2016 Q1 January-March
Health and Wellbeing Policy Update: January – March 2016
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).
31 March 2016
End of life care has improved considerably in the last few years but is still not good enough, according to a report by the Royal College of Physicians, jointly funded by NHS England and the charity Marie Curie. The report, which analysed the care of 9,302 people who died in hospital in England in May 2015, found that many people are not receiving proper palliative care in their last hours, with only 11% of hospitals providing specialist palliative services at all times. In 18% of cases, there was no written evidence that ‘do not resuscitate’ orders had been discussed with relatives or friends.
The RCN call for 24/7 specialist palliative care: http://www.theguardian.com/society/2016/mar/31/nhs-end-of-life-specialist-palliative-care-doctors-call-for-access
The BMA has launched a judicial review against the Government’s contract imposition on the junior doctors on the grounds that it did not carry out an equalities impact assessment. The Government published its assessment on 31st March, the same day as the BMA initiated its legal action. Some changes to the contract are to be made as a result. The assessment says that there are features of the new contract that disproportionately impact on women, some positive and some negative, but that the impacts can be ‘comfortably’ justified so do not constitute discrimination. Female doctors will lose out financially from the new contract according to the presidents of the Royal College of Physicians (Prof Jane Dacre) and the Royal College of Surgeons (Clare Max). The Medical Women’s Federation also said it was disappointed and dismayed by the equality impact assessment.
A new improvement and assessment framework for CCGs has been published by NHS England.
Britons are losing an hour’s sleep a night on average, equivalent to a full night’s sleep every week, with consequent health effects according to a survey of 2,000 adults published in a report by the Royal Society for Public Health. Sleep deprivation is implicated in conditions including cancer, depression and high blood pressure. The RSPH says there should be a national sleep strategy with guidelines (including a ‘slumber number’ of the number of hours sleep different people need) and more public education.
Having the flu vaccine reduced the risk of having a stillbirth by 51% according to an analysis of data from nearly 58,000 births in 2012 and 2013 in research led by the University of Western Australia and published in the journal Clinical Infectious Diseases. They found that stillbirth rates increased after outbreaks of flu and reduced prior to them and women who had recently been vaccinated were less likely to have a stillbirth.
NHS England has promised a crackdown on conflicts of interest with new rules to be drawn up for the health system, according to an NHSE board report.
Multimorbidity care draft guidelines have been published by NICE for consultation. It suggests that GPs should systematically review patients with multiple long-term conditions and develop individualised care plans. The guidance also suggests: stopping treatment of limited benefit; identifying medicines with a higher risk of unwanted side effects; offering treatments other than medicines; and making it easier to attend a range of appointments for different conditions.
Press release: https://www.nice.org.uk/news/press-and-media/nice-tackles-complex-health-issues-for-people-with-multimorbidity
The 2% adult social care council tax precept was levied by 144 of 152 eligible authorities in whole or part, according to DCLG details of council tax levels set by local authorities.
A report on health in urban areas has been published by the WHO, suggesting that there are significant opportunities for improving health outcomes despite continuing health inequalities.
NHS England has published its business plan for 2016-17.
30 March 2016
The number of managers and support staff grew more quickly than the number of doctors and nurses in the year to September 2015, but still saw much bigger falls since 2009, according to figures from the HSCIC which has revised the way the statistics are calculated. The number of managers increased by 6.5% in the year to September 2015, but fell by 21.0% since 2009. There was an increase in the number of professionally qualified clinical staff (including doctors, nurses, midwives, ambulance staff, therapeutic and technical staff) of 1.2% since 2014 and 4.5% since 2009. The total workforce was 69,317 less than originally thought as at September 2015. [The Mail article only gives the changes in the last year, so presents a limited picture.]
(Rgn) The RCN criticises the small growth in the nursing workforce: http://www.nursingtimes.net/7003675.article
NHS staff in Wales: http://gov.wales/statistics-and-research/staff-directly-employed-nhs/?lang=en
Children living in poverty are more likely to be solitary and have problems with friendships according to research by the National Children’s Bureau in partnership with the Joseph Rowntree Foundation.
The ban on ‘legal highs’ will not come into force for at least a month following claims that the current definition of psychoactive substances is not enforceable by the police. The Psychoactive Substances Act was due to have come into force on 6th April.
The 11 most important factors in dying well have been identified in an analysis of 32 previous peer reivewed studies defining a good death, in research led by the University of California San Diego School of Medicine published in the American Journal of Geriatric Psychiatry. The eleven core themes were: “preferences for a specific dying process, pain-free status, religiosity/spirituality, emotional well-being, life completion, treatment preferences, dignity, family, quality of life, relationship with the health care provider and ‘other.'” [source: press release].
The test for prostate cancer should be made available to men from the age of 40 rather than 50 as at present, according to a panel of 335 experts, published by Prostate Cancer UK. The blood test, for prostate-specific antigen (PSA) is not very accurate. That guidance based on a consensus of views of the experts goes beyond the official PHE guidance on the use of the PSA test published on the same day.
Press release from Prostate Cancer UK: http://prostatecanceruk.org/about-us/news-and-views/2016/3/younger-men-should-now-consider-prostate-cancer-test-say-clinicians
The consensus guidance from Prostate Cancer UK: http://prostatecanceruk.org/PSAconsensus
Press release on the new prostate cancer pack for GPs: https://www.gov.uk/government/news/new-improved-prostate-pack-for-gps
(29/03/16) Official summary (2pp) guidance for GPs: https://www.gov.uk/government/publications/prostate-specific-antigen-testing-explanation-and-implementation
(29/03/16) Fuller guidance: https://www.gov.uk/government/publications/prostate-cancer-risk-management-programme-psa-test-benefits-and-risks/prostate-cancer-risk-management-programme-pcrmp-benefits-and-risks-of-psa-testing
A report on the NHS’s approach to its workforce has been published by the Health Foundation. The report, ‘Fit for Purpose?’ provides an overview of the NHS workforce policy in England and makes proposals for how it plans, trains, regulates, pays and supports its people.
The leaders of the Sustainability and Transformation planning in all but 44 of the areas have been announced by NHS England.
29 March 2016
Both sides in the junior doctors’ dispute should ‘step back from the brink’ and re-enter negotiations, with a suspension of the proposed all-out strike and of the imposition of the contract, the Academy of Medical Royal Colleges says. The head of the BMA Junior Doctors’ Committee said, in a tweet, that this was a sensible idea.
Fines on health trusts for missing targets are nonsensical and only add to the deficits they are facing this year, according to NHS Providers. Fines are expected to be about £600m this year which is almost a quarter of the expected £2.8bn deficit by health service providers in England. The rules on fines changed at the start of 2015-16 and CCGs can no longer waive fines and can also no longer reinvest the proceeds with the providers but must retain them to set against their year end financial position.
Safe discharge from hospitals at the weekend needs enough community nurses according to a report on the hospital discharge process published by the Queen’s Nursing Institute. It said that discharge planning should begin on or soon after patient admission. There is also a need for good communication and collaboration between the hospital and community teams. A named nurse or key worker from the community should be responsible for co-ordinating the person’s care.
28 March 2016
The Government will fail to recruit and retain the 5,000 extra GPs by 2020 that it promised before the last election, according to a calculation by Pulse Magazine, which estimates that it will increase the workforce by 2,100 on a best case scenario. The magazine also accuses the Health Secretary of changing the target, with the Government now saying the 5,000 includes doctors in training.
Further comment: http://www.pulsetoday.co.uk/your-practice/practice-topics/employment/why-hunts-pre-election-promise-of-5000-new-gps-is-a-long-way-off/20031461.article
Detailed breakdown of the figures: http://www.pulsetoday.co.uk/your-practice/practice-topics/employment/the-numbers-how-the-dh-is-falling-short-of-its-2020-gp-target/20031459.article
27 March 2016
A draft cycling and walking investment strategy has been published for consultation by the Department for Transport. It proposes an investment of £316m in this Parliament, but this includes already announced money, such as the £101m still to be spent from the Cycle Ambition Cities programme which is supporting eight cities. Although the aim is to make cycling and walking the natural choice for shorter journeys, the target date for this is 2040. Although there is an aim to double cycling trips by 2025, according to cycling charity CTC, when population growth is taken into account this would mean an increase from 2% to 3.5% of trips outside London, compared to 19% of trips in in Denmark and 27% in the Netherlands. Although it recognises that it will require local bodies, businesses, communities and individuals to make it work, the draft strategy is published solely by the DfT. The consultation closes on 23rd May 2016.
CTC blog: http://www.ctc.org.uk/blog/roger-geffen/cycling-walking-investment-strategy-woefully-little-investment
Rapid evidence review of the economic benefits of cycling: https://www.gov.uk/government/publications/the-value-of-cycling-rapid-evidence-review-of-the-economic-benefits-of-cycling
Study into the creation of a tool to predict cycling levels in local authority areas: https://www.gov.uk/government/publications/national-propensity-to-cycle-first-phase-development-study
Framework for establishing a relationship between cycling investment and local impacts: https://www.gov.uk/government/publications/cycling-infrastructure-framework-for-evaluating-economic-and-social-impacts
Press release: https://www.gov.uk/government/news/transport-minister-robert-goodwill-calls-for-an-increase-in-cycling-and-walking
The draft strategy: https://www.gov.uk/government/consultations/draft-cycling-and-walking-investment-strategy
26 March 2016
More low alcohol and alcohol-free drink are needed to combat the health problems caused by excessive drinking, according to the LGA, which says the government should reduce the duty on lower strength beers, ciders, wines and spirits. Unusually for such announcements, the proposals were welcomed by industry bodies such as the Portman Group and the British Beer and Pub Association.
Leaving the EU would put the NHS under threat, with budget cuts, falling standards and the departure of doctors and nurses from overseas, according to Jeremy Hunt, writing in the Observer. He says that the adverse impact on the economy would mean there was not sufficient funding for the NHS.
24 March 2016
Disabled people are being failed by the Government according to a report by the House of Lords select committee on the Equality Act and Disability. The committee found that some parts of the Act are not being properly adhered to, some provisions, such as the requirement that taxis take wheelchairs, have not yet been implemented, and some provisions have been repealed to reduce the burden on business. As a result, there are problems with access to transport, public buildings, sports stadia, pubs and restaurants. Increased fees for discrimination tribunals had led to a fall since their introduction in 2003. Disabled people, the report says, are only an afterthought for the government.
Feature article: http://www.theguardian.com/commentisfree/2016/mar/23/life-wheelchair-disabled-people-equal-rights
The NHS’s shortage of nurses is due to the Government’s desire to save money according to a report from the Migration Advisory Committee, which reluctantly agreed that nursing should remain on the shortage occupation list, with a cap of 3,000-5,000 to be allowed from non-EEA countries in the next four years. It said that the nurse shortage was down to factors that could and should have been anticipated by DH and related bodies. It estimated that the current vacancy rate for nurses was 9.4%. It said that Health Education England had wanted to commission 3,000 training places in 2016-17 but funding constraints meant it only commissioned 331. Non-EU nurses are paid £6,000 less than UK nurses.
‘Bosses accused of using cheap labour to ‘undercut’British staff’: http://www.dailymail.co.uk/news/article-3508810/NHS-signs-foreign-nurses-Bosses-accused-using-cheap-labour-undercut-British-staff-plans-recruit-14-000-medics-four-years.html
The Government’s dispute with the junior doctors has derailed the move towards a ‘seven day’ NHS according to Prof Sir Bruce Keogh, Medical Director of NHS England, talking to doctors and medical students at King’s College London. An advocate of ‘seven day services’ he said it became derailed when it was linked to the junior doctors. There was a need instead for a focus on the availability of senior doctors. He said the imposition of the contract was one of the saddest days he had seen in the NHS.
Levels of ‘flu are at the highest levels for five years according to Public Health England. More than 320 people have been admitted to hospital in the last two weeks, which is four times the normal figure.
Lower back pain should not be treated with acupuncture but by stretching, yoga and aerobics, according to draft NICE guidance now out for consultation. Acupuncture has been removed from the list of recommended treatments because there is not enough evidence that it is better than a placebo response from sham treatments. About 40% of working age UK adults suffer from the condition with treatment costs of £1bn a year and lost earnings costing £12bn. The final version of the guidance is due to be published in September 2016.
The ‘national living wage’ will push care services to breaking point the LGA has said. They say that the new minimum wage will increase costs by about £330m, which will swallow up most of the £372m they say will come from the 2% social care precept.
LGA press release: http://www.local.gov.uk/web/guest/media-releases/-/journal_content/56/10180/7763990/NEWS
The Frontline fast-track children’s social work training scheme has received a mostly positive judgement in an evaluation by Cardiff University. The scheme is producing highly skilled practitioners, but it is not clear if that is because of the nature of the programme or the selective nature of the recruitment. Questions remain about the durability those who qualify. A separate report on costs says that the unit costs are much higher than traditional courses but it is cheaper in terms of the total cost to the economy because the course does not take so long.
Initial child protection (S.47) enquiries rose by 12% in 2014-15 compared to the previous year, while the number of initial child protection conferences rose by nearly 10% according to DfE statistics.
The number of looked after children getting at least five GCSEs increased slightly, from 12% to 14% between 2013-14 and 2014-15, according to figures from the DfE. That compares to 53% of all children obtaining those grades.
23 March 2016
An all out strike by junior doctors, including withdrawal from emergency cover, has been announced, the first such strike in the NHS’s history. The 48 hour strike is to take place on 26th and 27th April. Emergency cover will be provided by other clinical staff. Another 48 hour strike, on April 6th will be non-emergency cover only.
Britons are healthier, better off, less likely to be victims of crime and living greener lives since the recession, according to a wellbeing assessment by ONS. There had been improvements in 17 of the measures considered, a deterioration in 8 and no change in 11. Most of the improvements were in objective measures such as personal finances and the employment rate, while deterioration was more often in subjective measures such as satisfaction with health. In terms of longer term sustainability, human capital is still below levels of before the financial crisis and natural capital shows a long term decline.
The prescription of antibiotics in primary care fell by 5.3% from 2014 to 2015, a fall of 2.2m prescriptions, according to NHS England. This follows the introduction of financial incentives for reducing antibiotic prescription.
Care workers are not being paid the minimum wage in many areas with 75% of councils in England and 90% in Wales not including a requirement in contracts that care providers should pay for time when travelling between appointments, according to foi responses received by Unison from 150 councils in England and Wales.
Survival rates improved for 7 of the 8 most common cancers, for both 1 and 5 year survival, between 2005 and 2009, according to figures from ONS. There were wide differences in survival rates between the 25 NHS Area Team areas in England, with a range of 10% or more (i.e. 10 percentage points difference).
Many fruit juices, smoothies and fruit drinks have ‘unacceptably high’ levels of sugar according to research led by the University of Liverpool and published in BMJ Open. The researchers analysed 203 such drinks stocked by seven major supermarkets and found 42% contained the maximum daily recommended limit for a child, 19g or nearly 5 teaspoons.
Making all schools academies could weaken child safeguarding according to the Association of Directors of Social Services. They note ‘the crucial link’ between social care and education and say that local authorities need to be able to support and challenge schools to ensure appropriate help and support is provided to all pupils, especially the most vulnerable children.
Maternity care is subject to wide variation across England according to a report from the Royal College of Obstetricians and Gynaecologists, produced in collaboration with the London School of Hygiene and Tropical Medicine. One finding is that many mothers are having their babies by caesarean section before 39 weeks, even though that is risky for the child, with this being the case for more than 40% of women giving birth in some hospitals. Variations in services included the proportion of emergency caesarian sections which varied from 8% to 15% between trusts.
Press release: https://www.rcog.org.uk/en/news/rcog-press-release-report-highlights-variation-in-maternity-care-across-england/
The ‘Mutuals in Health Pathfinder Programme’ final report has been published by DH and the Cabinet Office. The report summarises the findings from the programme, whose aims were to explore how a mutual model could increase staff engagement.
This year’s NHS national tariff payment system has been published by Monitor and NHS England.
The PHE Bulletin has been published by Public Health England.
22 March 2016
A&E waiting times in Wales were 77.2% waiting less than four hours in February down from 78.5% in January, compared to the 95% target. There was the highest number of attendances in A&E in February since records began in 2006.
Daily salt consumption by adults in England has fallen by nearly a gram in the last decade but at 8g it is still above the recommended 6g a day according to data from PHE based on measurements from a random sample of 689 adults. Intake has fallen by 11% since 2005-06.
Press release: https://www.gov.uk/government/news/new-phe-data-on-salt-consumption-levels
Guidance on mid-life approaches to reducing dementia has been launched by Public Health England.
(21/03/16) Article by PHE’s Prof Kevin Fenton: http://www.theguardian.com/skills-for-health-partner-zone/2016/mar/21/tackling-dementia-whats-good-heart-good-for-brain
Press release: https://www.gov.uk/government/news/health-matters-promotes-midlife-approaches-to-reduce-dementia-risk
The guidance: https://www.gov.uk/government/publications/health-matters-midlife-approaches-to-reduce-dementia-risk/health-matters-midlife-approaches-to-reduce-dementia-risk
People in England at risk of Type 2 diabetes are to be offered a support programme involving exercise, education and lifestyle changes. The programme, to be launched in the spring, will initially be available in 27 areas with the aim of helping 20,000 people this year at a cost of £7m. There are to be 100,000 places available by 2020. There are currently 2.6m people with type 2 diabetes in England with a further 200,000 new diagnoses each year.
(24/03/16) Only a fifth of patients attended the lifestyle programme in one of the pilot areas: http://www.pulsetoday.co.uk/clinical/more-clinical-areas/diabetes/four-out-of-five-patients-rejected-lifestyle-programme-in-diabetes-prevention-pilot/20031449.article
70% of council websites do not provide all the information required by the Care Act and 23% did not have up to date information on assessments and eligibility, according to a review of all websites conducted in July 2015 commissioned by Independent Age.
A report on how people can take a more active role in their own health and care has been published by the Behavioural Insights Team. The report, “Making the change: Behavioural factors in person- and community-centred approaches for health and wellbeing” identifies five supportive factors: building self-efficacy and ‘grit’; removing small barriers to healthy behaviour; strengthening social connections; tapping into intrinsic motivation; and goal setting and feedback.
A report on how the NHS can be galvanised to adopt innovation has been published as part of the Accelerated Access Review. The review was commissioned from RAND Europe by DH, the Wellcome Trust and NHS England.
A review of research on ‘What Works to Enhance Inter-parental Relationships and Improve Outcomes for Children’ has been published by DWP.
Greater social media use was associated with higher likelihood of depression according to research from the University of Pittsburgh School of Medicine, to be published in the journal Depression and Anxiety. The research was based on a representative sample of 1,787 US adults aged 19 to 32 and asked about their use of the 11 social media platforms most popular at the time. There was a linear association between social media use and depression with the heaviest users being 2.7 times more likely to be depressed than those who checked their accounts least frequently. Causation could not be demonstrated and the researchers suggest there could be two way causation, suggesting there could be a vicious downard cycle.
Mindfulness and CBT were better at relieving chronic lower back pain than usual care according to U.S. research published in the Journal of the American Medical Association. The research involved 342 people with chronic back pain, aged 20-70. They were randomised into three groups: mindfulness-based stress reduction (MBSR); cognitive behavioural therapy (CBT); or usual care. After six months, 61% of those receiving MBSR and 58% CBT showed improvements in their ‘functional limitations’ compared to 44% from the usual care group. Improvements in self-reported pain ‘bothersomeness’ were 44% for the MBSR group, 45% for CBT and 27% for usual care.
Previous studies showing that moderate alcohol consumption has health benefits are flawed according to a Canadian review of 87 previous studies published in the Journal of Studies on Alcohol and Drugs. The researchers said that many previous studies were poorly designed and also noted that those abstaining completely were sometimes doing so because of ill health, which would distort the results.
21 March 2016
The Government may fail to train and retain 5,000 extra GPs by 2020 as promised before the last election, according to health minister Lord Prior, speaking in a House of Lord debate. He said there was a risk whether they would be able to get that number of people into general practice and without it, it would be difficult to deliver their ambitions.
The cuts to personal independent payments announced in the budget last week are to be dropped, the new DWP Secretary of State, Stephen Crabb is to announce to the House of Commons.
143 out of 154, that is 93% of hospital trusts are at over 85% bed capacity, thought to represent a safety limit, according to figures obtained by Labour. A third have run out of beds at least once this winter.
A vegetarian or vegan diet would save lives and cut greenhouse gas emissions according to research led from Oxford University which modelled the global impact of four scenarios, published in Proceedings of National Academy of Sciences. The four scenarios were: current trajectory; following advice on the minimum recommended levels of fruit and vegetables; limiting intake of red meat, sugar and total calories; and adopting vegetarian and vegan diets. A vegan diet would save 8.1m lives by 2050, a vegetarian diet would save 7.3m and following minimum global dietary guidelines would save 5.1m. Food related emissions make up half of those that can be afforded to keep within a 2 degree temperature rise. A vegan diet would reduce such emissions by 70%, a vegetarian diet by 63% and following global dietary guidelines would cut them by 29%.
The BMA says Government funding for the NHS in England will only increase by £4.5bn p.a. by 2020-21, compared to the current financial year, compared to the £10bn the Government claims is being added. The claim is based on previous analysis by the King’s Fund, the Nuffield Trust and the Health Foundation, which identified that while NHS England’s budget would rise by £7.6bn, the Department of Health’s budget as a whole (which has been used in the past as the unit for health spending) would only rise by £4.5bn, meaning that money is being cut from things like training and education, NICE and the CQC to fund extra for NHS delivery.
Advice designed to reduce the number of stillbirths has been published by NHS England. It is aimed at both healthcare professionals and the parents to be. It is based round four key interventions: reduce smoking in pregnancy; improve detection of limited fetal growth; improve awareness of the importance of fetal movement; and improve fetal monitoring during labour.
20 March 2016
The Government has cut the capital budget of the NHS in England by £1.1bn in the coming year, from £4.8bn to £3.7bn, transferring the money to revenue to go towards projected deficits. Outstanding maintenance work in hospitals is estimated to be £4.3bn, including £458m of ‘high risk’ repairs which, if not done, could threaten patient safety. The change was revealed in an analysis by the House of Commons Library for Labour.
The Government pressured NHS England to reduce its estimates of how much money the NHS would need in its Five Year Forward View, according to a new book by David Laws, who was a Lib Dem cabinet minister. Both Downing Street and NHS England deny that Simon Stevens was leant on. NHS England reiterates its view that between £8bn and £21bn extra in real terms per year would be required by 2020.
Levels of heavy drinking increased following the extension of licensing hours in England and Wales, which led to worse physical and mental health in those concerned, according to research from Lancaster University due to be presented at the Royal Economics Society annual conference. The changes to licensing hours had little impact on normal drinkers. The research involved mapping the number of extended hours licences granted for each region and then used survey data on the number of drinks consumed on the heaviest drinkingday. Extended hours led to a 36% increase in the number of drinkers consuming 12 or more units of alcohol. Survey data then found an association between heavy drinking and self-reported physical and mental health problems.
Payments to victims of a blood contamination scandal could be reduced according to letters from the Department of Health. The changes, which could cap payments at £15,000 and end index linking, affect about 5,000 people infected with HIV and/or hepatitis C in the 1970s and 1980s. Financial support has been increased to victims in Scotland, however there is criticism from lawyers there that not enough has been to trace victims.
18 March 2016
Extra pension payments by NHS employers will cost £650m a year from 2019, as public sector employers have to pay more to pensions, following confirmation of changes in the budget, according to figures from the House of Commons Library publicised by the Liberal Democrats. Overall the changes will save the Treasury about £2bn a year.
The BMA is to step up its action over the junior doctors’ dispute but it has not yet specified what this will be.
People with autism die on average 16 years younger than the general population according to a Swedish study analysing the records of 27,000 autistic people compared to a control sample of 2.7m members of the general population, and published in the British Journal of Psychiatry. The study was highlighted by the charity Autistica, which is trying to raise £10m for more research into the condition, in a report ‘Personal Tragedies, Public Crisis’. It also says that autism costs the UK economy £32bn a year. Suicide and epilepsy are the most common causes of early death but it is thought that bullying, social issues and the side effects of medication could be contributing factors.
Locating physiotherapists in GP surgeries could save the average practice £2,500 a week according to the Chartered Society of Physiotherapy. A three month pilot has been conducted in West Cheshire in which 700 patients were seen by a physiotherapist rather than a GP. It is thought that up to 30% of GP appointments are for musculo-skeletal conditions.
The Chief Social Worker for Adults’ annual report has been published by the DH. Amongst other things, the Chief Social Worker for Adults, Lyn Romeo, said the NHS should recognise the value of social workers and employ more of them.
17 March 2016
An ‘Eatwell Guide’ replacing the ‘Eatwell Plate’ has been published by Public Health England. The guide has been updated in the light of recent recommendations from the Scientific Advisory Committee on Nutrition. The new guidance increases the recommended proportion of bread, rice, potatoes, pasta and other starchy carbohydrates from 33% to 37%, increases fruit and vegetables from 33% to 39% and reduces milke and dairy from 15% to 8%, and foods high in fat or sugar from 8% to 3%.
(News item but sniping at it as being ‘nanny state intervention’): http://www.dailymail.co.uk/health/article-3496574/What-eating-day-according-Government-Two-slices-toast-jacket-potato-plenty-fruit-veg-t-rely-smoothies.html
Press release: https://www.gov.uk/government/news/new-eatwell-guide-illustrates-a-healthy-balanced-diet
The Government has offered no evidence to justify its decision to set up a social work-specific body by 2020, taking the responsibilities away from the existing Health and Care Professions Council, according to the latter’s Chief Executive, Marc Seale.
Commuters who walk, cycle or use public transport to get to work weigh less than those who drive according to research from the London School of Hygiene and Tropical Medicine on 150,000 UK adults aged 40-69, who were weighed and measured and completed a survey about their typical journey to work, published in the Lancet Diabetes and Endocrinology. The benefit remained even after allowing for differences in leisure time, exercise, diet and occupation.
Councils should be given powers to ban junk food advertising near schools, nurseries and children’s centres, the LGA says, to support their efforts to tackle obesity in children. Cllr Richrd Kemp, Deputy Chair of the LGA’s Community Wellbeing Board, speaking at its Healthy Weight, Healthy Futures Conference, also said that overweight children should have separate exercise classes to let them exercise without embarrassment. Case studies of how councils have been addressing childhood obesity are contained in a new publication from the LGA, ‘Healthy Weight, Healthy Futures’.
Press release: http://www.local.gov.uk/web/guest/health-wellbeing-and-adult-social-care/-/journal_content/56/10180/7746761/NEWS
A 15 year NHS plan is needed to transfer money from hospitals to communities according to a report from the NLGN, ‘Get Well Soon: Reimagining Place-Based Health’.
The Government is to review all its major contracts with Atos in the light of a Public Accounts Committee report in January which accused the company of taking ‘advantage of a weak client’ in its charging for the GP extraction service that automatically takes data from GP IT systems.
More needs to be done to retain social workers rather than just attracting new people to the profession, in the Government’s social work reforms, according to evidence from the LGA to the Education Select Committee’s enquiry into the reforms.
There is little existing evidence that sit-stand desks benefit health according to a Cochrane review of 20 previous studies involving 2,174 participants in the US, UK and rest of Europe. However, many of the studies were deemed of poor quality and it suggested that more research is necessary.
16 March 2016
* There is to be a levy on sugary drinks [see also separate item, 16/3/16.]
* Changes to pension arrangements are likely to cost the NHS £650m a year from 2019 [see separate item, 18/3/16]
* There is to be a 3% increase in the tax on cigarettes but no change to that on beer, cider, whisky or other spirits.
* Cuts to disabled people will result from changes to the way PIP is calculated [see also separate items on this].
* £115m is to be made available to tackle homelessness and rough sleeping.
* There are to be cuts in business rates for small businesses … just after they have said local authorities can retain business rates.
* There were new devolution deals for East Anglia, the west of England and Greater Lincolnshire in England as well as for Cardiff and Edinburgh and south east Scotland.
* All schools are to become academies, taken out of local authority control.
* The changes in the budget will benefit those on higher rather than middle or lower incomes according to an analysis by Liverpool Economics.
* The OBR says that a weaker than expected economy had left a £56bn hole in the public finances over the next five years.
Budget summary: http://www.bbc.co.uk/news/uk-politics-35813973
The levy on sugary drinks. http://www.bbc.co.uk/news/health-35824071
£56bn hole in the public finances and impact by income level: http://www.theguardian.com/uk-news/2016/mar/16/budget-2016-osbornes-giveaways-mask-56bn-black-hole
The sugar tax, £55m black hole in public finances and summary of other measures: http://www.independent.co.uk/news/uk/politics/budget-2016-george-osborne-sugar-tax-black-hole-economic-gloom-forecast-public-finances-a6935161.html
What the budget means for local government: http://www.theguardian.com/public-leaders-network/2016/mar/16/local-government-budget-2016-devolution-academies
Housing, including £115m funding to tackle homelessness. http://www.theguardian.com/housing-network/2016/mar/16/housing-budget-2016-disappointing-planning
Charities welcome the money on homelessness but say more needs to be done to tackle underlying causes: http://www.theguardian.com/society/2016/mar/16/homeless-crisis-budget-charities
(Rgn) Money from banking fines is to go to children’s hospitals: http://www.nursingtimes.net/7003324.article
(18/03/16) Analysis. It is not clear where savings will come from so more cuts will be required in 2018. http://www.theguardian.com/public-leaders-network/2016/mar/18/george-osborne-cuts-public-sector-2018-budget
The budget documents in full: https://www.gov.uk/government/publications/budget-2016-documents
Tory backbenchers are calling for a rethink on the disability benefits changes in the way in which Personal Independent Payments are calculated which could lose them a total of £1.2bn a year. Iain Duncan Smith, who had written to MPs explaining the changes, would listen carefully to concerns raised in a consultation. Two MPs have been asked to step down as patrons of local disability charities and one from a national charity (Kit Malthouse from the MS Society). David Cameron says the Government will consult with disability charities over the proposed cuts. Iain Duncan Smith resigns. His replacement, Stephen Crabb says the cuts won’t go ahead.
(18/03/16) Cameron says there will be consultation with disability charities: http://www.theguardian.com/society/2016/mar/18/budget-disability-benefits-cut-just-a-suggestion-nicky-morgan
(18/03/16) The Treasury signals that the cuts may be ‘kicked into the long grass’: http://www.theguardian.com/society/2016/mar/18/treasury-in-retreat-over-disability-benefits-cuts
(19/03/16) Iain Duncan Smith resigns: http://www.bbc.co.uk/news/uk-politics-35848687
(19/03/16) The new DWP Secretary of State, Stephen Crabb, says the cuts will not go ahead: http://www.theguardian.com/society/2016/mar/19/labour-urges-new-work-and-pensions-secretary-to-reverse-disability-beneift-cut
A soft drinks levy, or ‘sugar tax’ was announced in the budget. The details are not yet clear, but it will start in April 2018 and it is likely to have two bands, one for drinks products with at least 5g of sugar per 100ml and a higher rate for those with more than 8g per 100ml. It will not apply to milk or fruit juices. It is expected to raise £520m which in England is to be used to boost school sports, provide breakfast clubs and extend the school day, with the devolved administrations being able to choose how they use it.
(17/03/16) Drinks makers hit back at the plan: http://www.theguardian.com/business/2016/mar/17/coca-cola-hits-back-at-sugar-tax-plan
(18/03/16) Blog from the Behavioural Insights team on how it is likely to affect behaviour (mostly principles rather than specific modelling): http://www.behaviouralinsights.co.uk/health/behaviour-change-and-the-new-sugar-tax/
(18/03/16) It could unfairly impact on those with Type 1 diabetes who use such drinks to manage their blood sugar levels: http://www.bbc.co.uk/news/uk-35831139
(19/03/16) Experts suggest the tax should be extended to other sugary products: http://www.theguardian.com/society/2016/mar/19/extend-sugar-tax-to-biscuits-and-cereals-says-government-adviser
A public health bill in Wales which would have included a ban on e-cigarettes has been defeated following a jibe by a Labour minister against Plaid Cymru, calling a previous deal between the parties ‘a cheap date’. As a result the vote was tied 26-26 with the Presiding Officer being required to vote against the legislation.
There was a 60% increase in bed days lost awaiting a care package at home between 2014 and 2015, according to Age UK. The nearly 3m bed days lost due to a lack of social care provision between June 2010 and January 2016 has cost £910m.
The BMA is to hold an extraordinary conference to discuss the deepening NHS crisis, on 3rd May. It was said that the conference will attempt to come up with solutions, challenging politicians to rescue the NHS from collapse.
The LGA’s latest Care Act Stocktake showed responses to adult safeguarding cases doubled in the first six months of the Care Act, although the reasons for this are not certain. The Act introduced a statutory threshold for starting safeguarding enquiries. It may be that the growth was because of increased reporting, greater awareness of the need for safeguarding interventions or that the Care Act’s statutory threshold may be greater than local definitions previously used by councils.
The stocktakes: http://www.local.gov.uk/care-support-reform/-/journal_content/56/10180/6341378/ARTICLE
43% of women who stop smoking in pregnancy start again within six months of the birth according to an analysis of previous trials involving almost 1,000 women internationally who had participated in smoking cessation courses between 1989 and 2014. The research was published in the journal Addiction. 13% of women who enrolled on stop-smoking courses quit initially.
Genetic testing results warning people of the conditions they risk getting does not lead them to change their behaviour or lifestyle even if it would reduce the risk getting such things as cancer or dementia, according to research from Cambridge and Manchester Universities and Imperial College, analysing 18 previous studies involving more than 6,000 people and published in the BMJ.
Draft NICE guidance on the transition between inpatient mental health and community care has been published, which proposes that every mental health patient should have a ‘named practitioner’ to help the transition, liaising with services, keeping family, friends and carers up to date and ensuring discharge and recovery plans are regularly reviewed.
15 March 2016
A report on environment related deaths globally has been published by the WHO, titled, “Preventing disease through healthy environments: a global assessment of the burden of disease from environmental risks”. It estimates that nearly a quarter of deaths are attributable to environmental risk factors such as air and water pollution, chemical exposures, climate change and ultraviolet radiation.
The 44 ‘footprint areas’ which will draw up Sustainability and Transformation Plans have been announced by NHS England, along with some of those who will lead the work in each area. The five year plans for health and care, need to show how the Five Year Forward View aims of improved health and wellbeing, transformed quality of care delivery and sustainable finances, can be met across the health and care system. They will be the means for applying for the Sustainability Transformation Fund, worth £2.1bn in 2016-17, £2.9bn in 2017-18 and £3.4bn in 2020-21. The areas have an average population of 1.2m covering 4.8 CCGs. A number of the areas cover existing large counties. Some span boundaries (e.g. one CCG, Cumbria, is split into two areas; the area for Lincolnshire is different than that of the combined authority which has just been announced; Berkshire is split into two areas despite having a community and mental health trust covering the whole county). Information about governance and priorities is to be submitted by 15th April with final submissions by the end of June.
The Government has not done enough to save the NHS from a funding black hole with long term damage having been done by unrealistic savings targets, the Public Accounts Committee says. It says that the Government has not acted quickly enough to keep acute hospital trusts in financial balance and there is not yet a convincing plan for closing the £22bn p.a. gap that is to be met by efficiency savings. Trust finances have significantly worsened in the last three years. It says that the data used to estimate trusts’ potential cost savings targets is ‘seriously flawed’. More should be done to control agency staff costs but also to address deep-rooted problems with NHS workforce planning.
40% of consultant posts remain unfilled according to an annual audit by the Royal College of Physicians. The RCP President, Prof Jane Dacre, is to tell the College’s annual conference that the extent of vacancies puts the Government’s plans for a ‘seven day NHS’ at risk. The NHS is facing a ‘gathering storm’ because of staff pressures, financial problems, disillusioned junior doctors and a continuing rise in the number of patients admitted as emergencies.
The Government has said it will pass a law to limit carbon emissions to zero, enshrining the commitments made in Paris in December, in statute. However, they have already made a number of policy changes likely to increase emissions in relation to nuclear energy, carbon capture and renewables.
Police have been unable to enforce the ban on smoking in cars because police can stop cars but not issue fines while local authority enforcement officers can issue fines but not stop cars, according to the Chartered Institute of Environmental Health. According to BBC freedom of information requests, to which 39 of 44 police forces responded, there have been no fines or court summons in the first three months of the law, and only six warnings. The Police Federation is quoted as saying there is no physical ticket that can be issued to enforce the law.
Antibiotics have become ineffective in about half of cases of urinary tract infections in children and antibiotic resistance in children treated with commonly used antibiotics can persist for up to six months, according to an analysis of 58 previous studies involving 77,783 cases of UTIs in 26 countries, published in the BMJ.
The WHO has published the Health Behaviour in School-aged Children study based on responses from nearly 220,000 children aged 11, 13 and 15 from 42 countries in Europe and North America in 2013-14. It found that British teenagers are amongst the least satisfied with their lives with 15 year old girls feeling particularly stressed. Across all countries, the number of teenagers who smoke fell from 24% to 17% in five years and the proportion of those drinking once a week fell from 21% to 13%; One in four 15 year old girls is on a diet or taking action to lose weight. Only 25% of 11 year olds and 16% of 15 year olds met current physical activity guidelines. Girls reported poorer mental health than boys.
Mothers who are overweight in pregnancy are likely to have heavier babies according to research led by Bristol and Exeter Universities using data on 30,000 healthy women and their babies from 18 previous studies, published in the journal JAMA. High blood sugar and low blood pressure also increase the chances of a heavier baby. Higher blood pressure leads to smaller babies but the mother’s blood lipids do not seem to have any influence.
Quitting smoking is more successful when stopping abruptly rather than gradually according to a randomised controlled trial of 697 UK smokers, funded by the British Heart Foundation, led from Oxford University and published in the Annals of Internal Medicine. After six months, 15.5% of the participants in the gradual-cessation group were abstinent compared with 22% in the abrupt-cessation group. People generally preferred the idea of quitting gradually but were still more likely to quit in the ‘abrupt’ group. However, the report author said it is still better to try and cut down than do nothing at all.
Jeremy Hunt says the NHS should not focus only on nurse numbers as the only way to improve patient safety but it should look at how it could make better use of nurses’ time, in an interview with Nursing Times. He said that the quality of care also depended on how well supported staff were, their training and how much time they could spend with patients.
A quarter (24%) of elderly patients had superbugs on their hands when they were transferred to care homes, in research on 357 patients by the University of Michigan. Even more patients then acquired the multidrug resistant organisms in the subsequent weeks. The researchers said there is a need for more education of patients on hand washing.
The Child Health Profiles for 2016 have been published by Public Health England, providing data on 32 indicators by local authority and CCG area for England.
Press release: https://www.gov.uk/government/news/child-health-profiles-2016-published-by-public-health-england
The profiles: http://www.chimat.org.uk/profiles
14 March 2016
Brain tumour patients have been failed for decades according to Parliament’s Petitions Committee. It criticised the Government for providing inadequate funding for research. Brain tumours are the biggest cancer killers of people under 40.
Advertising of junk food to children on-line could be banned according to the Advertising Standards Authority, with a consultation to be launched soon by the Committee of Advertising Practice. There is already a ban for such advertising on television.
Tai Chi was found to reduce the risk of falling in older people in a Taiwanese trial involved 368 people aged over 60 who had received treatment for a fall, published in the Journal of the American Geriatrics Society. They were randomly allocated to two groups, one of which received Tai Chi classes for 24 weeks and the other 24 weeks of lower extremity training (LET) with sessions including stretching, muscle strengthening and balance training, in both cases with further practice at home. A year after undertaking the training, the Tai Chi group were 50% less likely to experience an injury-causing fall.
Teenagers with strong connections to family, classmates and friends were less likely to smoke, binge drink or smoke marijuana according to a study of 1,000 high school students aged 13 to 17, by a team from the University of Dundee published in the British Journal of Developmental Psychology. The difference between those identifying with all three groups and those with zero identification was 24.1% to 8.8% for smoking, 41.6% to 25.6 for binge drinking and 13% to 2.7% for cannabis.
There have been changes to the Care Act Guidance which clarify the role of principal social workers, saying they should be given “the credibility, authority and capacity to provide effective leadership and challenge, both at managerial and practitioner level”.
A report on end of life care has been published by the BMA, suggesting that clinical judgement is required to determine what is best for the individual, which may mean resisting family wishes for continued treatment.
13 March 2016
Judicial review into the imposition of the junior doctors’ contract is being progressed by a group of doctors and patients who have instructed solicitors to investigate proceedings. The grounds would be patient safety and the stability of the NHS [different from that in the BMA’s case which is around the lack of an equality impact statement]. It is hoped to raise the funding for the proceedings through crowd funding.
The delayed housing allowance cap and 1% reduction in social housing rents could lead to thousands of people evicted from hostels and supported housing if they go ahead, the St Mungo’s charity is to tell an MPs’ inquiry.
12 March 2016
Cuts to disability benefits could mean 500,000 people losing £150 a week according to charities responding to a Government announcement. The changes will reduce the ‘points’, which are added up to qualify for funding for the Personal Independence Payments, for those with toilet needs and who struggle to dress themselves and could cut more than £1.2bn from the welfare bill. 640,000 people could be affected by the change by 2020.
Cuts to social care are putting pressure on the NHS according to a letter to the Chancellor from 14 doctors’ leaders, including the heads of various royal colleges, asking him to increase spending on it in the budget.
11 March 2016
The Government must do more to encourage and support whistleblowers to come forward, the Public Accounts Committee says. It says it is disappointed with the lack of urgency in addressing the issue since its previous report in August 2014, with more needed to help change culture. It was concerned that the Cabinet Office didn’t know which departments were doing well and which were lagging behind. A ‘task and finish’ group to look at whistleblowing across Whitehall had met only once.
(14/03/16) (Rgn) http://www.nursingtimes.net/7003193.article
Payments to hospitals will be linked to staff health improvements in the latest changes to the CQUIN scheme.
Dental charges in England are to be increased by 5% this year and next the Government has announced. The increases do not go to dentists. The parliamentary written statement announcing the changes linked it with the need for the NHS in England to find £30bn p.a. more by 2020.
A report on getting more diasbled people into work has been published by the social market foundation. In it, the author, government adviser Matthew Oakley proposes that the current fit-for-work tests should be abandoned and benefit sanctions scrapped for people with chronic illness or disability.
Family-based counselling was found to increase physical activity and children’s diets in a Finnish study looking at the effects on 500 children aged 6-8 over a two year period, and published in the journal Preventive Medicine.
A financial improvement programme for NHS trusts has been launched by Monitor and the TDA, offering on-site ‘improvement expertise’, help with developing a longer term savings plan and a package of NHS peer learning.
A report on the public health workforce has been published by the Centre for Workforce Intelligence. It was commissioned by DH, HEE and PHE. It found that practitioners come from a variety of backgrounds with a range of qualificaitons; there is a broad range of job titles and definitions to describe the role; and there are multiple routes to becoming a practitioner, generally with no linear career progression.
10 March 2016
The NHS suffered its worst ever performance in January according to the latest figures. It missed targets for A&E (83% in hospitals and 88.7% for all emergency departments, compared to the 95% target); the 18 weeks referral to treatment for planned care (92%); treatment for cancer within 62 days (81% against a target of 85%); diagnostic tests within six weeks (97.9% against a target of 99%); Red 1 urgent ambulance calls (69.9% against a target of 95%); and there was an increase in the number of delayed transfers of care, with patients fit, but unable, to leave hospital. NHS England noted that there had been a 10% increase in the number of patients going to A&E. In response, the President of the Society for Acute Medicine said the NHS was now in an ‘eternal winter’ and hospitals are so overwhelmed that patients could die, to which the DH responded that he was exaggerating the problems.
Deprivation of liberty cases for vulnerable people will be delayed unless financial support to provide legal representation can be found, following an adjournment of four test cases by a high court judge. People with conditions such as dementia or learning disability should be able to take part in deprivation of liberty proceedings (for instance when their treatment will involve them being held securely as inpatients). Mr Justice Charles issued an ‘invitation’ for the government to pay for legal representation. Without it, hearings would breach article 5 of the European convention on human rights guaranteeing the right to liberty and the common law.
A pair of drugs were found to dramatically reduce certain forms of breast cancer in 11 days, in a test on 257 women reported to the 10th European Breast Cancer Conference in Amsterdam. The drugs target a weakness found in one in ten breast cancers, the HER-2 positive form. The drugs were lapatinib (also known as Tyverb) and trastuzumab (more widely known at Herceptin). Further trials will be needed to confirm the results.
A national programme to combat antimicrobial resistance has been launched by NHS England. A £150m incentive scheme will make funding available to hospitals through CQUINs (Commissioning for Quality and Innovation) with money for CCGs (worth up to £150k for one with a population of 300k) through the Quality Premium scheme.
The gap in healthy life expectancy between men and women has narrowed slightly according to the latest figures from ONS. For those born between 2012-14, healthy life expectancy is 64 years for women and 63.4 years for men. Although men have lower life expectancy, a greater proportion of it is in good health, 79.7% to a woman’s 76.9%. There are also large geographical differences, with a man in Wokingham or Richmond upon Thames being able to expect over 70 years of good health compared to 55 years for those in Blackpool or Manchester.
An overview of developments in using e-health in the WHO European region has been published by the WHO.
09 March 2016
NHS Whistleblowers are to be given ‘safe spaces’ and legal protection to enable them to speak up, and a Healthcare Safety Investigation Branch is to be created, Jeremy Hunt has announced. Doctors and nurses admitting to mistakes will be protected from disciplinary action or being sued by patients or relatives, unless they are found to be careless or negligent. From April 2018, all hospital deaths are to be independently reviewed to help improve care; something recommended in 2005 in the report on the Harold Shipman killings. NHS trusts are being ranked on their ability to learn from mistakes based on feedback from staff about their ability to speak out. It finds 120 as ‘outstanding’ or ‘good’, 78 with ‘significant concerns’ and 32 with a ‘poor reporting culture’.
Press release: https://www.gov.uk/government/news/plans-to-end-the-cover-up-culture-in-the-nhs
There are not enough GPs to meet demand, according to a report from the Public Accounts Committee which warns of a ‘looming crisis’. It found that demand grew faster than capacity throughout the last decade and it accuses the Department of Health and NHS England of being complacent about general practice’s ability to cope with increasing demands. It says that access to GPs depends too much on where people live and concludes that “patients who are older, white or in a more affluent urban area get better access than anyone else”.
Press release: http://www.parliament.uk/business/committees/committees-a-z/commons-select/public-accounts-committee/news-parliament-2015/access-to-gp-england-report-published-15-16/
The report: http://www.publications.parliament.uk/pa/cm201516/cmselect/cmpubacc/673/67301.htm
Cases of recorded child sexual abuse increased by 30% last year to 45,456 cases in the UK according to foi responses from every police force to the NSPCC. It is thought that this represents not just an increase in reporting but a growth in the number of attacks with more opportunities for crime through the internet.
Stem cells have been used to grow a new lens for children with cataracts in a technique pioneered by scientists in China and the USA, reported in the journal Nature. The trial involved 12 children under the age of 2. There was faster healing and fewer complications than those in a control group receiving existing treatments.
85% of trusts have breached the cap on hourly rates for agency staff on a total of 60,000 occasions, according to foi responses to Nursing Times from 75% of trusts.
Pregnancies in women under 18 are at the lowest levels since records began in 1969 according to ONS statistics. The number of under 16 year olds becoming pregnant fell by 10% in the year to 2014, while for those under 18 the fall was 6.8%. However England continues to lag behind comparable European countries. There are big regional variations, with the north east having 30 conceptions per 1,000 women compared to 19 in the south east and south west. The number of women becoming pregnant after 40 has doubled in two decades.
Electronic referrals to hospital are to be incentivised through £55m of funding to CCGs through the Quality Premium in 2016-17 and further funding to NHS trusts through the CQUIN scheme in the following year. There is also to be a consultation on whether commissioners and providers should not be paid for any referals made by letter after 2018. Currently about 50% of patients are referred electronically.
Most people (53%) support patient data being used by commercial companies for research but are unhappy with some other uses, with only 26% supporting the sharing of anonymised health records with insurance companies to help them develop their pricing, according to research commissioned by the Wellcome Trust from Ipsos MORI. The research also highlighted how unaware the public is about how patient data is already being used, and recommended that more honest and open engagement is needed with the public about how their data is used for purposes beyond their care.
Domestic violence doubles the risk of premature birth according to a meta-analysis of 50 studies by the University of Iowa published in the journal, BJOG: An International Journal of Obstetrics & Gynaecology.
Higher salaries were not associated with higher levels of life satisfaction according to research tracking 18,000 people over 9 years, asking them each year about income and satisfaction. The research is due to be published in the journal Personality and Social Psychology Bulletin. While a rise in income did not lead to a rise in life satisfaction a fall did lead to a fall in satisfaction amongst people defined as ‘conscientious’.
Smoking and vaping are being banned at a beach in Pembrokeshire in what is thought to be the first trial of its kind in the UK. The aim is to stop children being encouraged to start smoking by seeing adults doing it in family friendly places. There will be no penalities for breaches of the ban but there will be signs with people expected to self-police it. The trial is to last for a year.
The Health and Wellbeing System Bulletin for March 2016 has been published by the LGA.
A fact sheet (12pp) on key trends in mental health has been published by the Mental Health Network.
08 March 2016
Junior doctors start a 48 hour strike leading to the cancellation of 5,000 non-urgent operations, about 8.5% of the number that would normally be carried out over a 48 hour period. The majority of the public supporting the strike has remained firm at 65%, with 57% blaming the Government for the dispute.
(10/03/16) Striking doctors put on free lifesaving courses for parents at 25 events throughout the country. http://www.bbc.co.uk/news/health-35766166
The UK has the shortest hospital stay for mothers after giving birth of any developed country and is the eighth shortest of 71 countries included in a study by the London School of Hygiene and Tropical Medicine, published in PLOS Medicine.
Public sector workers, including NHS staff, are to receive a 1% pay increase this year, following recommendations from pay review bodies. There was an angry response from trade unions.
Press release: https://www.gov.uk/government/news/nhs-staff-to-receive-1-pay-rise
Only 5% of hospital mistakes get reported according to two reports from the Patient Safety Translational Research Centre at Imperial College. It is thought that many staff are afraid to report incidents for fear of repercussions. According to the latest statistics, in the six months to March 2015, 716 patients died because of incidents and mistakes.
Feature article by Lord Darzi: http://www.theguardian.com/healthcare-network/2016/mar/08/nhs-mistakes-cost-lives-four-ways-to-improve-patient-safety
Press release: http://www3.imperial.ac.uk/newsandeventspggrp/imperialcollege/newssummary/news_7-3-2016-17-16-1
Around 9% of drinkers in the UK (2.5m people) drink more than the weekly recommended limit in a single day according to figures from the ONS. 58% (28.9m) people drink some alcohol in a typical week. Of those who drink more than the weekly amount in a day, the majority are men. The biggest proportion were from Wales (14%), followed by Scotland (13%) and then England (8%). Those aged 16-24 were less likely than other age groups to have drunk in the previous week, but of those that had, more (17%) were likely to have drunk more than 14 units in a single day, compared to 11% for the next highest group, 25-44 year olds.
Anti-depressant prescriptions to young people increased by 54% between 2015 and 2012 according to a study published in the European Journal of Neuropsychopharmacology. The WHO has said that this rise is a concern.
There is concern that extra money promised for children’s mental health is not reaching the front line, expressed by the Mental Health Network, which represents NHS providers. £143m was to be allocated this year, including £75m to CCGs, but there is a worry that some have diverted the money to other areas. There are also reports of cuts in local authority funded services.
Jeremy Hunt says judicial review of the doctors’ contract is bound to fail as he has not yet finalised its terms so can take account of an equality impact assessment, the grounds for the BMA action.
Plans to phase in smoking bans in English prisons can continue after the Court of Appeal ruled that the ban on smoking in public places does not apply to state prisons.
A report on integrating physical and mental health has been published by the King’s Fund, suggesting that there is a £11bn a year cost of treating them separately. The report identifies 10 areas where there is scope for improvement.
07 March 2016
Public Health England has launched a £3.5m public health campaign, One You, encouraging adults, and particularly those in middle age to do more to avoid lifestyle diseases. It suggests that: 40% of all deaths are related to behaviour; the NHS spends more than £11bn a year on lifestyle related diseases (including £6.1bn from people being overweight, £900m from lack of exercise and £3.5bn from alcohol misuse); and living healthily in mid-life can double your chances of a healthy life at 70.
The Department of Health’s ‘rescue package’ for GPs has been delayed with suggestions that the proposed £110m funding is inadequate, according to Pulse Magazine.
A risk score which predicts preventable 30-day re-admissions has been developed by researchers using data from over 117,000 patients discharged from 9 different hospitals in 4 countries. The results were published in JAMA Internal Medicine. The score has the acronym HOSPITAL.
The duty of candour on health and care professionals has been extended to Scotland with the Passing of the Health (Scotland) Bill.
Social work reform is being approached in a way that is damaging for staff and service users, undermining the profession, according to the British Association of Social Workers in its submission to an education select committee inquiry.
Councils should focus on increasing the consistency of social workers’ judgements rather than cutting front line staff numbers as a way of reducing costs, according to a report from the Institute of Public Care, by John Bolton.
There is to be a campaign to boost patient feedback through the Friends and Family Test in the week 14th-18th March, NHS England has announced.
06 March 2016
A dementia implementation plan has been published by the Government, aiming to make the UK the most dementia friendly country in the world by 2020. The measures include: providing information on dementia to those aged over 40 when they have their NHS health check; the inclusion of standards of dementia care in CQC inspections; ratings for the quality of dementia care in each area; a personalised care plan for everyone with dementia; and all patients in high dependency care to be seen and reviewed by a consultant twice a day, every day of the week, by 2020.
Press release: https://www.gov.uk/government/news/health-secretary-unveils-plans-for-safer-7-day-dementia-service
Visitors and non-UK residents should not be charged for end of life care, Hospice UK, a body involving about 200 charities, says in its response to Government consultation on charging migrants for health care. The Royal College of GPs says it has doubts about the cost-effectiveness of charging overseas visitors for access to general practice and argues that it could lead to more deaths overall, in the general population as well as among migrants, as it would be more difficult to control infectious diseases.
05 March 2016
More than a million people have seen their GP about stress and anxiety caused by housing money worries, Shelter estimate, based on a survey of over 3,500 adults in England, by YouGov, which found that 5% of those with money difficulties had seen their GP. Overall, 54% said they were struggling with, or falling behind on, their rent or mortgage.
The NHS in England is to remove adverts, check out displays and price promotions for unhealthy food in hospitals and other health centres from next month as part of moving towards a 20% sugar tax, chief executive Simon Stevens has said. £450m is being made available to trusts in 2016-7, which must bid for the money on the basis of helping staff adopt healthier lifestyles such as walking or cycling to work, mental health initiatives and access to physiotherapy services. PHE estimates that staff absences cost the NHS £2.4bn a year.
The Government is planning to soften its ‘pay to stay’ proposals under which those in social housing earning more than £30k a year have to pay market rents, it has been reported. Instead there is likely to be a taper, with small extra costs at £30k and the full market rent only when household income reaches £50k. It is suggested that this is one of a number of measures being changed or delayed to avoid controversial policies before the EU referendum.
A new think tank, the ‘Money and Mental Health Policy Institute’ has been set up funded by the founder of moneysavingexpert.com, Martin Lewis, and headed up by Polly Mackenzie, a Lib-Dem policy adviser to the Coalition Government.
04 March 2016
Nearly half of new mothers do not know what child care support is available according to a survey of 1,000 parents for the Social Mobility and Child Poverty Commission by Qa research.
Press release: https://www.gov.uk/government/news/parents-in-the-dark-about-governments-flagship-childcare-policy
Eating peanuts as a baby cuts the risk of an allergy which is long lasting, according to research backing up previous findings. A 2015 study found early exposure to peanut products could cut the risk of allergy by 80%. The latest research, also by King’s College London, found that if exposed to peanut products in the first 11 months of life then the child can stop eating them for at least a year at age five and maintain no allergy. The study involved 550 children from the earlier research and was published in the New England Journal of Medicine. The research could have implications for the development of other allergies. A separate study published in the same edition on research on 1303 children introduced to a range of possibly allergenic foods found that those introduced to peanut and egg white proteins from three months had less chance of developing allergies as those introduced at 6 months but only if the recommended quantities were consumed.
Nearly half of new mothers do not know what child care support is available according to a survey of 1,000 parents for the Social Mobility and Child Poverty Commission by Qa research.
The report: https://www.gov.uk/government/publications/parents-experiences-of-services-in-the-early-years
Eating peanuts as a baby cuts the risk of an allergy which is long lasting, according to research backing up previous findings. A 2015 study found early exposure to peanut products could cut the risk of allergy by 80%. The latest research, also by King’s College London, found that if exposed to peanut products in the first 11 months of life then the child can stop eating them for at least a year at age five and maintain no allergy. The study involved 550 children from the earlier research and was published in the New England Journal of Medicine. The research could have implications for the development of other allergies. A separate study published in the same edition on research on 1303 children introduced to a range of possibly allergenic foods found that those introduced to peanut and egg white proteins from three months had less chance of developing allergies as those introduced at 6 months but only if the recommended quantities were consumed.
Cuts to social care have been morally wrong as well as economically illiterate leading to misery behind closed doors, according to the shadow health secretary, Heidi Alexander, talking to the Nuffield Trust health policy summit. She said it was not possible to have a sustainable NHS without recognising the needs of an ageing population.
03 March 2016
The Department of Health’s monitoring of personal budgets does not enable it to understand how they improve outcomes, according to a report by the NAO. Personal budgets became mandatory in April 2015 as a result of the Care Act. The Department is relying on a 2007 report and evidence relating to particular sub-groups of users. Funding for personal budgets was about £5bn in 2014-15. The report says that aggregation of data show no association between higher proportions of those on personal budgets and satisfaction or other outcomes.
A tenth of GP surgeries could face closure because of financial pressures according to a BMA survey which received responses from about a third of practices. It found 294 of 2,830 responding were financially ‘unsustainable’. Nearly half (46%) of the practices have doctors planning to leave the NHS, with about 10% saying they had doctors intending to leave the UK and 37% having doctors planning to retire.
A report on ‘Cutting Red Tape’ in adult social care has been published by BIS, showing concern within the sector about duplication of inspections and information requests, detracting from the delivery of front line care.
Jeremy Hunt’s confrontation with the junior doctors derailed the NHS’s own efforts to move towards a seven day service according to an editorial in the BMJ. It accused Hunt of misusing evidence to beat up doctors, pushing many to the brink of leaving the profession or the country.
02 March 2016
Councils making cuts risk failing to meet Care Act duties according to the Care and Support Alliance, representing 80 charities, in written evidence to the Health Select Committee on the impact of the comprehensive spending reivew on health and social care services. An analysis of planned cuts from 15 councils found examples of cuts to staff and reduced assessments which a law firm has said may mean they cannot adequately undertake assessments, undertake safeguarding activities and fulfil Deprivation of Liberty Safeguards duties.
Pregnancy statistics show a 19% rate of obesity and 26% of women overweight out of 33,950 attending their first antenatal appointment last year according to figures from the HSCIC. The average age was 30 and a fifth were over 35.
E-cigarettes could be taxed at a common, higher rate across Europe if initial steps come to fruition. Three nations have called for a minimum excise duty set at a the highest common denominator. Finance ministers are due, at a meeting on 8th March, to sign off a call for a legislative proposal to be drafted by 2017. There would also have to be impact assessments, technical analyses and public consultations.
A pilot scheme to embed job coaches in GP surgeries will contaminate healthcare with the punitive culture of the government’s work programme according to people protesting against the scheme in a march in London. The aim of the scheme is to provide voluntary support to help people into work which is generally better for their mental and physical health. Critics are concerned about blurring of the lines between the services with patients afraid to speak honestly, fearing repercussions and threats to confidentiality with job advisers able to write directly into patient records.
28% of those attempting to stop smoking used e-cigarettes as an aid in 2014, with 37% of 8.46m smokers attempting to quit, according to research by University College London.
The later Mail Online item also quotes UCL but says 40% of those trying to quit used e-cigarettes.
Calls for the meningitis B vaccine to be given to all children under 11 have been rejected by the Government on the grounds that it is not cost effective, despite a petition signed by over 800,000 people calling for it. It is currently offered to children under one year old. This was the most popular parliamentary petition ever.
The Scottish Government is to end the freeze on council tax, allow rises up to 3% and increase the four highest bands, but it has been criticised for making ‘timid’ changes and muddying the waters.
Hip operations on the under 60’s have increased by 76% in the last decade from 10,145 in 2004-5 to 17,883 in 2014-15 according to analysis by the Royal College of Surgeons of hospital episode statistics. The number of operations across all ages rose by 36%, from 89,919 to 122,154 over the same period.
There are wide regional variations in rates of weight loss surgery with twice as many in the north east as anywhere else in the country, according to responses to foi requests received by the BBC. In 2014-15 there were 497 procedures per million people in the north east compared to 30 in the East Midlands, the lowest region.
‘Interventions to Prevent Burnout in High Risk Individuals’ are explored in a literature review published by Public Health England. It suggests that combination of organisational and individual level measures are likely to be most effective.
A website to help nurses share information about public health schemes they have been involved with has been launched by the Royal College of Nursing. The website, (http://publichealth.testrcnlearning.org.uk/), has brief details of 18 schemes from across the country.
01 March 2016
NHS England has announced 10 new town developments it will support in designing health promoting environments. Expressions of interest in the ‘Healthy New Towns’ programme were invited last year and produced 114 applications from local authorities, housing associations, NHS organisations and housing developers, from which the initial list of 10 sites has been chosen. Overall the developments will have 76,000 new houses and 170,000 residents. The sorts of design features could include: no fast food outlets near schools; making it easier to walk and cycle; enabling older people to live more independently; and the provision of digitally enabled local health services sharing physical infrastructure with community groups and schools.
Press release: https://www.england.nhs.uk/2016/03/hlthy-new-towns/
Government spending on early support for children is being cut by 71% from £3.2bn to £939m in real terms between 2010 and 2020, so a reduction to 29% of the original figure according to a report, ‘Losing in the Long Run’, from Action for Children, the National Children’s Bureau and the Children’s Society. In a survey of 500 local authority councillors, 87% said early intervention is a high priority for their local area but 59% were worried that government cuts would lead to a reduction in relevant services. It is feared that those cuts now will lead to greater demands on social care in a few year’s time.
Press release: https://www.actionforchildren.org.uk/news-and-opinion/policy-latest/2016/march/government-spending-on-early-support-for-children-slashed-by-71-per-cent/
Link to the report: https://www.actionforchildren.org.uk/resources-and-publications/reports/losing-in-the-long-run/
The cap on housing benefits for rented social housing is to be deferred for a year following warnings from the sector that proposed new supported housing developments were being scrapped or delayed because the cap would make them uneconomic. The announcement was made in a written statement a month before the changes were due to come into effect. However there were concerns about continuing uncertainty as the cap could still be implemented in future.
The Government must reduce air pollution drastically or risk legal action from law firm ClientEarth which took a case to the Supreme Court that ruled in April 2015 that the UK had breached EU limits for nitrogen dioxide (NO2) and so an urgent plan was needed. The firm has given the Government 10 days to respond. Despite taking some action, the Government does not expect to meet EU standards until 2020.
There has been increase in salt levels in many everyday foods coinciding with a change from responsibility for salt reduction by the Food Standards Agency to voluntary regulation by the industry under the ‘responsibility deal’ according to research on a number of products by the campaign group Consensus Action on Salt and Health.
No individuals are to be prosecuted for the mid-Staffordshire health scandal a police-led review, which also included the coroner and Crown Prosecution Service, has concluded. It said that there was not enough evidence to prosecute any individual managers or clinicians.
A 3% fall in deaths directly related to alcohol has been reported in the latest figures from PHE, with alcohol-specific deaths now numbering 17,755. Alcohol-related deaths, where the link is not so direct, such as via heart disease or some cancers, have risen by 1% from 22,779 in 2013 to 22,976 in 2014.
Press release: https://www.gov.uk/government/news/fewer-adults-dying-from-conditions-directly-caused-by-alcohol
The NHS should pay for care home places to allow medically fit people to be discharged from hospital to release more hospital beds, the think tank Res Publica says. Funding for the report was received from care home providers.
Press release: http://www.respublica.org.uk/press-centre/press-releases/press-release-care-cure/
GPs have met targets for reducing the prescription of antibiotics with 92% of CCGs meeting the target for overall antibiotic prescribing and 81% meeting the target on broad spectrum antibiotics.
Patients in the East of England who do not visit their GP for five years risk being de-registered if they do not respond to letters confirming they wish to remain, in a process of ‘list cleansing’ being considered by NHS England East regional team, which aims to save money by not paying for patients who have moved or died.
An analysis of NHS finances and the factors affecting financial performance has been published by the Nuffield Trust. The report is: ‘A perfect storm: an impossible climate for NHS providers’ finances?’
Ofsted is to bring the management of early years inspection back in house when the current contracts with two companies, Tribal and Prospects, who manage the inspections now, end in April 2017.
The PHE Bulletin for March is published with links to a wide range of recent stories and publications.
29 February 2016
The NHS vacancy rate for nurses was 9% for England, Wales and Northern Ireland as at December 2015, compared to a rate of 2.7% across the economy as a whole, according to information obtained by the BBC from freedom of information requests received from 106 of 166 trusts and health boards. Across the UK as a whole, 69% of NHS trusts and health boards are trying to recruit staff from overseas, while in England and Wales the figures is 74%. Health Education England has said there will be a shortfall of nurses until at least 2020.
A report on poor communications in the NHS has been published by Marie Curie. The report, “A long and winding road – Improving communication with patients in the NHS” estimates that poor communications cost the NHS more than £1bn a year. It says that better communications between healthcare professionals and patients can save costs, improve outcomes and enhance the quality of experience.
(04/03/16) Feature, based on personal experience: http://www.theguardian.com/commentisfree/2016/mar/04/patients-poor-communication-doctors
10 of the 12 most declining UK cities are in the north of England according to an analysis by the Joseph Rowntree Foundation of 74 UK cities with populations of more than 100,000. The top three cities were Rochdale, Burnley and Bolton with Hull and Grimsby in 5th and 6th place. The JRF developed an index based on changes in employment rates, levels of highly qualified workers, the number and type of full-time jobs, net migration rates and population change.
NHS trusts interpreted NICE guidance on nurse-patient ratios too mechanistically according to the Chief Executive of NHS Improvement, Jim Mackey and a senior DH civil servant, Charlie Massey, giving evidence to the Public Accounts Committee. According to Massey, trusts were interpreting NICE guidance and what they thought CQC inspectors would say in a way that meant they ‘felt quality was much more important than cost’, rather than looking at quality and cost in the round.
People’s wellbeing tends to increase during their 60’s with people asked how confident, cheerful and relaxed they felt aged 60-64 and then again aged 68-69, as part of Medical Research Council research tracking 1,700 people from birth. While this is similar to other results, this is a cohort study, so rather than looking at different people over a range of ages, it looks at the same people as they age.
Feature article about this birth cohort study: http://www.theguardian.com/society/2016/feb/27/class-of-46-shed-light-on-health
Press release: http://www.mrc.ac.uk/news/browse/longest-running-cohort-study-in-the-uk-celebrates-turning-70/
Earnings from smoothies and juices fell by 5.3% in the last year, to £1.4bn according to analysts Kantar Worldpanel, published in The Grocer, the Mail reports. It is thought that at least part of the reason for the decline was ‘the war on sugar’.
A report, ‘Building the Foundations – tackling obesity through planning and development’ has been published by the LGA.
A guide on how involvement with the local voluntary sector can help improve equalities within the NHS has been published by the Race Equality Foundation with the LGBT Foundation, Disability Rights UK and the Men’s Health Forum.
28 February 2016
A free app providing guidance on cancer referral for health professionals has been launched. It was commissioned by the Scottish Government, based on existing advice.
An interesting feature article on 10 ways to beat loneliness.
27 February 2016
The Government does not appear to have calculated the cost of ‘seven day working’ in the NHS, leading Labour to call on Jeremy Hunt to ‘come clean’ on how it will be paid for. The Independent on Sunday concludes that, having contacted various advisers, the Government is not revealing a cost because it has not yet done the ‘financial arithmetic’.
26 February 2016
Ministers have acquiesced to a Lords decision that they should continue to have a statutory duty to publish material deprivation measures of child poverty. Lord Freud published an amendment largely accepting the original House of Lords amendment. The measures include the number of children living in households with less than 60% median household income. The Government suffered a defeat from the House of Lords over the issue in January. The Welfare Reform and Work Bill repeals the Labour Government’s Child Poverty Act, which set targets for government to reduce child poverty.
Website about the bill: http://services.parliament.uk/bills/2015-16/welfarereformandwork.html
The amendment (pdf): http://www.publications.parliament.uk/pa/bills/lbill/2015-2016/0098/amend/amend098-a.pdf
A group of junior doctors have said they will boycott the review of morale announced on the same day as the imposition of the new contract, since it will exclude consideration of pay and conditions and an industrial dispute is ongoing. The statement was said to have been made by elected representatives of junior doctors from different royal colleges, the Academy Trainee Doctors’ Group.
The Government’s childhood obesity strategy has been delayed again and is now unlikely to be published until the summer. It was originally to have been published in December but was delayed to January and then to February or March. There has been considerable pressure for it to include a sugar tax.
Half of children diagnosed with asthma may not have it according to research at four medical centres in the Netherlands published in the British Journal of General Practice. NICE is currently developing new guidance on how to diagnose the condition. Asthma is estimated to cost the NHS £1bn a year.
Dental extractions for young children have increased by 10% in four years with nearly 33,800 children under ten having had at least one tooth extracted in English hospitals last year, according to figures from the HSCIC. There was a wide variation across England with a rate of 165 tooth extractions per 100k population in the East of England, but 895 in Yorkshire and Humber. A strong correlation was found between areas of deprivation and the rate of tooth extraction.
Neurological health care in England is not good enough according to a report from the Public Accounts Committee. The report criticises poorly co-ordinated local services, variations in the quality of hospital care and delays in diagnosis.
Cold homes are costing the NHS £1bn a year according to the charity National Energy Action. It says that 117,000 people have been killed over the last four years by the cold.
A big rise in deaths due to complications in illegal drug use could be linked with council cuts to support services according to PHE’s Director for Drugs, Alcohol and Tobacco, speaking at a conference. After a long period of decline, the number dying has increased significantly in the last two years, with the highest number in 2014 since records began. An official PHE response said it was too early to tell if council cuts were impacting on the number of drug deaths.
People referred to memory services who were then found not to have dementia increased by 152% between 2011-12 and 2014-15, according to information obtained by Pulse Magazine from 11 trusts through freedom of information requests. There was an increase by 87% of those referred who were found to have dementia. The incentive payment for each new dementia diagnosis has now been scrapped.
10% of bereaved people said the dying person’s care had been poor in the last three months of their life, equivalent to 48,000 people in 2015, according to a report by seven charities including Macmillan Cancer Support, Marie Curie and Sue Ryder. A key issue was a lack of support for dying at home, where a lot of people would like to be, rather than in hospital.
25 February 2016
A revised Cancer Drugs Fund (CDF) is to start in July 2016, with a £340m budget, NHS England has announced. NICE will make the decisions on which drugs are available through the fund, selecting from those which have not been given a clear go ahead for routine availability but which seem most promising and innovative. Drugs will continue to be made available to patients currently receiving medication through the fund.
At least 80 NHS trusts have written to local authorities claiming they are eligible for an 80% discount on business rates claiming they should be classified as charities. If successful the discount would be worth about £250m a year, but if backdated for six years, it would be £1.5bn.
The number of people sleeping rough in England has increased by 30% in the last year and has doubled since 2010, to now stand at 3,569 according to government figures. There has also been an increase in people with mental health problems sleeping rough. The average age of death of rough sleepers is 47.
An inadequate workforce strategy is at the heart of the NHS’s deficit according to evidence given to the Commons health select committee by Anita Charlesworth, director of research and economics at the Health Foundation. She said that at the beginning of the decade the NHS was planning on having a smaller workforce, assuming there would be fewer admissions to hospital and that nurse to patient ratios could be reduced. As a result fewer nurses were trained or brought in from abroad. That approach proved unsustainable and there is still no coherent workforce plan she said. Others giving evidence said they didn’t see how the planned £22bn efficiency savings could be made.
Self-rated health was the top predictor of mortality risk followed by: female gender, fewer years as a smoker and smaller decrements in processing speed with age, in an analysis of 65 mortality risk factors in data over 29 years of 6,203 people ranging in age from 41 to 96 at the initial assessment, undertaken by researchers from Oxford University and Switzerland and published in the journal Psychological Science. Since the psychological factors – self-rated health and decrements in processing speed – are easy and cheap to obtain, the authors suggest they could be used in prevention, diagnosis and treatment of conditions related to mortality risk. The research doesn’t demonstrate that thinking positively helps you live longer: it seems more likely that self-rated health captures a wider range of factors than narrower medical ones.
Junior doctors’ leaders criticise Health Education England for bias towards the Government, despite its claims of impartliality, with reports of growing numbers of complaints from BMA members.
The new junior doctors’ contract risks disrupting their sleeping patterns leading to fatigue and affecting their health and their patients’ safety according to evidence to the Public Accounts Committee from researchers at the Cass Business School.
The ban on smoking in public spaces appears to have reduced smoking rates amongst teenage girls, with a fall from 24% to 19% amongst 15 year old girls, according to research from the University of Glasgow, the Welsh Government and the University of Stirling, published in the journal Nicotine and Tobacco Research. The association between smoke-free legislation and adolescent smoking was estimated using linear regression adjusted for trends over time and country. No significant reduction was seen for boys.
Press release: http://www.gla.ac.uk/news/headline_446716_en.html
The article: http://ntr.oxfordjournals.org/content/early/2016/02/22/ntr.ntw018.short?rss=1
The proportion of NHS spending on general practice will not rise this year despite such a promise from Jeremy Hunt, according to Pulse magazine. Instead, the allocation is due to fall from 7.31% to 7.23%.
24 February 2016
The proportion of women in England aged 50-70 screened for breast cancer after their first invitation fell to 63.3% in 2014-15, down from 65.8% the previous year and 70.1% ten years earlier, according to figures from the HSCIC. The coverage of all women between 53 and 70 who had been screened as at 31st March 2015 was 75.4%, down from 75.9% the previous year. This was the fourth year in a row that coverage had fallen.
Jeremy Hunt misrepresented data to put his case for a seven day NHS, according to Jeremy Corbyn. In July, the health secretary said there were 6,000 deaths a year because of a lack of a ‘proper seven-day service’ which emails obtained by the BBC suggest was based on information from a paper subsequently published in the BMJ shared by Sir Bruce Keogh, NHS England’s medical director. NHS England has now admitted Hunt had advance site of figures from the BMJ article despite its Freedom of Information Officer having said in October that Keogh had not discussed any of the study findings at the Department of Health before publication.
There are to be 657 physician associate training places next year, an increase of 220%. This is part of the programme to have 1,000 physician associates working in general practice by 2020.
Pancreatic cancer is at least four separate diseases each with different causes, requiring different treatments and with different survival times, according to research looking at 456 patients, published in Nature.
23 February 2016
The junior doctors are to hold three more strikes and take judicial action against the Government’s imposition of a new contract. The three strikes will be for 48 hours each, but will allow the provision of emergency cover. They are to be held on 9th March, 6th April, and 26th April. The judicial review will be in relation to the requirement in the Equality Act 2010 to show due regard to equalities issues by undertaking an equalities impact assessment.
Pregnant women should be given a personal health budget of around £3,000 to choose the NHS maternity care they want, with support from the same midwife throughout the pregnancy and into the early weeks of motherhood according to an independent review commissioned by NHS England and chaired by Conservative peer Julia Cumberlege. There is a wide variation in care around the country and the proportion of babies stillborn or dying in the first week varies from 4 to 10 in a thousand. There should also be better use of technology such as accessing information and advice from smartphones or tablets.
Summary of recommendations (Rgn): http://www.nursingtimes.net/7002674.article
Around 40,000 deaths a year in the UK are attributable to outdoor air pollution according to a report by the Royal College of Physicians and the Royal College of Paediatrics and Child Health, ‘Every Breath We Take: the llifelong impact of air pollution.’ [A previous widely quoted estimate is 29,000 deaths a year.] The report also highlights the risks of pollution indoors. Amongst the recommendations of the report are: to put the onus on polluters; to monitor air pollution effectively and then warn the public and take appropriate action such as closing roads; and to quantify the relationship between indoor air pollution and health.
Social care services are at breaking point and even though 9 out of 10 councils (143 of 152) are intending to levy the 2% social care precept, most of this will be swallowed up by the costs of the new national living wage (about £330m of £372m), according to the LGA. Revenue support grant is being reduced by £2.5bn next year. A ComRes survey for BBC 5 Live has found three quarters of people do not want local authorities to cut social care spending and are prepared to pay more council tax to enable payment of the national living wage. The LGA warns that “despite council tax rising, the quality and quantity of services on offer could drop” as demand and costs rise.
The annual NHS staff survey found a third of respondents had experienced work-related stress, a quarter had faced harrassment by colleagues, 15% had suffered violence from patients or members of the public and 10% had felt discriminated against. The survey, undertaken by the Picker Institute was answered by nearly 300,000 people or about a quarter of the workforce. The percentage of staff saying they work extra hours is 73%, the highest for five years, up from 64% in 2011. 58% said they often or always look forward to going to work.
(26/02/16) Comment piece: http://www.theguardian.com/healthcare-network/2016/feb/26/nhs-staff-survey-reveals-pressures-and-positives-of-work-on-the-frontline
The number of new cases of cancer has continued to rise, from 292,680 to 296,863 between 2013 and 2014, according to figures from ONS. More men than women were diagnosed with cancer. Four cancers accounted for over half of registrations: breast (15.6%), prostate (13.4%), lung (12.6%) and colorectal (11.5%).
92% of children with leukemia from high poverty areas relapsed within three months compared to only 48% in low poverty areas, while 85% of children from high poverty areas lived a further five years or more compared to 92% of other children, according to U.S. research based on the medical records of 575 children between 2000 and 2010, and published in the journal Pediatric Blood and Cancer.
A report on ‘Improving Quality in the English NHS: a strategy for action’ has been published by the King’s Fund, arguing that unwarranted variations in clinical care should be tackled, with a reduced burden of national regulation and performance management, developing a learning and improvement culture and providing education and training for clinical leaders.
A briefing on ‘Active Ageing and the Built Environment’ has been published by the Housing Learning and Improvement Network.
22 February 2016
The TTIP trade deal could mean that any privatisation of the NHS could not be reversed by future governments, according to legal advice for the Unite trade union by Michael Bowsher QC, a former chair of the Bar Council’s EU law committee. Unite argues that the NHS should be excluded from the deal. It is said that the Transatlantic Trade and Investment Partnership would give investors legal rights extending beyond UK and EU law. It is suggested that the TTIP procurement rules could force the NHS to tender out services. BIS is quoted as saying that provision by a private provider is not irreversible.
There should be a learning disabilities commissioner to protect the rights of vulnerable people, according to the final report, by Stephen Bubb, on the Winterbourne View scandal. There are 900 more people in institutions than officially recognised, he says, and the scale of the reforms needed are more challenging than originally thought. An additional 10,000 staff will need to be recruited and trained in order to complete plans to move people with learning disabilities from institutions to community-based care.
People with learning disabilities are being failed, in part because of a shortage of staff, according to a report from the Royal College of Nursing. It says that the number of learning disability nurses has been cut by a third, 1,700, since 2010. Training courses for specialists have fallen by 30% in the last decade.
Children who had suffered sex abuse had reduced levels of trauma after receiving creative therapies according to an evaluation of the NSPCC’s ‘Letting the Future In’ project, in a randomised controlled trial involving over 240 families in 18 NSPCC centres, conducted by Durham and Bristol universities. For the children aged eight and over, the proportion of those experiencing the highest level of trauma fell from 73% to 46% after six months. There was no comparable fall in the control group, during that period, who afterwards also received the therapy.
Increasing the number of GPs would reduce the number of premature deaths and improve population health, according to research analysing various health statistics against 7,858 GP practices in England by researchers from Leicestershire, Keele, Florida and Dunedin, and published in BMJ Open. The researchers say that recruiting 8,500 more GPs would reduce premature deaths by more than 1,000. Deprivation was the most powerful predictor of premature mortality.
Even a small weight loss of 5% in obese people produced significant benefits in terms of better control of insulin, according to a study of 40 obese men without diabetes, led by Washington University and published in the journal Cell Metabolism. The researchers looked at the effects of losing 5%, 10% and 15% of body weight but said that the 5% loss gave ‘the biggest bang for your buck’.
Text messages that helped make the recipient feel better about themselves produced higher sign up to health checks than those emphasising social motivation according to research by the Behavioural Insights Team in New Orleans. 21,000 recipients were randomly allocated to three groups. The ‘simplicity’ group had the option to text YES to be contacted for a free appointment, or STOP to unsubscribe. The ‘ego’ group added ‘you have been selected for a FREE doctor’s appointment’. The ‘social motivation’ group had added: ‘“Take care of yourself so you can care for the ones you love.” The proportion of responses from each of the three groups were: ‘social motivation’ – 0.69%; ‘simplicity’ – 1.01%; and ‘ego’ – 1.41%.
The Health and Wellbeing System Bulletin for February 2016 has been published by the LGA, providing a round up of policy and support available.
A report, ‘Using Evidence to Strengthen Policies for Investing in Children’ has been published by the Rand Corporation.
21 February 2016
A petition calling for the vaccination against meningitis B of all children up to the age of 11 has been signed by 640,000 people, the largest number in parliamentary history. It is now most likely that it will be debated in Parliament.
Half of registered care home managers are over 50 which could lead to 10,000 retiring in the next 15 years according to an analysis of official figures by Skills for Care (the employer-led workforce body for adult social care in England). Turnover rates for managers in nursing homes is 33% and in care homes is 22%.
20 February 2016
69% of people with autism who have come into contact with the police were left troubled with how they were treated, and only 37% of police officers said they had been trained in how to deal with autistic people according to research from the University of Bath and City University, published in the Journal of Autism and Developmental Disorders. The research involved interviews with 31 adults and 49 parents and an online survey of 394 police officers.
NHS 111 may not be safe and effective for diagnosing illness in very small children, according to the president of the Royal College of Paediatrics and Child Health, Prof Neena Modi, speaking to the Press Association. She said that NHS 111 had been brought in without any proper evaluation of whether it would be safe. She criticised the assessment of children, and especially very young children, over the phone, by non-clinicians and sometimes the lack of access to medical records.
NHS income from private patients rose by 30% in five years between 2010-15, from £408m to £526m, according to a parliamentary written answer.
Fizzy drinks should have child friendly labels with the amount of sugar expressed in teaspoons, to tackle child obesity and tooth decay, the LGA has said.
19 February 2016
NHS trusts could have a deficit of £2.8bn by the end of the year, with the figure being £2.26bn for the first nine months of the financial year, according to official figures from Monitor and the Trust Development Authority. Three quarters, (179 / 240), of NHS providers are running deficits. The £2.72bn spent on agency and contract staff is £1bn more than planned
Press release: https://www.gov.uk/government/news/nhs-providers-urged-to-take-more-action-to-counter-pressures
A 20% sugar tax could prevent 3.7m people from becoming obese and reduce health and social care spending by £10m a year by 2025, according to a report from Cancer Research UK and the UK Health Forum. Although the tax would only lead to a reduction of an average of 15 calories a day, they suggest that this is enough to prevent the rise in obesity which is otherwise predicted to occur.
A new GP contract for England in 2016-17 has been agreed between NHS England, the Government and the BMA. It includes an additional £220m investment and a 3.2% total funding uplift.
The health ‘Shared Delivery Plan’ for 2015-20 has been published setting out the priorities and programme for delivering them of the Department of Health and 15 of its agencies, including NHS England, PHE, HEE, HSCIC, Monitor and the TDA.
18 February 2016
A promise by Jeremy Hunt that junior doctors would not have to work consecutive weekends appears to have been broken in examples of 17 rotas published by NHS Employers showing what junior doctors should expect to work when the new contracts are imposed in August.
NHS Trusts are predicted to be £2.3bn in deficit by the end of the year, up from an earlier estimate of £2bn, according to the King’s Fund’s survey of finance directors in about a third of trusts. More than a half (53%) said they thought quality of care was worsening in their area. A majority of CCGs and trusts thought the NHS in England would not be able to make the 2-3% (£22bn) savings required in the Five Year Forward View. The King’s Fund said there was a move back to central control with funding decisions depending on cost reduction targets. Monitor was due to report on the financial position the following day.
Press release: http://www.kingsfund.org.uk/press/press-releases/nhs-trusts-deficit
The Quarterly Monitoring Report: http://qmr.kingsfund.org.uk/2016/18/overview
Antibiotic prescribing was reduced by 3.3% by a letter to selected GPs saying they were prescribing more than their peers in a randomised controlled trial involving over 15 GP practices. The trial was a collaboration between the Chief Medical Officer, PHE, DH and the Behavioural Insights Team and was published in the Lancet. It is estimated that this approach, which cost 6p per prescription saved, could reduced the prescribing rate across all surgeries by 0.85%. Another intervention aiming to educate patients through the use of leaflets and posters in surgeries was found to have no effect.
The proportion of 16-34 year old women smoking has risen for the first time since 2008 from 20% to 21% the previous year. The proportion of young men smoking fell from 28% to 26%.
There have been nearly 1,200 ‘never events’ in the last four years, according to information collected by the Press Association. They are events which it is deemed should never happen, such as operating on the wrong body part or leaving a foreign body inside a patient after an operation.
More investment in early years services is needed to prevent mental health problems later in life, according to the Institute of Health Visiting. They say that health visitors lack time and training to support infant’s mental health, with more than a quarter saying, in a recent survey, that they had never received such training.
An Australian hand washing campaign was found to be cost-effective but expensive according to an evaluation of the National Hand Hygiene Initiative in 50 Australian hospitals between 2009-12 by the Queensland University of Technology. The cost per life year gained was about £14,850.
A new pay premium for GP trainees will produce roughly the same remuneration for most, although some have calculated that it will lead to a slight reduction. The premium of £8,200 p.a. was introduced as part of the imposition of the junior doctors’ contract and replaces the previous GP supplement. It will only be paid to GP trainees while on GP placement (not for periods working hospital or the community) and not to other trainees doing temporary placements in GP surgeries. There is some concern that the supplements may change over time, as they are supposed to be targeted at areas of staff shortages.
Cancer care in England will be negatively affected by the imposition of the junior doctors’ contract, according to 470 oncologists who have written to Jeremy Hunt. They say it will damage the recruitment and retention of cancer doctors.
A report on how Health and Wellbeing Boards can engage effectively with providers has been published by the LGA, working with NHS Providers and NHS Improvement.
A report on “Person-centre Care in Europe” has been published by the Picker Institute, providing “a cross-country comparison of health system performance, strategies and structure.”
17 February 2016
NHS Trusts that do not impose the new junior doctors’ contract could lose funding for training programmes, Health Education England has said in a letter to trust chief executives. The 152 foundation trusts are not legally obliged to impose the contract. HEE says it is not prepared to see a system where recruitment is based on ability to offer different terms rather than patient and service need. Monitor has also urged trusts to ‘ensure consistent implementation across the NHS.’
Claimants will have to use a 45p a minute phone line to claim universal credit (or 12p a minute from a landline) if they cannot access the service online as the DWP refuses to make available a freephone number.
79% of GPs say at least one of their patients has had a problem in the last month with poor co-ordination of care within the health and care system, according to a report from the Health Foundation, ‘Under Pressure’, analysing the results of the Commonwealth Fund’s 2015 International Health Policy Survey of Primary Care Doctors [reported on 19/1/16]. GPs in the UK reported the greatest challenges in co-ordinating care with social services or community providers at 70% saying it was very or somewhat difficult. GPs in the UK are less satisfied with the time they can spend with patients than the average of the 11 countries and there has been a big fall since 2012 in the proportion thinking the system of general practice works well, from 46% to 22%.
RCGP response: http://www.rcgp.org.uk/news/2016/february/rcgp-response-to-health-foundation-report-on-pressures-facing-uk-general-practice.aspx
Proposed new visa rules could reduce the number of foreign doctors, according to a letter from the BMA to the Immigration Minister James Brokenshire. Proposals from the Migration Advisory Committee (MAC) include the requirement that international graduates from UK medical schools would only be eligible for the second round of applications for specialist posts when most had already been filled by UK and EU citizens. There could also be an increase in the minimum salary requirement for Tier 2 visas to £30k.
35% of drinks surveyed from high street coffee shops had more sugar than a can of coke, with the worst having 99g, equivalent to 25 teaspoons, according to an analysis of 131 drinks by Action on Sugar.
A major NHS IT project has been successfully completed by the Health and Social Care Information Centre, bringing a significant part of the national infrastructure in-house. The ‘NHS Spine’, described as “the technological backbone of the NHS”, connects clinicians and patients to such things as the Electronic Prescription Service, Summary Care Record and e-referral service. Over 18 months it was redeveloped and rebuilt on open source software and inhouse management. The transition was achieved with minimal, and no unplanned, downtime.
A report on ‘Delivering the benefits of digitial health care’ has been published by the Nuffield Trust.
(29/02/16) Feature: http://www.bbc.co.uk/news/health-35660333
Guidelines on major trauma have been published by NICE including advice on improving treatment of severe blood loss, which it says is inconsistent, and which costs 1,500 lives a year.
16 February 2016
Hundreds of new sheltered housing developments have been scrapped or delayed as a result of cuts to housing benefit. The National Housing Federation estimates that 2,500 units have been scrapped or delayed, as the providers of sheltered housing face losing £68 per week per tenant.
Article by the Chief Executive of the South Yorkshire Housing Association: http://www.theguardian.com/housing-network/2016/feb/16/benefits-cap-supported-housing-vulnerable-tenants
Article by the Chief Executive of Refuge: http://www.theguardian.com/housing-network/2016/feb/17/housing-benefit-womens-refuges-domestic-violence
Children’s life satisfaction in England was 13th out of 16 countries in a survey of 990 eight year olds by Children’s Worlds, funded by the Jacobs Foundation. England came no higher than eighth for any of the measures and scored particularly badly for relationship with teachers, enjoyment of outdoor areas, views of their own bodies, and the way they look. The survey in England was co-ordinated by the Social Policy Research Unit at the University of York.
Belonging to social groups in retirement was associated with a reduced risk of death equivalent to exercising, according to research comparing 424 retirees with a matched sample of 424 people who continued in work (both living in England), undertaken by the University of Queensland and published in BMJ Open. Those retirees who belonged to at least two groups before retirement had a 2% risk of death in the first six years of retirement but this rose to a 5% risk if they lost one group and a 12% risk if they lost two groups.
There were 5.6% more deaths in 2015 than the previous year, the biggest increase in the death rate since the 1960’s, according to analysis of provisional ONS data. A Director of Public Health, Prof Dominic Harrison from Blackburn with Darwen, suggested cuts in social care budgets may have played a part. PHE said that a bad strain of flu and an ineffective vaccine may have been partly to blame. Final figures will be published in July.
Government plans to cut the number of community pharmacies by 3,000 through a £170m cut could be a disaster for GPs who would have to deal with many more minor illnesses, according to doctors’ leaders.
Income tax will have to rise by at least 3p in the pound to guarantee future healthcare according to Lord Kerslake, former head of the home civil service in an interview with the Guardian. He said that health spending needs to rise in line with GDP. He said a Royal Commission should be set up to establish a national consensus on NHS funding.
A scheme paying local pharmacies to give the seasonal flu vaccine did not increase take up of the vaccine in at-risk groups and led to duplicated record keeping and records going missing according to an evaluation of the London scheme by the London School of Hygiene and Tropical Medicine published in BMJ Open.
A report, “At the Heart of Health: Realising the value of people and communities” has been published by Nesta.
15 February 2016
A seven day NHS would not necessarily cut death rates from weekend admissions according to a leaked DH report. The report says 11,000 more staff, including 3,000 nurses and 4,000 doctors, would be required to run a seven day service in hospitals and the overall cost would be £900m. It says it will be ‘challenging’ to recruit the promised extra 5,000 GPs by 2020. Another problem is that community and social services could not cope with more hospital discharges at weekends.
An additional £1bn a year is to be invested in mental health by 2020-21, to help more than a million people, NHS England has said in response to an independent task force, although the money will come out of the £8.4bn already promised for the heatlh service by the end of the Parliament. The task force said that seven day a week services should be a priority, with a greater availability of intensive home treatment as an alternative to inpatient care. The taskforce was chaired by Paul Farmer, chief executive of Mind. An NHS spokesman is quoted by Pulse (18th) as saying: “Only the most bizarre mangling of that fact would claim this isn’t “new” money when it patently is new funding for mental health over and above what is being spent today …” [presumably implying that this also represents a cut of £1bn to what was otherwise going to be spent on physical health?]
Feature article: http://www.theguardian.com/commentisfree/2016/feb/16/mental-health-david-cameron-nhs-debts
(18/02/16) The £1bn will have to come out of existing NHS funding: http://www.pulsetoday.co.uk/clinical/mental-health/1bn-uplift-for-mental-health-to-come-out-of-existing-ccg-budgets/20031172.article
Councils and NHS trusts are to be banned from boycotting foreign countries signed up to the World Trade Organisation government procurement agreement, such as Israel. Procurement boycots are said to be inappropriate unless there are formal legal sanctions put in place by government. The plans were first announced in October. The Government is also stopping public bodies divesting pension investments from companies they consider unethical such as fossil fuel or arms companies.
Levels of nursing care have only just returned to the levels of 2011 according to a report by NHS Improvement, ‘Evidence from NHS Improvement on clinical staff shortages: a workforce analysis.’ It reports the intensity of nursing care by the proportion of adult hospital nurses to the number of patient days. Improvements had been driven by the increasing number of nurses since the Francis report. Part of the increase in availability of nurses has been through the use of agency staff and altering the range of work people can taken on. There have also been reductions in average lengths of stay of patients in hospital.
Many households in poverty have someone in work, with 60% of those below the Joseph Rowntree Foundation’s minimum income standard (MIS), that is 2.6m households, having at least one adult in work. It says that 11.6m people live below its MIS, a rise to 28% from the 21% before the 2008 banking crisis.
Proportionately fewer older people in Britain live to old age than other parts of Europe along with the Netherlands and Scandinavia, whilst those in northern Spain, north eastern Italy and southern and western France tend to live longer, according to a study published in the BMJ’s Journal of Epidemiology and Community Health. The analysis shows the percentage of those aged 75-84 in 2001 who survived to be 85-94 in 2011, in 18 European countries.
14 February 2016
Budgets for mental health trusts fell by 2% between 2013-14 and 2014-15, according to information from foi requests from 53 of 59 mental health trusts to the BBC. The Department of Health said this did not show the full picture because it excluded local authorities, voluntary organisations and NHS England.
13 February 2016
Unison have said there could be strikes if the Government tries to impose contracts on other NHS staff. Speaking on Radio 4’s Today programme, Christina McAnea said the imposition of the contract sent a worrying message to other members of staff. She said the Government wants to extend seven day services but not to fund it, relying rather on cuts to pay and conditions. So far 180,000 people have signed a petition calling for a vote of no confidence in Jeremy Hunt. A number of nursing unions also criticised the imposition of the contract
Nearly a tenth of those who died from cancer in 2014 spent the last 48 hours in pain because of lack of support for people at home, according to an analysis by Macmillan Cancer Support of ONS figures from last year. They called on the Government to implement the recommendations from a review published in February 2015, “What’s Important to Me: A Review of Choice in End of Life Care.”
Press release: http://www.macmillan.org.uk/Aboutus/News/Latest_News/Thousandsofcancerpatientsarespendingtheirfinalhoursinpain.aspx
(06/07/15) The source data: http://www.ons.gov.uk/ons/publications/re-reference-tables.html?edition=tcm%3A77-407293
12 February 2016
Public health funding for councils is to be cut by £77m in 2016-17 and by £84m the following year. The total available for next year is £3.38bn. There will be a flat rate cut of 2.2% across all authorities, rather than the use of a formula to allocate the cuts. The Government no longer counts this as part of the overall health budget so it does not count as part of the health ring fence.
The 152 foundation trusts do not need to impose the new junior doctors’ contract but can negotiate their own local deals, the Department of Health has confirmed. Non-foundation trusts, however, have no choice. The Royal College of Surgeons has criticised the imposition of the contract.
14 of 20 signatories to a letter that Jeremy Hunt claimed supported his position said they had never agreed to forcing through the deal with an imposition of the contract. A number have asked for their names to be removed. Sir David Dalton denied that the letter implied any agreement to imposition of the contract. However, the letter says that the signatories support the advice to “the government to do whatever it deems necessary to end uncertainty for the service and to make sure that a new contract is in place which is as close as possible to the final position put forward to the BMA yesterday.”
Almost 760 doctors were issued with certificates enabling them to work abroad in the first four weeks of 2016: http://www.dailymail.co.uk/news/article-3443298/Flight-striking-junior-doctors-Hunt-imposes-new-contracts-200-week-applying-easier-life-abroad.html
More than 44,000 sign a petition against imposition of the contract: http://www.dailymail.co.uk/news/article-3443793/Jeremy-Hunt-faces-backlash-rules-new-contract-imposed-striking-junior-doctors-42-000-sign-petition-overnight.html
The letter (pdf): www.nhsemployers.org/~/media/Employers/Documents/Need%20to%20know/Letter%20to%20SofS%2010%20Feb%20DD%20FINALFINAL.pdfhttp://www.nhsemployers.org/~/media/Employers/Documents/Need%20to%20know/Letter%20to%20SofS%2010%20Feb%20DD%20FINALFINAL.pdf
A review of junior doctors’ morale, training and support has been launched, to be led by Prof Dame Sue Bailey. It will look at “non-contractual issues” that affect morale such as relations with employers and with senior doctors, competing demands of the service and training and working environments.
The NHS in Wales is no better or worse than the rest of the UK according to a review of healthcare quality in the UK by the OECD. However it expresses concern about the system of Health Boards and suggests there should be more central control in Wales, but less central control in England.
GlaxoSmithKline has been fined for anti-competitive practices together with the producers of various generic drugs after GSK paid them to delay bringing their drugs to market.
Life expectancy for those over 65 continues to rise, but there is concern about the number of elderly people living in poor health, according to a report from PHE looking at recent trends. There is also concern about worsening health for older people in some parts of the country.
A report on “Youth Mental Health: New Economic Evidence” has been published by the PSSRU, which summarises international evidence on the economic impact of youth mental health services and the impact of youth mental health problems.
11 February 2016
The health Secretary is to impose a contract on the junior doctors after agreement could not be reached. Junior doctors’ leaders have said they will continue to fight on, using ‘all options available’.
The Royal College of GPs says this will make it harder to recruit GPs: http://www.independent.co.uk/news/uk/politics/royal-college-of-gps-warns-jeremy-hunts-new-contract-will-starve-the-nhs-of-doctors-a6867646.html
How the imposition of the strike unfolded with links to key documents: http://www.pulsetoday.co.uk/hot-topics/junior-doctor-contract/how-the-end-of-junior-doctor-contract-negotiations-unfolded/20031104.article
Statement by Simon Stevens calling for implementation of the proposals: https://www.england.nhs.uk/2016/02/junior-doctors-contract-statement/
The Welsh Assembly has passed a safe staffing bill which requires setting minimum nurse staffing levels for acute wards. It legally requires the use not just of safe staffing tools but also professional judgement of the nurse in charge and consideration of the acuity of patients. The Bill also includes powers to extend the requirements to other settings such as mental health wards.
December’s performance statistics for the NHS in England show key targets not being met. The numbers seen in A&E was 91% against the 95% target, the second lowest on record. Other targets missed include treatment within 18 weeks, ambulance response times and six week waits for diagnostic tests. The number of delayed transfers of care was the second highest on record.
Some agencies are finding it harder to provide doctors and nurses to fill shifts following the cap on pay rates with 80% of agencies responding to a survey saying they could only supply staff for up to half of requests compared to 53% saying this last June. Monitor said 64% of trusts had said it was no more difficult to fill a shift with the caps while 36% said it was more difficult.
More use of vaccinations could help the fight against antimicrobial resistance according to the latest report from the government commissioned review being led by Jim O’Neill, now a Treasury minister. Vaccinating people against certain common illnesses would reduce the need for antibiotics to treat them later.
E-cigarette vapour caused developmental problems for the babies of mice, suggesting they may not be healthy for pregnant women, according to research led by New York University and reported to the American Association for the Advancement of Science.
42% of parents of children with cancer felt their concerns were ignored by GPs and 34% felt the diagnosis was delayed, according to a survey of 147 16-24 year olds and 186 parents by charity CLIC Sargent. 44% of the young people felt they had not been taken seriously enough. A survey by the charity of 1,000 GPs found that 46% felt more training was needed to help them identify cancer in children.
Levels of winter pressures in the NHS are now common all year around, according to research by the Nuffield Trust and the Health Foundation.
63% of hospital trusts have at least one scanner that is at least 10 years old despite advice that they should be scrapped after 10 years, according to data received by Sky News in response to foi requests from 111 trusts.
Changes to NHS tariffs are open for consultation for 28 days.
10 February 2016
The junior doctors strike. Jeremy Hunt claims the turnout for this strike is lower than the last one, but the 43% turning up for work includes those who had never intended to strike such as those working in emergency care. Last minute offers and counter-offers did not lead to an agreement.
Student nurses walk out for an hour in protest at the removal of bursaries (rgn): http://www.nursingtimes.net/7002338.article
The number of doctors applying to train as specialists has fallen by 8% in three years to an all time low according to HEE figures obtained by the Guardian. There was a 25% fall over three years in the number seeking to become GPs, from 6,447 in 2013 to 4,863 this year.
The number of adult social care staff employed by councils has fallen by 25% since 2011, with a fall of 8% between 2014 and 2015, according to figures from the HSCIC.
Funding for former Independent Living Fund recipients is to be provided to local authorities for the next four years by the Government, but it will not be ring fenced, so councils will not have to spend it on ILF or adult social care. This proposal is currently out to consultation.
The Department of Health is to receive an additional £205m by the Treasury because it is unable to balance its books. This is the second year in a row that the department has needed extra funding. There may now be an investigation by the Public Accounts Committee. DH described it as a ‘small addition’ to its budget and equivalent to less than the NHS spends in a day.
A lack of fitness in their 30’s and 40’s was associated with smaller brains two decades later, which could contribute to cognitive decline and dementia, according to research from Boston University School of Medicine analysing medical data from 1,583 people with an average age of 40 tracked over 20 years. They were tested for fitness in the 1970s and early 1980s then underwent MRI scans and neurological tests between 1998 and 2001. The results are published in the journal Neurology.
A brief guide to where the money flows in the NHS is available in the Guardian. [A handy overview if you’re unsure or want a refresher.]
09 February 2016
The Prime Minister has been accused of buying off potential Tory rebels in the local government financial settlement after a Labour analysis showed that 83% of a £300m two year relief fund will go to Conservative controlled councils. The extra funding was announced after thirty Conservative MPs were expected to vote against the local government finance settlement. The five most deprived councils in the country will receive none of the funds. The DCLG said the transitional funding had gone to those councils facing the biggest fall in central government grant. The settlement sets out funding for the next four years, with a gradual withdrawal of all central government grant.
Press release on the local government financial settlement: https://www.gov.uk/government/news/greg-clark-confirms-historic-4-year-settlement-for-local-government
Settlement documents: https://www.gov.uk/government/collections/final-local-government-finance-settlement-england-2016-to-2017
Death rates were higher on wards with fewer registered nurses in an analysis of figures from 137 acute hospital trusts in research led by the University of Southampton alongside King’s College, London, and published in BMJ Open. There was an increased risk of mortality in trusts that employed more heatlhcare assistants (HCAs) relative to the number of beds. The lead author suggested that you cannot therefore consider nurses and HCAs interchangeably when considering safe staffing levels.
(10/02/16) (Rgn) http://www.nursingtimes.net/7002268.article
Sending patients with mental health problems long distances for inpatient care must end, according to the report of an independent commission chaired by former NHS Chief Executive Nigel Crisp set up by the Royal Society of Psychiatrists. It also says there should be a maximum four hour wait for acute care, so there is equality with patients with physical problems.
There is no such thing as a safe sun tan but short bursts of exposure to the sun are needed to build up vitamin D, according to NICE. An existing tan provides little protection against sun exposure. There is also guidance on applying sun cream.
There is a crisis in breastfeeding because of a lack of support due to budget cuts according to an open letter from a range of academics, health and breastfeeding related organisations including the Royal College of Paediatrics and Child Health and the Royal College of General Practitioners. This follows a Lancet article showing the UK as having the lowest breastfeeding rates at one year in the world. However, the letter notes that around 80% of women start breasteeding but the numbers plummet in the following weeks and months. The letter calls for protection of public health budgets, a breasteeding strategy and laws to protect mothers from aggressive marketing of infant formulas.
(12/02/16) (Rgn) http://www.nursingtimes.net/7002416.article
Press release: http://ukbreastfeeding.org/press-release/
Link to letter http://ukbreastfeeding.org/open-letter/
Abortion should be decriminalised and women allowed to make their own decisions on it, according to a campaign from the British Pregnancy Advisory Service backed by other organisations including the Fawcett Society, the Royal College of Midwives and Women’s Aid. Currently the decision is made by two doctors who have to agree that the woman’s physical or mental health would suffer if forced to continue the pregnancy. Last year a young woman was sentenced to two and a half years imprisonment for inducing a miscarriage.
Pollution in the 1970s led to increased mortality 30 years later according to research tracking 380,000 people over 38 years, assessing pollution levels then checking those with death records and census information from 1971 to 2001. The research was led by Imperial College and published in the journal Thorax
(Open access) http://thorax.bmj.com/content/early/2016/02/01/thoraxjnl-2015-207111.short?g=w_thorax_ahead_tab
Chronic fatigue syndrome sufferers were six times more likely to commit suicide according to research by King’s College London, looking at the records of 2,000 patients over seven years and published in the Lancet. They found 17 people with the syndrome died between 2007 and 2013, 8 from cancer (with no difference in the rate of the rest of the population), 5 from suicide and 4 from other causes.
The EuroHealth Consumer Index has been criticised in a BMJ blog. In its most recent assessment (26/1/16) it ranked the UK health system as 14th out of 35 countries studied. However, it is criticised as using arbitrary scoring with a points system that does not reflect what matters to citizens and no clear basis for selecting the indicators.
A report on how nature based activities can benefit people suffering mental ill health has been published by Natural England. The report was commissioned from the University of Essex and Mind.
08 February 2016
The world is unprepared for global pandemics that could kill millions and spread rapidly according to a WHO panel set up after the Ebola epidemic. It quotes figures from the Bill and Melinda Gates Foundation that a virulent airborne flu virus could reach all major global capitals within 60 days and kill 33 million people within 250 days. Recommendations from previous reviews, such as one following the 2009 flu pandemic have not been followed up. What is needed now, it says, is a centre for emergency preparedness with real command and control capacity and the best technology available. More funding is required from countries, with annual reporting to the WHO.
Public satisfaction with the NHS fell by 5% last year with dissatisfaction rising by 8%, according to the latest British Social Attitudes Survey, carried out by NatCen Social Research and based on 2,167 responses from England, Scotland and Wales. There has been a fall in those saying they are satisfied with the NHS from a high point of 70% in 2010 to 60% now. Although GPs have the highest ratings, their satisfaction at 69% is the lowest since the survey started in 1983. The most common reasons for dissatisfaction were taking too long to get a GP or hospital appointment (55%), not enough NHS staff (44%) and the government not spending enough money on the NHS (39%). Amongst those who were satisfied, the main reasons were quality of care (61%), a service free at the point of care (59%) and the range of services and treatments (54%). Those who had had personal contact with the NHS in the previous year were more positive than those who had not.
(09/02/16) (N.B. the misleading headline talks about patients dissatisfaction when this was a survey of the public, whether patients or not): http://www.dailymail.co.uk/news/article-3438172/Why-record-one-three-fed-GPs-Patients-particularly-unhappy-waiting-times-standard-appointments.html
A team of frontline health professionals is being assembled to improve procurement by identifying the best clinical products for the NHS and whether they can be purchased more efficiently such as through block contracts. The work will tie in with Lord Carter’s proposals for efficiency savings through procurement. Interviews are currently underway for the nine member team.
CCGs’ attempts to block tax avoiding companies from bidding for contracts are being dropped in at least two cases following legal advice that it could be discriminatory, according to the Independent. The paper lists ten CCGs with clauses in their constitutions prohibiting contractors’ use of offshore jurisdictions or improper tax avoidance schemes. Bristol CCG is now in the process of removing the clause following legal advice that they could be subject to challenge if they exclude bidders whose arrangements are lawful. Hackney CCG is also believed to be considering such a change.
The BMA claim Jeremy Hunt blocked a deal to end the junior doctors’ dispute despite support for it from DH and NHS Employers. This was disputed by DH and NHS Employers said the BMA had not made any substantive proposals since the new year. It is said that negotiations have broken down and there are no more planned dates for talks. Agreement would be needed very soon for a contract to apply to new doctors starting in August. The Government appears to be moving towards imposing a contract. Last ditch talks were held to try and avoid a strike.
Three quarters of school heads say they lack the resources to provide the kind of mental health care that children need, according to a survey of 1,455 English heads by the National Association of Head Teachers. It found that 65% of schools did not have access to a counsellor on site and in three quarters of those cases the reason was financial.
A review of IT systems across the NHS has been launched, to be led by Prof Bob Wachter of the University of California. The review is to be undertaken by the National Advisory Group on Health Information Technology in England with members from England, the U.S., Denmark and Scotland.
Increased privatisation in the NHS risks a slide to a U.S. system where the level of care is determined by income rather than need, according to a statement signed by the leaders of ten major health unions, including Unison, Unite, the GMB, the Royal College of Midwivies and the Society of Radiographers. Figures from a campaign group say that more than a third of contracts let since April 2013, worth £5.5bn, have been won by private firms. DH says that 6.3% of the overall NHS budget is spent on commissioning private providers. The unions are also concerned about the amount of money spent on the commissioning process.
The letter: http://www.theguardian.com/society/2016/feb/08/call-time-on-the-failed-nhs-privatisation-experiment
Doctors and nurses working for agencies are being urged to return to the NHS by Monitor and the Trust Development Authority to help save the NHS money. A union official is quoted as saying that it is hardly surprising that some staff opt for better paid agency work when NHS wages have been cut and conditions lack flexibility.
A report on ‘The future of child health services: new models of care’ has been published by the Nuffield Trust.
A report on ‘Designing More Affordable and Effective Healthcare’ has been published by the Commonwealth Fund.
A briefing on the introduction of electronic health records has been published by the Parliamentary Office of Science and Technology, explaining the plans to introduce them, what they will contain and opportunities and challenges of the implementation.
07 February 2016
More use of a particular antibiotic in poultry farming has been blamed for increasing drug resistance of human food poisoning illnesses according to figures from the British Poultry Council obtained by the Bureau of Investigative Journalism. The use of a class of antibiotics called fluoroquinolones rose from 0.71 tonnes in 2013 to 1.126 tonnes in 2014. These antibiotics were banned in chicken farming in the US in 2005 and are also banned in Australia, Finland and Denmark. Although figures on the use of antibiotics are kept by farmers, they are not collected by the regulator, the Veterinary Medicines Directorate.
The Government has launched another drive for more technology and a paperless NHS, the BBC reports. It says that £4bn has been set aside, including: £1.8bn to create a paperless NHS; £1bn on cyber security and data consent; £750m for outside of hospitals including digitising social care; and £400m for a new website, nhs.uk, devloping apps and free wi-fi in NHS buildings.
Jeremy Hunt says the rise in childhood obesity is a national emergency and the government will provide a ‘gamechanging’ response, while Jamie Oliver promised to get ‘less nice’ and ‘more ninja’ if a sugar tax isn’t introduced in the forthcoming strategy, both in comments on the Andrew Marr show. Hunt also accused the junior doctors of being irresponsible.
Over 100,000 patients spent longer than 12 hours in A&E in England last year according to data from the HSCIC seen by the BBC. This was 1% of attendances. The way the indicator is measured is different in England from Wales, Scotland and Northern Ireland, making comparisons difficult.
Cutting benefits would not lead to weight loss according to Dame Carol Black who is leading a review on how to get people who are obese or addicted to alcohol or drugs back into work. In announcing the review last year, David Cameron said it wasn’t right that taxpayers should fund the benefits of people who refuse the support and treatment to get them back to work. Carol Black was speaking on Desert Island Discs. No date has been given for publication of the report.
Barts Health NHS Trust is predicted to have a deficit of £135m this year, reported to be the highest in NHS history, according to information from health minister Alistair Burt to Labour’s Sadiq Khan. The trust noted that they are the largest in the country and their deficit is a similar proportion of their turnover (10%) as other acute trusts. These predicted deficits in Barts and other London trusts are being seen as evidence of an escalating financial crisis in the NHS.
06 February 2016
A new staffing measure for nurses and healthcare assistants recommended in the Carter review has been criticised by workforce experts. The metric, the care hours per patient day (CHPPD), measures how many hours of care are provided by nurses and HCAs in a 24 hour period. The new measure is based on ones already used in New Zealand, Australia and the US. However the measure has been criticised as it averages different types and levels of care. It also risks hiding particular shifts with unsafe staffing levels.
The Government is to prevent charities using government funding for lobbying, through a clause in new and renewed grants agreements.
The Scottish Government has launched a recruitment drive for junior doctors. This ties in with the opening of applications for training places across the UK, on 10th February, which is also the day of the junior doctors’ national strike in England. One of the adverts apparently shows a picture of two doctors with the words ‘I feel valued’.
Specialist mental health support for victims of FGM is to be developed, the Government has said.
The government’s obesity strategy should focus on parents rather than children, according to the former adviser to the coalition government on obesity, Dr Susan Jebb, referring to the forthcoming children’s obesity strategy. She argues that it is parents who have most influence on children’s behaviour. It is thought there are disagreements between government departments over what should be included in the strategy.
05 February 2016
Lord Carter’s review says £5bn could be saved by hospital trusts, following up the interim report published last year. Areas for saving included: £2bn through better management of staff; £1bn on procurement; £1bn from better management of estates; and £1bn from the drugs bill. The report says that delayed discharges could be costing £900m a year with an estimate of 8,500 beds blocked per day compared to the official figure of 5,500. Each hospital has been given its own savings target, though these are not being made public. The review is based on a detailed examination of 136 of the 156 acute hospital trusts. The savings could be made by increasing efficiency to match the standards of the best.
(Rgn) Report recommends new measure of nurse productivity: http://www.nursingtimes.net/7002173.article
Press release: https://www.gov.uk/government/news/review-shows-how-nhs-hospitals-can-save-money-and-improve-care
The report: https://www.gov.uk/government/publications/productivity-in-nhs-hospitals
The NHS’s systems for recruiting doctors, nurses and midwives are fragmented, inefficient and expensive according to a report from the National Audit Office. With a 6% vacancy rate, the service was increasingly reliant on agency staff to fill gaps in rotas. The NAO says that HEE should be more proactive in addressing variations in workforce pressures around the country. It says that trusts could do more to reduce reliance on temporary staffing. There has been a big fall in the number of nurses recruited from outside the European Economic Area, from 11,359 in 2004-05 to 699 in 2014-15.
Management of the Cancer Drugs Fund has been criticised by the Public Accounts Committee, which accuses the Department of Health and NHS England of not knowing whether patients get any benefit from the drugs or whether they provide value for money. It says they have little control over its increasing budget and there is no assurance that they are using their buying power effectively to pay a fair price for drugs. NHS England is currently consulting on reform of the system.
A deprivation of liberty court case could have significant implications for children’s social care. As a result of the ruling councils may have to bring many cases involving 16 and 17 year olds to the Court of Protection.
The Department of Health is to cut about 650 jobs, reducing the number of non-senior staff members from 1800 to about 1200-1300 by April 2017. The Department has to make 30% savings in the next five years.
The social care funding gap cannot be filled by council tax increases according to the GMB union which says the gap will be more than £3.3bn by 2020, while the council tax increase will raise £1.8bn a year by 2019-20 with an additional £1.5bn for the Better Care Fund. It is feared that many of the private care home providers could go bust or leave the industry.
Management style was found to affect retention of nurses and patient care in a Canadian study by McGill University involving an online survey of 541 registered nurses, published in the Journal of Advanced Nursing. A transformational leadership style helped retention and patient care.
A briefing on what the planning guidance means for the NHS has been produced by the King’s Fund. While there are positives, such as multi-year allocations and a move towards place-based systems of care, there is a shift in the balance of priorities from safety towards finance but ‘it is inconceivable that the NHS will be able to achieve both financial sustainability and large-scale transformation’ within its financial constraints.
04 February 2016
The Department of Health may overspend its budget this year and require additional cash from the Treasury, Whitehall sources have told the Guardian. If it does overspend, it could trigger an investigation by the Treasury and a review by the Public Accounts Committee. The last such overspend was in 2005-06.
Smoking bans in public places led to reductions in admissions to hospital for heart disease, according to a Cochrane review of 77 studies from 21 countries. The team of Irish researchers could not give a general figure for the reduced risk of heart disease because of the different methodologies used, but 33 out of 44 studies on heart disease showed a significant reduction in admissions with the rest showing a downward trend.
The Zika virus has been linked with four deaths in Columbia from Guillain-Barré syndrome which attacks the nervous system and causes paralysis. There is not yet any proof of a causal link.
The death rate from cancer after diagnosis has fallen by 10% in the last decade with a fall from 312 per 100,000 to 284 in 2013, according to figures from Cancer Research UK. However, the absolute numbers dying from cancer has continued to rise as the population rises and people live longer. Cancer survival rates continue to lag behind some comparable countries as they improve as well. There are also substantial regional variations.
The latest suicide figures have been published by ONS showing 6,122 suicides across the UK in 2014, 2% fewer than the previous year (although not all 2014 suicides will have been registered yet). In England, there was a 14% increase in the number of female suicides, while those amongst men remained stable, taking the total to 4,882 for those aged 10 and over, but still with the majority, 76% being men. There were 98 suicides amongst children aged 10-14 between 2005 and 2014.
Sir David Dalton, the Government’s negotiator with the junior doctors, has written to them directly about next week’s planned strike, criticising the BMA over intransigence for not considering at least part of Saturdays to be within the normal working week for which no extra payment is made.
Guidance on a framework for evaluating art projects’ contribution to health and wellbeing has been published by Public Health England. This is intended to support the provision of robust evidence so that the arts can be included in the commissioning of health and social care services.
03 February 2016
68% of GPs said their workload is unmanageable and 55% said the quality of the service they provide has deteriorated in the last year (against only 7.5% saying it had improved), in a survey of 2,837 GPs by the BMA. The survey covered 35% of England’s 7,962 GP practices. 92% of GPs said demand for appointments had increased in the last year. The BMA’s GP lead, Dr Chaand Nagpaul said the pressures on GPs mean they feel they are failing patients and potentially providing unsafe care.
Devolution deals should involve the public more in proposals, negotiations and outcomes, the Communities and Local Government Select Committee has said. It also said elected mayors should not be imposed on local areas as a condition for devolution and they should be allowed to propose an alternative.
Care for people who are dying is below expected standards at more than 40% of hospitals according to CQC figures, with 8 facilities classed as ‘outstanding’, 94 ‘good’, 67 ‘requires improvement’ and 7 ‘inadequate’. [This is described as data ‘supplied by’ the CQC, so does not appear to be new, but being used for what is more a feature than a news article.]
More nurse training places would have been commissioned by Health Education England if it wasn’t for the funding cuts in the comprehensive spending review. Its annual workforce plan had to be rewritten after it was awarded a flat cash settlement to 2020. However HEE believes the number of training places will be enough to meet future needs. Ian Cumming, HEE Chief Executive said more focus was needed on retaining nurses.
The number of people dying on the roads has remained largely unchanged, according to provisional figures for the year to September from the Department of Transport. Althought there was a 3% increase in the number of deaths to 1,780, this was not statistically significant. The numbers have largely plateaued over the last three years. In separate figures, about 240 people were killed where at least one driver was over the drink drive limit. The number of drink drive casualties reduced by 1% to 8,220, the lowest ever figure. The overall number of reported road casualties was 188,830, which per vehicle mile represented a reduction of 5%.
‘Public Health Transformation Three Years On’ is published by the LGA, consisting of a series of case studies.
A report on teenage pregnancy has been published by the LGA, bringing together case studies from local councils and highlighting examples of good practice. Although the under 18 conception rate has halved since the Teenage Pregnancy Strategy was launched 15 years ago, England still has one of the highest rates in Western Europe.
02 February 2016
Applications for GP training in 2016 have fallen by 5% from the previous year, to 4,863 applications for 3,790 places according to Pulse magazine. Last year, 5,112 applications for 3,609 places produced 2,769 trainees. Since GP training takes three years, this is the last cohort to be fully trained by 2020, by when the Government has promised 5,000 extra GPs. HEE said there are still some months of the recruitment process to run.
Alcohol related deaths were highest among 60-64 year old men at 47.6 deaths per 100,000, compared to 14.3 for the UK as a whole, according to ONS figures. The figure was 9.1 in 1994 and peaked at 15.8 in 2008. Of the 8,697 alcohol related deaths in 2014, 65% were amongst males. Scotland had the highest rate out of the UK countries.
46% of psychological professionals said they were depressed and 70% said they find their job stressful, in a survey by the British Psychological Society and New Savoy. Plans to increase mental health provision in GP surgeries are to be launched soon by the Royal College of GPs and NHS England.
109 GP trainees are to be offered a £20k golden hello to work in any of seven areas with the lowest training fill rates, HEE has said. The seven areas are: Lincolnshire, Northern Lincolnshire (Scunthorpe and Grimsby), East Cumbria, West Lakes, South Cumbria, Blackpool and the Isle of Wight.
Every hour spent sitting down increases the risk of type 2 diabetes by 22% according to Dutch research from Maastricht University, measuring the movement and activity over eight days of 2,500 people with an average age of 60. It found that those with type 2 diabetes were least active, being sedentary for an average of 26 more minutes a day.
People aged 65 to 79 are the happiest age group, with those aged 45-59 reporting the lowest levels of life satisfaction, according to ONS data from more than 300,000 adults across the UK collected between 2012 and 2015.
01 February 2016
Microcephaly linked to the Zika virus has been declared a global public health emergency by the WHO. That means that research and aid will be fast tracked to address the problem.
Scientists have been given approval to genetically modify human embryos by the Human Fertilisation and Embryology Authority, for research purposes only. The research, to be done at the Francis Crick Institute in London, will edit genes in the first seven days after fertilisation.
NICE have published a set of indicators for consultation on atrial fibrillation, diabetes care and weight management. They are proposed to help service development and to be used in the Quality Outcomes Framework and CCG Outcome Indicator Set. That led to the Mail Online presenting it as: “Pay GPs bonus for weighing patients and putting them on diets”.
Press release: http://www.nice.org.uk/news/press-and-media/nice-targets-stroke-with-possible-new-indicators-for-gps-and-clinical-commissioners
The junior doctors’ strike is due to go ahead on Wednesday 10th February for 24 hours, after talks broke down, but it will not now include emergency services as originally planned. The strike was originally going to be from 8:00 to 17:00.
GPs voted at their special conference to stop looking after care home residents, and the BMA is likely to lobby the Government for such a change as part of the new contract negotiations according to a report in the Daily Mail. It is argued that such patients require specialist care which would formerly have been provided in hospital. In a subsequent report, the BMA deny reports that GPs are to stop seeing patients in care homes but say there should be changes to how such people are cared for, to include hospital doctors and nurses as well as GPs.
Films are the ‘last frontier’ for tobacco promotion and those showing smoking should be given an adult rating, according to the WHO. They say that in 2014, 44% of all Hollywood films and 36% of those rated for young people showed smoking.
Increased loneliness risks crippling NHS finances as more isolated older people are cared for in hospital, according to NHS England’s Director for Acute Care, Prof Keith Willett. The LGA is this week sending a ‘Combatting Loneliness Guide’ to the 370 councils it represents [see item 28th January]
The split of health spending across ages is presented in estimates for the Guardian by the Nuffield Trust. It finds that more than two fifths of national spending on health goes to those over 65. Average spending across all age groups is £2,069 per person, but it is £7,000 for those aged 85 and over.
Eating fibre rich fruit and vegetables can reduce the risk of breast cancer, particularly for teenage girls, for whom it could reduce the risk of ever getting cancer by 16% and of getting it before the menopause by 24%, according to research by the Harvard School of Public Health, analysing data on more than 90,000 women over a 25 year period, published in the journal Pediatrics.
31 January 2016
The Social Mobility Index is published by the Social Mobility and Child Poverty Commission, shows the different chances that children from poorer backgrounds have of doing well at school, finding a good job and having a decent standard of living. It shows that some well off areas, such as Oxford Worcester and Northampton, are worse at providing opportunities for their disadvantaged children than more deprived areas.
Press release: https://www.gov.uk/government/news/kids-education-and-employment-opportunities-ranked-by-area
30 January 2016
A special conference of GPs hears that surgeries are in a state of emergency, with up to 70 patients a day seen on a conveyor belt of 10 minute appointments, which is not safe. The comments were made by Dr Chaand Nagpaul, head of the BMA’s GP Committee to the special conference of local medical committees.
The BMA has moved closer to a mass resignation by GPs as a way of forcing government to produce a rescue package for general practice. At the special conference on 30th January, a motion was passed proposing that the BMA’s GP Committee should canvas GPs on their willingness to submit undated resignations unless negotiations with government for a rescue package for general practice is not concluded successfully within six months.
GPs are to explore ways in which they could lawfully withdraw from CQC inspections. A motion at the special conference of GPs on 30th January asked the BMA’s GP Committee to explore the question and to consider an alternative model of self-regulation based on peer review. In a BMA survey of 1,900 practices, 80% said that an inspection reduced time available for caring for patients, 70% spent money on staff overtime preparing for the inspection and three quarters reported that staff suffered significantly increased stress preparing for and undergoing the inspection.
Proton beam therapy is as effective as conventional radiotherapy but without the side effects, according to research published in the Lancet Oncology. The treatment was at the centre of a controversy in 2014 when Ashya King was taken out of hospital and abroad to have the therapy.
GPs are calling on the BMA to campaign for longer appointment times with patients and fewer appointments during the day to ease the pressures on GP workloads. The GPs’ special conference passed a motion which said that current working practices may be a threat to patient safety and to GPs’s health.
An interesting example of publicy available data in a hospital to drive improvement from the Golden Jubilee hospital in Clydebank.
29 January 2016
Hospitals in England will need to consider cutting their staff numbers as part of the approach to dealing with the financial crisis, according to a letter sent by Monitor and the TDA to trusts which says: ““We will be meeting a number of challenged providers this month to agree a set of actions, including headcount reduction, additional to the current plan, with the clear intention of improving the financial position of those individual providers.” This changes the policy following the Mid-Staff scandal of prioritising having sufficient staff to ensure patient safety and quality of care.
The Government needs to prepare for councils running out of money to run services and provide transitional help as government grant is gradually withdrawn from councils, the LGA has said in its response to the Local Government Finance Settlement consultation. Even if all 152 councils with social care responsibilities implemented the 2% precept for adult social care, it would only raise £400m, while councils face extra costs of at least £800m in 2016-17 including £340m to implement the living wage and the costs of extra demand. The LGA is asking the Government to bring forward funding planned for later years.
The Government is backing a private member’s bill that would allow wider access to experimental drug treatments by allowing doctors to search a new databse of drug trials and drugs licensed for a different purpose to see if any might be appropriate for their patients.
Three quarters of councils say they are still using 15 minute home care visits, though a third said these were for quick checks for justifiable reasons, according to information from foi requests by Unison received from all 152 councils with social care responsibilities. The union also received feedback from 1,100 care staff via an online survey.
Press release: https://www.unison.org.uk/news/press-release/2016/01/three-quarters-of-councils-still-insisting-on-15-minute-homecare-visits-for-elderly-and-disabled-people-reveals-unison-report/
A vaccine for the Zika virus could be ready for testing on humans later this year a Canadian company has said. It could be used in a public health emergency in October or November. The WHO warns that the virus could spread to Africa, Asia and Southern Europe.
Productivity growth for the NHS was 2.07% for the year from 2012-13 to 2013-14, according to the latest in a series of reports on NHS productivity from the Centre for Health Economics at York University.
There has been a surge in demand for NHS111 and A&E over the past few weeks.
Conservative led East Sussex Council has complained to the Prime Minister over ‘unrealistic’ budget cuts which it says will significantly reduce the quality of life for people in its area. It says the cuts will have to include preventive services which will cost more in the medium term than is saved short term.
A Bill to reduce the drink driving limit is being debated in the House of Lords. The Bill proposes lowering the blood-alcohol concentration limit from 80mg to 50mg per 100ml of blood. It is supported in a letter to the Times by the Alcohol Health Alliance, whose members include the Royal College of Physicians, the BMA and Alcohol Concern.
A report on ‘Monitoring change in health care through statistical process control methods’ has been published by the Nuffield Trust.
A report on Faith at the end of Life has been published by Public Health England, designed to provide “information to help ensure that commissioning and delivery of services and practice takes account of spiritual needs of the largest 6 faith groups in England and remains appropriate to the community setting in which they work.”
28 January 2016
Britain has the lowest rates for breastfeeding at 12 months in the world (for the 153 countries for which data was available) according to a report published in the Lancet as part of a series on breastfeeding. In the UK only 0.5% are still breastfeeding after a year, compared to 23% in Germany, 56% in Brazil and 99% in Senegal. In general there are higher rates in lower income countries. Babies who are breastfed have higher IQs, lower death rates and less risk of infection. For the mother it helps protect against breast cancer and may reduce the risk of ovarian cancer and Type 2 diabetes. Universal breastfeeding could save the lives of over 800,000 under fives per year globally.
Too many elderly people go to A&E unnecessarily because of a lack of appropriate support enabling them to be cared for at home or in their care home according to the NHS Confederation’s Commission on Improving Urgent Care for Older People. It cites examples of good practice round the country and calls for more to be done.
The number of over 90 year olds arriving at A&E by ambulance has increased by 61% in five years according to figures from the HSCIC, with Labour blaming cuts to social care for the rise.
The proportion of diabetics receiving all 8 recommended annual checks has fallen to the lowest level since records began six years ago, with 39% of Type 1 and 59% of Type 2 receiving all eight, according to the HSCIC. The figures were worse for those under 40. There was a wide variation across the country in those receiving all eight checks from 25% to 81%.
CQC ‘experts by experience’ inspectors are having to reapply for their jobs on half the pay after the contract in a number of areas was won by Remploy, the former government agency now a for-profit company owned by the US outsourcing company Maximus. Hundred of staff are said to be about to quit their roles. The reduction is from £17 to £8.25 an hour (the living wage). Remploy have taken over three of the four contract areas previously managed by two charities, Choice Support and Age UK. The experts provide real life experience to add to that of the other inspectors.
CQC response: http://www.cqc.org.uk/content/update-experts-experience
(29/01/16) Remploy confirms it doesn’t have enough staff to carry out inspections when it takes over the contract on 1st Feburary: http://www.independent.co.uk/life-style/health-and-families/health-news/remploy-private-company-responsible-for-inspecting-care-homes-admits-it-does-not-have-enough-staff-a6842366.html
The BMA is advising GPs to stop providing a number of ‘inappropriate’ services which they should not have to do, such as wound care management, nursing care of leg ulcers and prescribing medication for housebound patients, so as to cut down on the workload and improve the overall quality of care, according to the Mail Online.
The increased risk of ‘suicidality’ amongst under 18’s taking some common antidepressants has been confirmed in a review of 70 clinical study reports of trials involving 18,526 people, by the Nordic Cochrane Centre and the University of Copenhagen, published in the BMJ. This effect has been known about for some time. The study looked at the effect of five antidepressants (SSRIs and SNRI) on death, ‘suicidality’ (suicidal thoughts, suicide attemtps or self-harm), agression and akathisia (an unpleasant sense of restlessness and agitation). The risk of suicidality amongst under 18s rose by 239% but involving small numbers, from 1 in a hundred to 3 in a hundred. There were no incidents of actual suicide (although the participants were closely monitored during the trials). The same effects were not seen in adults.
There has been a rise in deaths and self-harm in prisons according to figures from the Ministry of Justice. Part of the reason for the increase is the rising and ageing prison population.
Consultation on the proposed new nursing associate role have been published by Health Education England.
Loneliness should be recognised as a major public health concern according to an LGA guide for local authorities. As well as the personal cost, it is increasing demand on social care and health services. It is estimated that 10-13% of older people are lonely with 17% in contact with family, friends or neighbours less than once a week. Loneliness is estimated to increase the risk of premature death by 30%.
Waiting times in Wales for many diagnoses and treatments are longer than in England according to official figures.
A Commission on Improving Urgent Care for Older People says that care should be tailored around individuals rather than institutions.
The Cities and Local Government Devolution Act received Royal Assent allowing for the creation of ‘metro mayors’ and the devolution of powers including transport, health, skills, planning and job support. The Prime Minister has also announced an Aberdeen city regional deal.
Lessons in using a panel of citizens for engagement following two years of the operation of a 31 person panel (the PANORAMA panel) in Ontario have been published by the Change Foundation.
Resources to help improve social work across the mental health sector have been published by the DH. They consist of a strategic statement, a self-assessment and guidance on getting feedback from service users, carers and families.
27 January 2016
The Government has been defeated in the Lords over its plan to cut the benefits of sick and disabled people by £30 a week. The House of Lords voted by 283 to 198 against the proposal to cut by £30 a week the employment and support allowance for those in the work related activity group (WRAG) who are deemed too ill to work but well enough to do preparation for work such as training. There are about 500,000 in this group and the cut would save £1.4bn over four years. Theh proposal will now go back to be reconsidered by the Commons.
The bedroom tax amounted to unlawful discrimination in two cases, that of a victim of extreme domestic violence and and for the grandparents of a severely disabled teenager, in a ruling by the appeal court. In one case a secure panic room to provide protection from a violent ex-partner and in the other a specially adapted room to provide overnight care had been classed as ‘spare rooms’. The DWP has said it will appeal to the supreme court.
There are insufficient mental health services for children who have suffered sexual abuse, according to an NSPCC survey of 1,256 psychologists, teachers, GPs, social workers and other health professionals, 96% of whom said there was not enough help for such children. 78% said accessing help had become harder in the last five years.
Adults who care for relatives’ children are to be exempt from the new two-child benefit limits following a Government u-turn announced in the House of Lords. Child tax credit is to be limited to the first two children from April 2017, but this will not now apply to ‘kinship carers’. It was argued that the policy might reduce the number of people offering such care, leaving the state to pick up the cost.
It could be 10 years before a vaccine for the Zika virus is publicly available American scientists have said. A vaccine could be ready for testing in two years but it would then take much longer for it to be approved by regulators. President Obama has called for the rapid development of tests, vaccines and treatments.
Children at risk of poverty rarely have access to high quality early years care according to a report by the Family and Childcare Trust which says that the Government’s childcare policies are fragmeneted, uneven and failing to deliver for families in poverty.
Press release: http://www.familyandchildcaretrust.org/stronger-focus-quality-and-early-intervention-needed-deliver-better-childcare-low-income-families
Link to the report: https://www.jrf.org.uk/report/creating-anti-poverty-childcare-system
A 1% cut in social housing rents is to be deferred for a year for sheltered housing to allow for a review of the housing sector to be completed, the Government has said.
The Government has now provided definitions of which supported housing this will apply to: http://www.housing.org.uk/latest-updates/clarification-from-clg-on-supported-housing-rent-reduction/
Requests to breach the cap on agency staff have been made to the regulator by over a quarter of NHS trusts, with 69 applications and 54 of 239 trusts having their ‘ceiling’ lifted.
Thousands of community pharmacies are likely to close because of £170m cuts, according to a Government minister, Alistair Burt, Minister for Community and Social Care. The comments were made at the All Partly Pharmacy Group earlier this month. He said that between 1,000 and 3,000 of the 11,600 pharmacies might have to close.
Student nurses and midwifes are planning to walk out of their clinical placements to protest against the Government’s proposal to remove bursaries, for an hour on 10th February, to coincide with the next planned junior doctors’ strike. This is to be part of a week’s campaigning on the issue.
Progress has been made in identifying the biological basis for schizophrenia. A genetic analysis of nearly 65,000 people identified a defective gene that appears to trigger excessive pruning of unwanted connections between brain neurons in adolescence which it is thought underlies the condition. It is hoped this could lead to more effective treatments targeting the causes rather than symptoms.
Examples of how CCGs are helping prevent ill-heatlh are given in a publication, ‘Delivering a healthier future: How CCGs are leading the way on prevention and early diagnosis’, published by NHS Clinical Commissioners.
‘Making Devolution Deals Work’ is published by the Institute for Government, arguing that the timescale for devolution has been very compressed and many are unclear about the future.
26 January 2016
There has been a rise in the number of mental health patients dying unexpectedly in NHS care, from 1,412 to 1,713 in three years, according to figures obtained by Norman Lamb MP who blamed underfunding of sometimes threadbare mental health services and called for an investigation into the causes. There was a 31% increase in the number of serious incidents reported between the year 2012-13 and 2014-15. It is possible that a more open culture, encouraging the reporting of incidents, may have contributed to the increase.
The Government has reversed its policy of imposing a benefit cap on people who care for adult relatives for more than 35 hours a week. The announcement was made during a debate on the Welfare Reform and Work Bill, in response to a Labour amendment proposing the change. A court judgement two months ago found that the policy unfairly discriminated against disabled people.
NHS 111 may not able to identify some potentially deadly diseases according to an NHS England report, seen by the Daily Mail and BBC News, following the death of one year old William Mead. The baby had also been seen by doctors who had not identified the relevant problems.
Jeremy Hunt accepts the recommendations in the report and said they will be implemented as soon as possible: http://www.theguardian.com/society/2016/jan/26/hunt-apologises-to-family-of-boy-who-died-after-nhs-failed-to-diagnose-sepsis
Hunt apologies and says lessons will be learned: http://www.bbc.co.uk/news/health-35410840
Hunt says the algorithms used by NHS 111 will be changed. http://www.bbc.co.uk/news/health-35410840
Jeremy Hunt has met the baby’s mother to apologise: http://www.independent.co.uk/life-style/health-and-families/health-news/william-mead-family-of-dead-baby-was-let-down-by-nhs-in-worst-possible-way-says-jeremy-hunt-a6835731.html
The benefit cap on social housing could put 82,000 specialist homes under threat of closure because of the extra costs of providing sheltered accommodation, that would no longer be covered, according to housing associations and charities. The cap is to bring housing benefit for social housing in line with that for private tenants.
The higher rate of depression amongst women has been linked to their lower average wages in U.S. research based on a survey of 22,581 adults aged 30-65, published in the journal Social Science and Medicine. It found that for women paid the same as their colleagues there was no difference in diagnoses of depression between men and women, but those paid less had 2.5 times the risk of major depression.
The number of people receiving personal health budgets is to increase to 100,000 by 2020 according to NHS England.
Negative messages about sugary food led dieters to eat almost 40% more of it according to research by Arizona State University published in the Journal of the Association for Consumer Research. There was no effect for non-dieters. There were three stages to the study involving between 300 and 400 participants, hearing positive, negative or balanced messages then being assessed for changed perception or the amount eaten while watching a video. Dieters who saw a balanced, two-sided message chose 37% fewer unhealthy snacks.
The NHS is only the 14th best health system in Europe, conflicting with other assessments, according to a Swedish based private company, Health Consumer Powerhouse. It says that insurance based (‘Bismark’) systems perform better than ‘Beveridge’ type systems where one body funds and provides most services.
Press release (pdf): http://www.healthpowerhouse.com/files/EHCI_2015/EHCI_2015_press_release.pdf
Police, fire and ambulance services should have shared control rooms, Home Office minister Mike Penning has said.
A private member’s bill to reverse many of the recent health reforms is being introduced by Caroline Lucas, who is calling on Labour to support it. The Bill is to receive its second reading on 11th March, but few such Bills end up becoming law. The NHS Reinstatement Bill was first introduced into Parliament last July and would abolish NHS trusts and CCGs.
Updated standards for social workers have been published by the Health and Care Professions Council.
Resources to help organisations in ‘Making Every Contact Count’ have been published by PHE. This aims to use everyday contact to help people make positive changes to their physical and mental wellbeing.
25 January 2016
The zika virus is likely to spread across nearly all of the Americas, the WHO has said, describing the outbreak as ‘extremely worrisome’. The virus has been associated with babies being born with small brains. It is thought only Chile and Canada will escape the virus because they are too cold for the mosquitoes which carry the virus.
The House of Lords has voted to keep child poverty targets based on relative income which were to have been abolished in the Welfare Reform and Work Bill, which would also therefore have scrapped the requirement to abolish child poverty by 2020. The Lords voted 290 to 198 for an amendment proposed by the Bishop of Durham. It will now be reconsidered by the House of Commons.
The number of specialist mental health nurses has fallen by more than 10% over the last five years from 41,320 in 2010 to 36,870 in 2015, despite an increase in the number of people in contact with NHS mental health services by up to 40% over the same period, according to figures from HSCIC obtained by Labour through a parliamentary question.
The UK is vulnerable to future epidemics because of a lack of capacity to manufacture vaccines according to the Science and Technology Committee. They also said the Government’s response to the Ebola crisis was undermined by systematic delay.
Advertising of unhealthy foods increases consumption in children, but not adults, according to an analysis of 22 previous studies by Liverpool University, published in the American Journal of Clinical Nutrition.
The CQC plans to inspect adult social care less frequently because of a proposed cut to its budget from £249m this year to £217m in 2019-20, it says in its draft strategy for 2016-21. It intends to make better use of intelligence and focus on areas of greatest risk.
The WHO ‘Commission on Ending Childhood Obesity’ has been published, recommending action from before conception through pregnancy and on to adolescence, including promoting better diets and more activity through such things as taxes, education, guidance, marketing, labelling of products and regulation.
Cuts are harming the relationship between social workers and their clients according to research commissioned by the Health and Care Professions Council to support its review of the standards of proficiency for social workers.
A £3bn fund to defeat malaria is being set up by Bill Gates and the British government, with the Government contributing £500m a year over the next five years.
Chronic fatigue syndrome is more common amongst children than previously thought, particularly 16 year old girls, and is more common among children from poorer families, according to a study by Bristol University, asking more than 5,700 parents and children about their experience of persistent exhaustion, published in the journal Pediatrics. The research was based on responses to questionnaires rather than diagnoses by a doctor.
Paint on some playground equipment has been found to contain toxic levels of lead, according to analysis of paint from 47 playgrounds in the south west of England by Plymouth University, published in the journal Science of the Total Environment.
The Government is considering scrapping social work bursaries according to leaked reports. Government funding for social work students on universtiy-run degree programmes has fallen by 30% in the past three years.
The NHS is to create 100,000 apprenticeship opportunities by 2020 in roles including nursing and healthcare, IT estates and facilities, domestic and housekeeping services and business administration and accounting.
Chronic stress and anxiety can damage parts of the brain, leading to depression and dementia according to research bringing together a number of recent studies, led by the University of Toronto and published in the journal Current Opinion in Psychiatry.
24 January 2016
The NHS spent £17.8m p.a. on agency midwives in 2014, an increase from £10m in 2012, according to a report from the Royal College of Midwives.
22 January 2016
Action on diabetes prevention and treatment has been too slow by Government and the NHS, according to a report from the Public Accounts Committee. The cost for those aged over 16 is £5.5bn a year. The number of adults with diabetes is going up by 5% a year, fuelled by increases in obesity. The committee criticised unacceptable variations in education, care and treatment.
The alcohol industry makes most of its sales, 69%, to problem drinkers, those who are risking or damaging their health, according to research from Southampton University. Separate work from Sheffield University indicates that £23.7bn of sales come from drinkers jeopardising their health. Those classed as ‘harmful’ drinkers account for almost a quarter of alcohol sales but make up less than 5% of the population. The number of hospital admissions related to alcohol have doubled in the last ten years, to over 1 million, with alcohol costing the NHS £3.5bn a year.
More than a dozen health organisations have called for a 20% tax on sugar in a letter to the Prime Minister. The organisations include the BMA and the Royal Society for Public Health.
The number of people who had to be turned away from A&E rose to 52 in the first two weeks of this year compared to 35 in the same period last year, indicating the increasing pressure A&E departments are coming under, according to NHS data. There were 318,442 A&E attendances at NHS trusts with a major A&E department last week compared to 299,281 in the same week last year.
A disproportionate number of medical students come from better of backgrounds, particularly in Scotland, Wales and Northern Ireland, according to research by Dundee and Central Lancashire universities looking at applications over three years between 2010-12
Pilots into the use of new technologies have been announced by NHS England, including wearable monitors, better use of data and apps to manage mental health conditions.
A report on how councils can use behavioural insights to help people make better health choices has been published by the LGA.
21 January 2016
The zika virus is spreading on a pandemic scale in southern and central America. The virus is carried by mosquitoes and is thought to be linked to babies being born with undeveloped brains. There is currently no vaccine or drug treatment for it. The US Centers for Disease Control has advised pregnant women not to visit infected areas.
An international declaration on antimicrobial resistance has been signed by 83 companies and 8 industry associations from 16 countries, announced at the World Economic Forum in Davos. Amongst other things, it recommends quicker diagnosis to improve how antibiotics are prescribed and reducing incentives for prescribing antibiotics. It suggests changing the financial basis for developing and prescribing antibiotics so that it matches the value to society.
Between 10% and 20% of consultant led maternity units should be closed because of a shortage of maternity doctors, according to the president of the Royal College of Obstetricians and Gynaecologists, Dr David Richmond. He said there should be an expansion in the number of midwife-led units.
The Southern Health mental health trust had been warned about health and safety failings four years ago, although its Chief Executive says these failings were addressed and do not relate to last year’s independent review of deaths of people with learning disabilities and mental health needs. The accusations were made by a health and safety specialist, Mike Holder, who was employed by the trust for three months in 2011.
A report on progress of the ‘Integrated Care Pioneers’ has been published by NHS England, describing what has happened in each area in the last two years.
A report showing how difficult it is for the average British family to eat a healthy diet has been published by the Food Foundation. The report is called, ‘Force-Fed’.
Guidance on ‘harmful drinking and alcohol dependence’ has been published by PHE.
20 January 2016
A&E departments are significantly understaffed nearly half the time according to a leaked NICE report which was never published after pressure from the government and transfer of responsibility for safe staffing to NHS Improvement. The document was leaked to the Health Service Journal. The draft report makes recommendations including staffing ratios of nurses to patients and suggests a ‘red flag’ warning system to indicate when departments are struggling to cope.
Britain’s spending on health is falling compared to some other European countries when measured as a proportion of GDP and would require an additional £43bn a year by 2020 to match them, according to an analysis for the Guardian by the King’s Fund’s John Appleby. If spending on health kept pace with the predicted growth of the UK economy, an additional £16bn p.a. would be spent on it.
More GP appointments in the early evening could reduce unnecessary visits to A&E in urban areas, according to research led by Imperial College and due to be published in the journal Pediatrics. The BMA suggested the study showed that improvements need to be made to out of hours services.
There are more deaths globally from heart disease from eating insufficient polyunsaturated fats than too much saturated fat, with the former making up 10.3% of such deaths compared to 7.7% of the latter, according to American Heart Association research led by the Tufts Friedman School of Nutrition Science and Policy, published in the Journal of the American Heart Association.
19 January 2016
UK GPs are the most stressed of 11 industrialised countries according to the Washington based Commonwealth Fund think tank. The survey, which included 1,001 from the UK found that 59% said their work was stressful and nearly 30% were planning to quit in the next five years. It found that British GPs spend less time with their patients, with 92% saying they spent less than 15 minutes with each, compared to 27% internationally.
The junior doctors’ strike planned for 26-28th January has been called off to allow more progress to be made in the talks.
(22/01/16) A leaked letter says the Government has retracted some of its demands on which hours would incur overtime: http://www.independent.co.uk/news/uk/politics/junior-doctors-government-retreats-on-some-of-its-cuts-to-out-of-hours-pay-says-leaked-letter-a6828406.html
Most of the 2.6m p.a. stillbirths globally could be avoided and barely no progress is being made in preventing them, with little chance at present of meeting international targets, according to studies published in the Lancet. Britain ranks 21st out of 186 countries with a rate of stillbirths of 2.9 per 1,000 total births (the range is from 1.3 in Iceland to 43.1 in Pakistan). It is estimated that there are 720 unnecessary stillbirths in the UK each year. The UK was ranked at 114 out of 164 countries in its rate of progress over the last 15 years.
The scheme to recruit 200 ‘physician associates’ has so far led to only 35 job offers, only 6 of them in General Practice, according to Pulse magazine based on information from Hillingdon Hospitals NHS Foundation Trust.
Nurses and midwives from the EU will have to prove they are fluent in English, bringing them into line with those from outside the EU, under new requirements by the Nursing and Midwifery Council.
A compendium of statistics on dementia has been published by HSCIC. It shows prescriptions for Alzheimers having risen six fold over the ten years from 2004, from 502,000 to over 3 million.
Guidance on obesity in adults is published by NICE, covering prevention and lifestyle weight management programmes.
GMC chief executive Niall Dickson is to step down at the end of the year.
18 January 2016
The GP Patient Survey finds 18.7% of respondents saying their surgery opening hours were inconvenient, equivalent to 10.2m people, with 18.1% having to wait a week or more for appointments. The proportion backing Sunday surgeries has risen from 31.7% in 2012 to 41.6%.
The Government’s new voluntary contract for GPs is a move towards larger organisations directly employing GPs the BMA’s GP Committee has said. They said that GPs could be asked to move en masse to the new arrangements which could be for shorter term contracts than at present.
The Government’s willingness to impose a contract on junior doctors has been confirmed by David Cameron, who said they should not have a veto on progress in the NHS.
Direct payments for residential care, which were planned to be rolled out from 2016, are to be delayed until 2020 the DH has said. Existing payments in the 17 pilot areas will be able to continue.
People with dementia suffer poorer health in hospital according to a report from the Alzheimer’s Society based on foi requests and a survey of 570 dementia patients which found examples of poor care. It found that 92% of people affected by dementia found hospital environments frightening. A number of people with dementia were being inappropriately discharged at night.
(31/12/14) Press release: https://www.alzheimers.org.uk/site/scripts/news_article.php?newsID=2537
Research on health inequalities has been published by the Centre for Health Economics at the University of York. The research has developed new health equity indicators for the NHS and outlines some of the consequences of inequalities. It found that social inequality was associated with nearly 38,000 deaths from treatable conditions. The most deprived fifth of neighbourhoods had nearly two and a half times more preventable emergency hospitalisations as the least deprived fifth.
Trying to meet QOF targets could lead to riskier prescribing according to Imperial College research looking at adverse drug reactions, published in BMJ Open.
Fluoride is to be added to schoolchildren’s milk in Blackpool to try and tackle problems of tooth decay, after approval of the scheme by the Council who will implement it with PHE, the local NHS Trust and the Borrow Foundation charity.
Those living 16 floors or higher have little chance of surviving a heart attack according to Toronto researchers who looked at the cases of nearly 8,000 people who suffered a heart attack at home between 2007-12, with the results published in the Canadian Medical Association Journal. It is thought the likely reason is the time it takes to reach the patient in such cases.
The Guardian begins a four week intensive look at the NHS, ‘This is the NHS’.
17 January 2016
The NHS is to impose a surcharge on sugar in the products sold in its premises, the head of the NHS in England, Simon Stevens, has said. It will be gradually implemented over the next five years.
15 January 2016
26% of adults have been diagnosed with a mental illness in their lifetime, according to the annual health survey for England, of 5,000 adults by the National Centre for Social Research, published by the HSCIC. A further 18% said they had experienced symptoms but had not been diagnosed. The most common mental illness was depression, at 19%. More women than men had ever been diagnosed with a common mental disorder, at 31% to 17%. (This is an update to the report on the survey published on 16th December).
Press release: http://www.hscic.gov.uk/article/6911/A-quarter-of-adults-diagnosed-with-a-mental-illness-in-their-lifetime
The report: http://www.hscic.gov.uk/catalogue/PUB19295
Jeremy Hunt says patient safety can’t be guaranteed in the proposed junior doctors’ strike on 10th February. Sir David Dalton, who he asked to lead the negotiations, said that last week’s strike had shown the BMA could ‘land a punch’ on the Secretary of State for Health.
Bereaved families may no longer be formally asked for consent for organ donations from registered donors, but rather will be given a leaflet explaining the general situation, in the light of 547 such donations being blocked since 2010 (14% of the total), which led to an estimated 1,200 people not receiving transplants. NHS Blood and Transplant says it expects the change to increase donations by 9%.
Food should have labels showing how much activity is needed to burn off its calories, the Royal Society for Public Health has proposed. Representatives of the food and drink industry have said it is an idea worth considering. Pictures might show how many minutes of walking or running were needed to burn off the calories. In a survey of 2,000 adults, the RSPH found 63% were in favour of such labelling.
Local areas should make more use of local data from a range of sources to improve services according to a report from Policy Exchange.
14 January 2016
The creation of a new professional body for social workers, to improve standards and in time become the new regulatory body for social work has been announced by the Government. The Secretary of State for Education, Nicky Morgan, also announced £100m government funding towards recruitment of social workers through the Frontline programme and Step Up to Social Work scheme. Frontline, an independent charity, has so far trained 220 recruits and aims to get 1,000 graduates into children’s social work by 2020. Funding of ‘up to’ £20m is also to be made available for a new ‘What Works Centre’ [a number of which already exist in other service areas] to help share learning from good practice. (It is unclear at this stage how that would relate to the existing Social Care Institute for Excellence). By 2020, social workers are to be assessed against a ‘knowledge and skills’ statement developed by chief children’s social worker Isabelle Trowler.
(26/01/16) Feature article: http://www.theguardian.com/society/2016/jan/26/bold-reforms-childrens-social-workers-nicky-morgan
The NHS continued to miss many of its key targets in November according to the latest monthly figures. The A&E four hour target was only met in 91.3% of cases, the worst performance since the start of those records in 2010 (the proportion seen in hospital A&E’s was 87.1%). Other targets missed included that for diagnostic tests within six weeks, ambulance response times for serious cases, the 62 days for the start of cancer treatment and answering NHS 111 calls within 60 seconds. The number of delayed transfers out of hospital was the second highest since recording begain in 2010.
Permission for nurses from outside the EU to work in England were refused in 2,341 cases last year, according to figures from freedom of information requests to the Migration Advisory Committee.
E-cigarettes ‘do not help people quit smoking’ but on the contrary people using them are 28% less likely to quit, according to a systematic review of 38 previous studies led by the University of California San Fransisco and published in the Lancet Respiratory Medicine. However the authors of a PHE report endorsing the use of e-cigarettes to stop smoking criticised the research including on the grounds that it only looked at current smokers, not former smokers who may have used e-cigarettes to help them quit. There has also been criticism from a number of other academics: one of the grounds is that this included studies of people using e-cigarettes but who were not trying to quite smoking.
Cigarette style warnings on fizzy drinks reduced the proportion of parents who said they would buy them for their children from 60% to 40%, according to research involving an online survey of 2,381 parents with at least one child aged 6-11, by the University of Pennsylvania, published in the journal Pediatrics. When shown labels with the number of calories, the proportion saying they would buy them for their children was 53%.
Many doctors are inadequately trained in end-of-life care according to a report by the BMA.
The experience of maternity services by people with learning disabilities has been gathered in research by CHANGE and the Patient Experience Network, supported by NHS England.
58% of the 1,391 ‘counties’ in Europe had more deaths than births meaning a ‘natural decrease’ in population, compared to 28% of the 3,141 counties in the USA, in the first decade of the 21st century, according to research by US researchers published in Population and Development Review. The UK, and particularly England, had a ‘natural increase’ in population.
Progress on the ‘Think Autism’ strategy has been published by the Department of Health.
Case studies of how councils are helping people with autism have been published by the LGA.
13 January 2016
Around 40% of councils are cutting their stop-smoking services according to a report by the charity Ash based on a survey of the views of tobacco control experts from 126 local authorities across England.
12 January 2016
Junior doctors in England go on strike for 24 hours after agreement couldn’t be reached on a new contract. 3,300 operations have been cancelled. There are more than 55,000 junior doctors in England, 37,000 of them members of the BMA. According to NHS England 10,000 junior reported for duty out of 26,000 scheduled to work, although some of those had agreed to provide emergency cover.
Being fat or obese may increase the spread of prostate cancer round the body according to research on mice and on human cells, led by Toulouse University in France and published in Nature Communications.
Data on dementia has been brought together in a new ‘dementia profile’ and ‘data catalogue’, by PHE. It includes data at both local authority and CCG levels.
Press release: https://www.gov.uk/government/news/using-data-to-improve-dementia-care-in-england
The dementia profile: http://fingertips.phe.org.uk/profile-group/mental-health/profile/dementia
11 January 2016
The Prime Minister has promised an ‘all-out assault on poverty’, with a focus on: family life and early years; education; equal opportunity; and treatable problems such as mental health and addiction. He also said he would flatten ‘sink estates’ that design in, rather than design out crime. He praised competition, high expectations and personal resilience [an individualistic rather than social approach]. He announced a relaunch of parenting classes. On mental health, he announced: £290m up to 2020 on perinatal mental health support for 30,000 women a year; £247m over five years for every A&E to have mental health services; teenagers with eating disorders to be seen within a month; and at least half of people with psychosis for the first time to be seen within two weeks.
09 January 2016
There should be an independent commission into health and social care with bold action to ensure the system is fit for purpose, according to almost 40 charities and three former secretaries of state for health.
Student nurses and midwives have marched in protest at the scrapping of bursaries, in London, Manchester and Newcastle.
08 January 2016
New draft guidelines for alcohol consumption have been published by the government. The guidelines reduce the upper limit for men to the same as that for women, 14 units a week. The review found that there was no justification of drinking for any health benefits and that any level of drinking raises the risk of a number of cancers. The 14 units should be spread over three or more days, rather than just one or two, and there should be several alcohol free days each week. The guidelines say that no level of alcohol consumption is safe in pregnancy. The guidelines are now open for consultation until 1st April.
A report on how the living conditions of gypsies and travellers lead to poor health commissioned by the National Inclusion Health Board has been published by DH. It found that two thirds of gypsies and travellers report poor health or worse.
A report on how educating health professionals can help the support of homeless and other vulnerable groups has been published by the Department of Health.
04 January 2016
A brand of e-cigarette could be prescribed on the NHS after it received approval from the UK medicines regulator to be marketed as an aid to help people stop smoking. The e-Voke is produced by British American Tobacco.
03 January 2016
The language used to describe people with mental illnesses affects others’ tolerance towards them according to a study from the Ohio State University, involving 700 people in three groups, published in the Journal of Counseling and Development. Attitudes were tested using an established 40 item questionnaire, ‘Community Attitudes Toward the Mentally Ill’ with participants randomly divided into those using the phrase ‘the mentally ill’ or ‘people with mental illnesses’. The questionnaire produces results in four domains but no overall score. Although there were not significant changes in all domains for all groups, where there were, the phrase ‘the mentally ill’ produced less tolerant results. This was true for each of the groups, undergraduates, counsellors and the community. This was thought to be the first research on the effects of labels on tolerance towards individuals.
02 January 2016
Alcoholic drinks should display the number of calories they contain, the Local Government Association has said to help tackle the obesity crisis.