developing melanoma.  According to Cancer Research UK less than half of melanomas develop from existing moles.
(20/10/15) (Rgn)

A risk evaluation tool for adult social care has been launched by the sector-led improvement coalition, Towards Excellence in Adult Social Care.

A briefing on increasing physical activity amongst children and young people, aimed at head teachers, college principals, staffing working in education, directors of public health and others, has been published by PHE.

Dr Don Berwick has been appointed to help support the vanguard sites with developing the new models of care set out in the Five Year Forward View.


18 October 2015

Parents should be persuaded to send their children to pre-school education, as a means of tackling poverty, with incentives including withdrawing child benefit from children not attending from the age of 3, or at the age of 2 for children from a disadvantaged background, according to ‘Bright Blue’, a Conservative pressure group.


17 October 2015

The health service is being damaged by social care cuts according to over 80% of NHS and CCG financial heads, the King’s Fund’s Quarterly Monitoring Report has found.  94% of trust directors and 90% of CCG leads felt fairly or very pessimistic about the state of the local health and care economy in the next year, the highest level in the four years since the monitoring reports have been undertaken.  Staff morale tops the list of NHS trust finance directors’ concerns for the fifth quarterly monitoring report in a row.
Press release:
(22/10/15) Blog:

High street restaurants offering too much sugar in much of their food and drink are named in a report by the Soil Association, ‘Out to Lunch’, due to be published at the end of the month.  A key problem was offering unlimited refills of sugary soft drinks.

21% of people have delayed seeking health care at the weekend because they fear the quality would be worse, 50% of people think it is more dangerous to be admitted to hospital at the weekend, 38% believe that consultants do not work at weekends and 41% think that junior doctors would be justified in taking strike action in their dispute with the Government, according to an Observer / Opinium survey of 2,002 UK adults.

A tenth of hospitals are charging disabled people for parking according to analysis by Labour of the annual Estates Return Information Collection.

Junior doctors have held a protest march in London over their ongoing dispute with the Government over new contracts.  The leader of the junior doctors in an address to the rally urged Jeremy Hunt to stop attacking them and to resume negotiations.


16 October 2015

New research indicates the extent of looming problems from antimicrobial resistance, with an estimate that up to half the bacteria causing infections after surgery and a quarter of infections after chemotherapy are resistant to antibiotics in the US.  The research, from a number of US institutions, was published in the Lancet Infectious Diseases.

Doctors have asked the Cabinet Office to investigate Jeremy Hunt’s statements about excess weekend deaths on the basis that they breach the ministerial code by not giving accurate and truthful information to Parliament, by saying that there are 11,000 excess deaths “because we do not staff our hospitals properly at weekends”.  In fact, the article on which Hunt’s statement is made says that it would be rash and misleading to assume those deaths are avoidable.

Junior doctors call on David Cameron to help resolve the dispute over their new contracts because of the polarising actions of Jeremy Hunt, the chair of the BMA’s Junior Doctors Committee, Dr Johann Malawana has said in an interview with the Guardian.
(17/10/15) Jeremy Hunt says the BMA is misrepresenting the Government’s position:

In Touch: Issue 14.


15 October 2015

NICE made a last minute decision to delay publication of a report on safe staffing in June after DH expressed its views which “were taken into consideration” according to heavily redacted emails released to the Health Services Journal following foi requests.  NICE had planned to publish the research on safe staffing in A&E’s on 30th July and sent a copy to DH on 24th July.  An email four days later confirmed in writing a conversation and led to the immediate decision to postpone publication.  NICE is quoted as saying that NHS Improvement should be given space to develop its own conclusions and that the public interest generated by the publication could delay their work.

57% of NHS trusts have been judged as ‘requiring improvement’, 8% ‘inadequate’, 34% ‘good’ and only 1% ‘outstanding’ according to the CQC’s annual report.  For the part of the judgements relating to safety, 13% of hospitals were ‘inadequate’ and 61% requiring improvement.  Staffing was reported to be one of the drivers of ratings on safety.  For GPs, 85% were rated as good or outstanding, 11% as requiring improvement and 4% inadequate.  In adult social care, 60% of services were good or outstanding.
Press release:
The CQC’s ‘State of Care’ review:

The restriction on recruiting nurses from outside of Europe has been temporarily lifted in the light of pressure on the NHS and the recently introduced cap on the use of expensive agency staff.  The change is to be reviewed by the Migration Advisory Committee which is to present further evidence to the Government by next February.

Commissioners are being recommended to set up ‘urgent care clinical hubs’, bringing together delivery of NHS 111 and GP out of hours services.  This arises from NHS England’s Urgent and Emergency Care Review.

A new mental health ‘passport’ for children and young people has been launched by NHS England.  It brings together key clinical information and personal preferences, produced in conjunction with the young person, to save them having to repeat themselves as they move within and between services.

Happier people lived longer on average according to research from the University of Carolina, involving 30,000 adults, followed over 30 years and published in Social Science and Medicine.  It found that more unhappy people were 14% more likely to have died by the end of the period than happier people.  They were asked to rate their happiness on a three point scale of ‘very’, ‘pretty’ or ‘not too’ ‘happy’.

Marks and Spencer has been criticised for having higher prices in hospitals and refusing to reduce them after WH Smith did bring their prices down after similar criticism.  Labour MP Paula Sherriff has asked M&S to reduce its prices but they have refused, citing competition laws.

Personal health budgets should be evaluated for their cost effectiveness, like any other initiative, according to comments made by NICE Chief Executive, Sir Andrew Dillon.

The Government’s response to the Health Select Committee’s report on end of life care has been published by DH.


14 October 2015

People with mental health problems are more likely to have physical health problems, with the rate for emergency admissions being five times higher for those with mental health problems, despite the fact that only 20% of the admissions were explicitly linked to their mental health, according to research by the Nuffield Trust and the Health Foundation, looking at more than 100m hospital records between 2009-10 and 2013-14.  It is suggested that this raises questions about how their other care issues are being dealt with.
Nuffield Trust press release:

2,400 deaths from cancer each year could be prevented by better use of two week referral, according to research looking at data on over 215,000 cancer patients and 8,000 GP surgeries in 2009, led by King’s College London and funded by Cancer Research UK and the National Institute of Health Researach, published in the BMJ.

The Family Nurse Partnership, providing support for pregnant teenagers offered no significant benefits compared to normal care, according to a study by Cardiff University which tracked 1,600 mothers in England, published in the Lancet.  The scheme has been running since 2007, following success in the US.  11,850 women were involved in the scheme in 2014 at a cost of £23.6m.  The researchers said that continued provision of the programme could not be justified, but that further research of any long term impacts was needed and that there should be some form of intervention.
(20/10/15) (Rgn)

A call for changed regulation and accountability in children’s services has been made by the LGA, ADCS and SOLACE, who are proposing a sector-led and multi-agency model.
Respective views from ADCS and Ofsted:

Local authority trading companies (LATCs) for social care, including the first cross boundary one in Dorset, Poole and Bournemouth, are described in this feature article.

Sir Albert Bore is to stand down as leader of Birmingham City Council after 16 years in the role.


13 October 2015

A report on the added value GPs bring to health commissioning has been published by PRUComm (Policy Research Unit in Commissioning and the Healthcare System).

Growing inequality of wealth is harming children’s wellbeing, according to a report from the OECD which found that in most of its 34 countries inequality was at the highest level for 30 years which was affecting the opportunities and wellbeing of young people.  The UK picture was mixed.  While child poverty had increased in two thirds of the countries, the UK had seen the biggest drop of all since 2007.  However the proportion of children in households where no-one worked, at 15% was one of the highest, and obesity and teenage birth rates were above the OECD average.
(Focusses on obesity):
The report, “How’s Life?”:

Sitting down rather than than standing up does not increase premature mortality as long as regular exercise is taken, according to research studying more than 5,000 people over a 16 year period, from Exeter University, UCL and the University of Sydney and published in the International Journal of Epidemiology.  The study only looked at associations with mortality, not other health risks such as obesity or Type 2 diabetes.  It was part of the Whitehall II study, so involving London based, white collar civil servants, whose physical activity may not be typical of the rest of the population. [Text amended 23/10/15 to take account of comments in NHS Choices article.]

Thousands of kinship carers will be particularly badly hit by welfare reforms, such as extended family members looking after children losing from the restriction on tax credits to two children or the reduction in the benefit cap to £20k or £385 a week, according to charity the Family Rights Group.  A briefing paper from the University of Bristol found that over 150,000 children lived in kinship care according to the 2011 census, with 76% of them living in a deprived household.
Feature article:
(pdf) the report from the Family Rights Group: ‘Doing the Right Thing’:

A US study identifies 5 factors that help overcome the ‘weekend effect’. They are: a better nurse to bed ratio; home help programmes, checking on patients after discharge; hospitals with electronic records; hospitals with inpatient physical rehabilitation programmes; and hospitals with pain management programmes.  The research was based on the records of 126,666 patients in 166 Florida hospitals between 2007-11 and was published in the Annals of Surgery. [Is it possible that these factors are indicative of better resourcing, systems and management more generally which influences the ‘weekend effect’ along with everything else?]

The 1:8 nurse to patient staff staffing ratio is a guide, not a requirement, according to a letter on safe staffing and efficiency from NHS England, Monitor the TDA, the CQC and NICE to trust senior managers, leading to a fear that patient safety may be sacrificed to making savings.  However others welcomed the flexibility the guidance provided.
(14/10/15) (Rgn)

Nature for health should be supported by 1% of NHS England’s £1.8bn public health budget, according to a report by a coalition of 26 nature organisations.  Accessing green spaces and the coastline can help reduce obesity and mental illness.  This is one proposal amongst a number on how to reverse the decline in the UK’s natural environment.

Further details of NHS agency staff caps have been set out by the Government. Payment for agency staff is to be limited to what would be paid for a shift inhouse, plus 55%, to be phased in from November and to apply fully from Apirl 2016.  It is expected that this will save 10% of the £3.33bn annual cost of agency staff, or a third of a billion pounds a year.
Press release:

Blood clots are contributing to the deaths of 4,000 cancer patients a year, according to a report from the all-party parliamentary thrombosis group, based on foi responses from 92 of the 157 trusts which found that venous thromboemolism (VTE) was one of the causes of death in 2.6% of the deaths of cancer patients in the last three years.  Although the risk is already known, the research found less than half the trusts provided patients with both written and verbal information about the risks.

Drinking red wine with an evening meal increased the amount of ‘good’ cholesterol in the blood of Type 2 diabestics, compared with those drinking white wine or mineral water, in an Israeli randomised controlled trial of 224 participants over two years, published in the Annals of Internal Medicine.  Both red and white wine helped improve sugar control in those with genes that helped them metabolise alcohol slowly.

A lack of resources could lead to failure of seven day services and an NHS collapse this winter according to the President of the Royal College of Physicians, Jane Dacre, in an interview with the Guardian.  Seven day services would require a proportionate increase in resources, she says.
The news story:
The interview:

There is not going to be a clawback of the £146m paid to councils to implement the care cap even though that element of the Care Act reforms has been delayed until 2020, DH’s Director General for Social Care, Jon Rouse, has told the Public Accounts Committee.  He said that whether the full £6bn which will be saved from delaying the cap will be made available to local authorities will be decided in the forthcoming spending review.


12 October 2015

A review of how the performance of local health systems can be assessed, commissioned by DH, has been published by the King’s Fund.  It recommends a simplification and alignment of existing performance frameworks, including consolidating the existing NHS, public health and adult social care outcomes frameworks.  They recommend against using the data to produce an aggregate score.

New indicators should be drawn up to measure the quality of care in GP practices, according to a Government commissioned report from the Health Foundation.  The report also proposes consolidating existing information on GP practices from different websites; developing a national strategy for improving primary care; providing support to people in GP practices on how to use the information to improve; and not to try and combine indicators to produce overall scorecards.
Press release:
The report:

£100m is being offered for cancer research in six awards of £20m each over the next five years, by Cancer Research UK.

A fifth of children were refused mental health services despite being referred by GPs and other professionals according to research by the NSPCC, looking at data from 35 mental health trusts, showing that nearly 40,000 of over 186,000 cases did not receive help, most commonly because they were not deemed to be above the clinical threshold.

The BMA has said it is unwilling to return to negotiations on the junior doctors’ contract unless certain conditions are met, Including: that their proposals on working hours stand a reasonable chance of being accepted; that there should be contractual safeguards against working an unsafe number of hours; and that there should be proper recognition that working evenings and all day Saturdays should have pay premiums to reflect the anti-social hours.

Shared principles for redesigning the local health and care landscape have been published by the LGA, ADASS, SOLACE, CfPS and ADPH.

There are to be joint inspections of special educational needs services by the CQC and Ofsted from May next year, covering local authorities, nurseries, schools, further education and health services.  There is a consultation on the proposals until January.

The £2bn NHS debt expected for this year could be met by efficiency savings according to junior minister Ben Gummer, in answer to an emergency question from shadow health secretary Heidi Alexander, who criticised Jeremy Hunt for not answering the question himself.

Guidance to help improve productivity in elective care has been published by Monitor, based on good examples in the UK and abroad of opthalmic and orthopaedic providers.
(08/12/15) Blog summarising and commenting on the report:


11 October 2015

The Health Committee chair has asked PHE to publish a report on a ‘sugar tax’ despite the ‘disinclincation’ of the Secretary of State to publish the report.  The Chair of the committee, Dr Sarah Wollaston says delayed publication of the report is as harmful as non-publication and would not allow sufficient consideration of the evidence before a strategy on childhood obesity is published later this year.
(13/10/15) Duncan Selbie, head of PHE, has been summoned to appear before the committee:
(13/10/15) Committee chair, Sarah Woolaston, criticises Jeremy Hunt for obstructing MPs as public hearings on childhood obesity start:

A shortage of midwives and budget cuts has meant that 42% of maternity units had to close at some point during the last year, according to a survey of 83 heads of midwifery at NHS Trusts, by the Royal College of Midwives.

A letter from junior doctors (not the BMA) demands more concessions from Jeremy Hunt.
The junior doctors’ letter:

The tax on smoking should be increased with the money raised being used for anti-smoking projects, according to a submission by the All Party Parliamentary Group on Smoking and Health to the comprehensive spending review.


10 October 2015

90% of hospices inspected by the CQC have been found to be good or outstanding. 37 out of a total of 324 hospices have been inspected so far with 10 judged ‘outstanding’, 24 ‘good’ and 2 ‘requires improvement’.

The number of delayed discharges from hospital increased by 22% in the 12 months to August 2015 compared to the previous year, from 873,415 to 1,116,661, according to Labour.

Many hospitals continue to sell unhealthy snacks, with half of the 76 responding to an foi request by the Observer not offering plain dried or fresh fruit although all offered less healthy snacks.  Simon Stevens, as well as campaigners, is pushing hospitals to sell more health food.

Technology companies should provide guidelines on the daily use of their products to protect their consumers from possible harmful effects such as on their mental health, according to a report, ‘Screened Out’, from the Strategic Society Centre, due to be published on Thursday.


09 October 2015

NHS Trusts had a  £930m deficit in the first three months of this year according to Monitor and the Trust Development Authority, made up of £445m from the 151 foundation trusts and £485 from the 90 non-foundation trusts.  Monitor said hospitals would have to make radical changes in the light of increased demand ‘and a worst-in-a-generation financial position.’  It had previously been reported that the Government had put pressure on these bodies to delay publication of the figures until after the Conservative party conference.  There are calls from a number of health organisations for an injection of funding by the Government.
Press release:

Current global obesity trends mean the UN’s target of no increase in obesity or diabetes from 2010 to 2025 is unlikely to be met according to an analysis of the latest figures by the World Obesity Federation.  In 2010, 11.5% of aults were obese and by 2014 that had risen to 13%.
(Also a case study of how one small town in Australia is tackling its obesity problem:

Age related macular degeneration can be delayed and slowed by eating more carotenoids, found in carrots and green leafy vegetables, according to research led by Harvard University using a survey tracking more than 100,000 over 50 year olds over 25 years, published in the journal JAMA Opthalmology.  Those eating certain forms of carotenoids had a 40% lower risk of developing the advanced form of the condition than those who ate the least.


08 October 2015

93% of private and voluntary sector social care providers have seen a real terms cut in their fees in the last year, and only 38% felt confident they would still be trading in a year’s time, according to a survey of 492 providers by the UK Homecare Association.  71% of providers with contracts with councils had refused to take on new packages of care because of an insufficient price.

The Government’s planned welfare cuts will lead to 200,000 more working households in poverty by 2020 according to new analysis by the Resolution Foundation, in contrast to David Cameron’s Conservative conference speech promising ‘an all-out assault on poverty’.  The report also found that: the number of working households in poverty will have reached 2m by 2020:  200,000 more children will move into poverty in 2016 as a result of change in the summer budget; the measures in the summer budget will decrease the income of the lowest fifth of the population by 4% but increase that of the richest third by 4%.

There should be comprehensive trials in the next flu pandemic to assess the effectiveness of different drugs, after Tamiflu was handed out ‘indiscriminately’ in the last swine flu outbreak, without knowing how effective it was, according to a review by the Academy of Medical Sciences and the Wellcome Trust.
(09/10/15) GPs should not be asked to routinely prescribe antivirals for flu prevention to large numbers of care home residents:

A blood test could rule out a heart attack from two thirds of people going to A&E with chest pains, so saving the people concerned the need for a hospital admission and saving the cost to the NHS, according to a study published in the Lancet.  About one million people come to A&E with chest pains each year and 18,000 actually have a heart attack.  The blood test measures levels of troponin.

A new three yearly revalidation of nurses and midwives has been approved by the Nursing and Midwifery Council.

Jeremy Hunt offers concesions in the junior doctors’ dispute. He said he is willing to rethink reclassifying 7am to 10pm on Saturday as part of the normal working week, and has said that incentives for going into emergency medicine or general practice will continue.

The number of ambulances not arriving within the target 8 minutes was the highest in August since records began in 2010, with 80,768 missing the target for the most serious calls, according to statistics published for England. [I can’t reconcile the figures in the article with the official statistics so it is possible I have misunderstood something here.]

Antioxidants can help cancers spread, although they do protect healthy cells from the cancer risk caused by free radicals, according to Swedish research on mice, published in Science Translational Medicine.

Only 25% of foster children are continuing in foster care after 18, although they now have the right to stay until 21.  This feature article considers what is happening.

The ‘Hunt Effect’ and other aspects of the current disputes with doctors are explained in this informative article.
(07/10/15) Doctors are collecting examples of patients not going to hospitals at weekends because they believe there won’t be sufficient services because of what Jeremy Hunt has said (only 14 examples so far, but still collecting):

There are 1.55m jobs in adult social care, with the total having increased by 40,000 between 2013 and 2014, according to a report from Skills for Care.  There were about 16,500 social workers in adult social care in 2014, of whom 15,700 were in local authorities.


07 October 2015

Patient confidentiality could be breached by doctors sending patient details on their smartphones, often to get a second opinion, according to research involving 287 doctors and 564 nurses in the Imperial College healthcare NHS trust, published in BMJ Innovations.  It found that 65% of doctors had used SMS messages to communicate with colleagues about a patient.  There would be risks if phones were lost or stolen or messages sent to the wrong number.

A ‘virtual GP practice’ for care home residents is planned in Southend subject to a successful pilot.


06 October 2015

Two thirds of requests for social care by older and disabled people are refused by their council, according to figures in three reports providing adult social care statistics published by HSCIC.  650,000 people received help, out of 1.85m requests.
(14/10/15) Further analysis of the crisis in social care revealed by the figures:
Adult social care survey, England, 2014-15

End of life care in the UK has been ranked the best of 80 countries according to a report by the Economist Intelligence Unit.  The assessments were made on the basis of quality of hospital and hospice environments, number and skills of staff, and affordability and quality of care.  The UK was also top last time the research was done in 2010.  The UK scored well in having specialised staff and a strong hospice movement.

NHS England has said CCGs should not be providing financial incentives to reduce cancer referrals in contradiction of NICE guidelines, and has written to the nine CCGs which were reported by Pulse magazine to have such incentives.

The European Health Interview survey shows women having some more healthy behaviour then men, including eating more fruit and vegetables and smoking less.  It also found more women taking time off sick, but returning to work more quickly when they had been off (it was thought that some of the absences might be for looking after poorly children, but no evidence was gathered on this).  The Eurostat survey was published by ONS and involved interviews with over 13,000 people in Britain and more than 200,000 across Europe.

Presumed consent for organ donation will start in Wales from 1st December. People will be invited to register to donate their organs with the assumption that they consent if they do not register a view.  Experts could make the decision for people without the mental capacity to decide.  Famiily and friends will be consulted but will not have a veto.

Nurses should be added to the list of shortage occupations exempt from new immigration rules, says Simon Stevens, head of NHS England, saying they should not be subject to the rules which say those from outside the European Economic Area earning less than £35,000 p.a. have to be deported after 6 years.  He was speaking to the Institute of Directors.  He also suggested that more could be done to prevent workplace ill-health, including cash incentives to small businesses.
Comments in the same speech on workplace health:

5, 451 new members joined the BMA in the nine days from 26th September, 80% of them junior doctors, in the context of the continuing dispute over the junior doctors’ contract.

A handbook on children’s mental health has been published by the British Psychological Society, titled, ‘What Good Looks Like in Psychological Services for Children, Young People and their Families’.


05 October 2015

George Osborne has announced a partial return of business rates to councils, with the existing transfers to equalise differences between areas remaining, but councils able to keep any growth in income.  There is to be a safety net for councils where business rate receipts fall by 7.5%.  They will also only be able to decrease, not increase business rates, except for elected mayors who will be able to increase them by up to 2p in the pound, if the money is used for infrastructure projects.  Business rates raise about £26bn a year.  Concerns have been expressed that this may increase inequality between areas.
Background information:
Which areas win and which lose:

Face to face contact with family and friends was associated with a reduction in depression for older people, according to resarch on 11,000 people aged over 50 by the University of Michigan published in the Journal of the American Geriatrics Society.  Of those who met up with family and friends at least three times a week, 6.5% had depressive symptoms two years later, while for those meeting up every few months or less, the figure was 11.5%.  Contact by phone or email had no impact on depression.

The new Chief Executive of NHS Improvement is to be Jim Mackey. NHS Improvement is the body created from Monitor and the Trust Development Authority.  Mackey is currently Chief Executive of the Northumbria Healthcare NHS Foundation Trust
(09/10/15) Background on Mackey:

Ten hours moderate exercise a week reduced the risk of heart failure by 35% while the recommended two and a half hours reduced the risk by only 10%, according to a review of 12 studies covering 370,000 people, by the University of Texas published in the journal Circulation.

Brighton and Hove Council is asking local food and drink shops to put a 10p surcharge on sugary soft beverages, with the money going into a children’s health and food education trust.

Prototype equity indicators at CCG level to support the NHS equalities duty have been produced by the Centre for Health Economics (CHE) at the University of York in a policy briefing, ‘How fair is your local NHS?’

Jeremy Hunt says more medical decisions should be left to computers, leaving doctors to make the sorts of judgements they are good at.  He also praised a US hospital for following the production techniques used by Toyota.

The Scottish Parliament’s health committee has questioned the value of targets and the risk of disproportionate spending for small improvements so as to meet a target, when the money could be better spent elsewhere.

A report on the effect of the new health system on public health and obesity, part of the PHOENIX project has been published by PRUComm (the Policy Research Unit in Commissioning and the Healthcare System).  This is the second interim report of the project.


04 October 2015

GPs are to be offered a voluntary contract to provide seven day a week services, the Prime Minister has announced, with the contract to be published in 2017.  They could provide the services by working in networks or federations with other practices. Access to seven day a week GP services is to be included in the government’s mandate to NHS England.
(01/10/14) The proposed new contract is a distraction from more important issues according to Dr Chaand Nagpaul, chair of the BMA’s GP Committee:

An agreement with junior doctors was close to being agreed last year but was then torn up by Jeremy Hunt according to former Tory health minister Dan Poulter, in an article for the Guardian.
Article by Dan Poulter M.P.:

A quarter (27%) of GP appointments could be dealt with in other ways, according to a report based on an audit of 5,128 GP consultations from 56 GPs, and and a survey of 250 practice managers, by the NHS Alliance and the Primary Care Foundation, ‘Making Time in General Practice’.  16% of patients could be treated by others such as pharmacists or nurses, or by social prescribing and more time could be saved with better technology and communications with hospitals.


03 October 2015

The Government have been accused of delaying publication of NHS financial information for political reasons, with a source from Monitor having told the Guardian that they had been leaned on by Whitehall.  It is expected that NHS trusts could have a deficit of £2bn by the end of the financial year.  Financial figures from both Monitor and the Trust Development Authority would normally have been published by now.  Unusually, Monitor’s Board discussed financial and treatment waiting time information in a private rather than public part of its meeting last week.

Hospitals need better leadership rather than more money according to the Chief Inspector of Hospitals, Sir Mike Richards, who acknowledged the financial pressures but noted that some hospitals were coping better than others, in an interview with the Independent on Sunday.

The Government is to prevent councils using procurement or investment decisions to boycot countries or companies which conflict with national policy, such as boycotting products from Israeli settlements in the occupied West Bank (as Leicester City Council did).  This was said to be in response to ‘growing concern’ about the ‘militant actions of leftwing councils’ ‘spurred on’ by the Labour leadership.  This, as the Conservative party conference is about to start, was said [apparently without any sense of irony] to be designed to prevent ‘playground politics’.


02 October 2015

A devolution deal is to be agreed with the Sheffield city region but looks as though it will not include responsibility for health as in Manchester.  Elections for a directly elected mayor could take place in 2017.

Children and young people feeling depressed are more likely to seek help from the internet than a doctor or mental health professional, with 66% saying they would use specialist websites, 50% seek help from a friend, 43% from a parent, 40% from a mental health professional or 40% from a doctor, according to a survey of 526 young people aged 11-25 for the Children’s Commissioner.
Press release:
The report:

An early evaluation of an integration programme involving 8 north west London boroughs and associated CCGs has been published by the Nuffield Trust and the LSE, providing lessons for other areas including on planning, governance and engagement.
(17/12/15) Blog:

A guide to help local organisations measure children’s mental health so as better to be able to help with problems, has been published by Public Health England.
Press release:
The resource:

A review on the prevalence of dementia in the various groups with ‘protected characteristics’ under the equalities act (socio-economic position, race or ethnic group, religion or belief, gender, sexual orientation and disability) is published by Public Health England.  It found some information but for many of the groups the evidence was limited.


01 October 2015

At least 9 CCGs have funding schemes which reward keeping referrals to specialists within target, according to research by Pulse magazine based on responses to foi requests.  This includes cancer referrals for which there is a new two week target.  The General Medical Council investigated one case and said they were concerned but that this was not entirely against guidance.

A third of GPs expect to leave their jobs in the next five years, with 35% expressing a high or considerable intention to quit, according to the University of Manchester’s national GP worklife survey of over 2,600 GPs.  The survey found that stress levels were the highest since the survey was first conducted in 1998 and job satisfaction was the lowest since 2001.  Intention to leave was 13% amongst those under 50 and 61% amongst those aged over 50.

About 15%, or 400,000 people with cancer have struggled to pay bills because of their condition according to a survey of 2,011 adults, weighted by age and gender, by YouGov for Macmillan Cancer Support.  The survey found that 42% of those with cancer were struggling to keep up with household bills and credit payments and 36% of those said they were struggling entirely or partly because of their diagnosis.,000peoplewithcancerstruggletopaybillsbecauseofdiagnosis.aspx

Firefighters are to make ‘Safe and Well’ visits, extending the scope of their existing 670,000 home safety visits already carried out each year, in a new ‘Consensus’ agreed between NHS England, Public Health England, the Fire and Rescue Service, Age UK and the Local Government Association.  They will do such things as spotting falls risks and identifying loneliness and possible dementia. [This was previously announced on 13/9/15]

The rate of increase in the number of adoptions fell last year to 5% from 26% the year before, but the numbers completing the preceding stages fell, by 24% for the number of children granted an adoption placement order and 15% in the number matched with a family for adoption, according to figures from DfE.  The number of looked after children, at 69,540 is now at the highest since 1985.  75% of those taken into care are fostered.  Part of the reason for the change is believed to be some court judgements.
The number of asylum seeking children in care rose by 29%:

People with mild hearing loss are now to be refused free hearing aids by North Staffordshire CCG, with new eligibility criteria making it harder for those with moderate hearing loss to get hearing aids.  The changes will affect about 500 people and save about £200,000 p.a.  The CCG is quoted as saying the changes are not financially driven but are clinically led and follow engagement with local people.  Charities say the changes contradict evidence on the beneifts of hearing aids.

Slough follows Doncaster as the second authority to have its children’s social care services taken from it, as an independent, not-for-profit children’s trust is launched.  The changed was announced last year (15/7/14) after an Ofsted report and further review.

A British e-cigarrette firm is to challenge proposed EU regulations at the European Court of Justice, arguing that they are disproportionate and may stifle an emerging industry.  A judgement is not expected until the new year.

The Royal College of GPs predicts there will be nearly 1m more people living with long term conditions in ten years time, at a cost to the NHS of £1.2bn a year.  Dr Maureen Baker, Chair of the RCGP, in addressing its conference, is to say to Jeremy Hunt that without an injection of support from the Government, not only will they not get a seven day service, they won’t have a five day service either.  She is calling for an addition £750m to GPs’ funding.

A range of health related changes come into effect on 1st October and are listed by the NHS Confederation.

Final year medical students say that letters warning them to be professional and not risk their careers in the junior doctors’ contract dispute have threatening undertones. The Medical Schools Council sent a standard letter to 34 schools, a number of which appear to have used or tailored them.  One email said the school was aware of the discussions on the junior doctors’ contract but said ‘the priority for medical students is to get on with your studies and pass the assessments.’

The ban on smoking in cars with children in comes into force on 1st October. The police say they will take a light touch, non-confrontational approach initially.
New research shows that even with the window open, smoking in the car exposes children to 100 times the safe limit of harmful smoke:

A revised structure chart for Monitor on one page gives a good idea of what the organisation does.

Statistics on sexual identity, smoking and health from the Integrated Household Survey have been published by ONS, showing a fall in the proportion of people smoking from 21.0% to 18.3% between 2010-14, with more men smoking (20.7%) than women (15.9%).

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