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2016 Q2 April-June

Health and Wellbeing Policy Update: April – June 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).

30 June 2016

The number of alcohol-related hospital admissions in England increased by 3% in the year to 2014-15, up from 1.03m to 1.06m, and was nearly double the level of 2004-5, according to figures from the HSCIC.  Men accounted for 65% of the admissions and women 35%.  The number of prescriptions dispensed for the treatment of alcohol dependence has nearly doubled in ten years.  There were 6,830 deaths related to the consumption of alcohol in 2014, up by 4% from 2013 and up by 13% from 2004.  The report, ‘Statistics on Alcohol – England 2016’, brings together statistics from a number of sources, some already published.

A register of hospitality payments to doctors, nurses and pharmacists has been published by the Association of British Pharmaceutical Industry, but a third of healthworkers have opted not to provide relevant details.  That 30% collectively received £55m in hospitality and payment.  Overall, the pharmaceutical industry spent £340m working with health professionals and organisations, of which £229m (67%) was related to research and development.

A majority of the public continue to be satisfied with the NHS, with 60% satisfied, 23% dissatisfied and 16% answering ‘neither’ according to the annual British Social Attitudes Survey from NatCen.  93% of people think the NHS has a funding problem and 32% a severe problem.  It also found that 77% of people thought the class divide was fairly or very wide.

A clinical champion for social prescribing has been appointed by NHS England. The appointee, Dr Michael Dixon is the former chair of the NHS Alliance.  The role is to make the case for social prescribing.

Heidi Alexander has criticised John McDonnell for setting up a team of NHS policy advisers without telling her. Two of the advisers are said to be, or to have recently been, members of other political parties.
Letter from a participant defending the meetings:

Councils are planning to spend £308m more on adult social care this year according to the Government.

The integration of health and social care should make better use of existing staff rather than creating new roles, according to a report from the King’s Fund, commissioned by NHS Employers and the Local Government Association, ‘Supporting integration through new roles and working across boundaries.’  It says many of the skills required to deliver integrated care already exist in the workorce and engagement with the workforce from the outset is important.


29 June 2016

A new regulatory body for social workers is to be accountable to the Education Secretary and set up by 2018, according to government plans.  The new regulator, replacing the Health and Care Professions Council, is to be an executive agency based in the Department for Education and supported by the DfE and Department of Health.  The report says that social work regulation urgently needs reform.  Ministers decided not to have an independent regulator but to bring regulation closer to government to ‘effect change quickly’.  Five social work bodies and unions have urged the Government to drop plans for direct regulation.  The two chief social workers are backing direct regulation.
Statement by social work bodies objecting to direct regulation:
The chief social workers support direct regulation:

NHS Improvement is proposing a three pronged approach to savings, set out in a letter to NHS Trusts.  It said it will work with providers which had high pay cost growth out of step with the sector, to see how much of the growth could be eliminated.  It also said plans for merging of back office and pathology services on a regional basis should be produced by the end of July.  Regional managers have also been asked to identify planned care services heavily dependent on locum staff that could be merged or transferred to other providers.  The aim is to reduce a forecast deficit amongst providers this year from £550m to £250m.

23% of deaths in England and Wales in 2014 were avoidable, that is 116,489 out of 501,424, with the average person dying early losing 23 years of life, according to figures from the ONS.  The deaths could have been avoided through better healthcare or prevented by people living more healthily.  Avoidable death rates were highest in Wales and the North East of England and lowest in the South East of England.  Men accounted for 60% of the premature mortality.  The largest cause was neoplasms, i.e. cancers and non-cancerous abnormal tissue growth at 35% of avoidable deaths, with 27% from cardiovascular diseases.

Alternatives to admission to acute hospitals for over 65s are generally safe according to research by Bristol University and the University of the West of England, based on 19 studies and 8 systematic reviews published between 2010 and 2015.  Other options to acute admissions included hospital type services delivered in a patient’s home or a nursing home, admission to a community hospital and interventions by paramedic staff.  They looked at conditions such as COPD, stroke, heart failure, pulmonary embolism and pneumonia and all were considered safe except stroke which should be dealt with in specialist units.

‘Baby boxes’ are being given to new mothers for the first time in the UK at a London hospital, Queen Charlotte and Chelsea.  Such boxes have been distributed in Finland for some years and are credited with reducing infant mortality.  Babies can sleep in the box itself.  Also included are a foam mattress with waterproof cover, a cotton sheet and educational materials on how to reduce the risk of infant mortality, parent-child bonding and support into parenthood.  It is thought that the small size of the box prevents the babies rolling onto their fronts, which could contribute to sudden infant death syndrome.

No fines have yet been issued for people smoking in cars with children, with only three police forces in England and Wales reporting incidents, dealt with by a total of seven verbal warnings according to foi responses from 42 English and Welsh forces.  Police representatives said the law was difficult to enforce.  However the Department of Health said the law was about changing attitudes and behaviour rather than enforcement.

Opportunities in pathology services to make improvements could save £200m and boost quality, according to a report from the Nuffield Trust.  Some areas have made changes, but progress is being held back by a shortage of doctors, with 40% of doctors in the field over 55 and most of them planning to retire within five years.

Social care is to be merged with health in an Integrated Care Organisation to be led by Salford Royal Hospital. Nearly 450 social care staff are to be transferred to the new organisation.  The new body will also run mental health services and have responsibility for domiciliary and nursing home care.

One serving of butter a day has little effect on mortality and no significant link with cardiovascular disease or strokes according to a meta-analysis from Tufts University, Boston, of nine studies from 15 countries involving 640,000 adults.  It found that one serving (14g or roughly one tablespoon) of butter a day was associated with a 1% higher risk of death but no association with any type of cardiovascular disease.  However other experts said that this should not be seen as a carte blanche to consume large amounts of butter.


28 June 2016

The UK is in breach of its international human rights obligations, the United Nations Committee on Economic, Social and Cultural Rights has said.  It said that austerity measures are having a disproportionate effect on the most disadvantaged citizens, including women, children, people with disabilities and low-income families.  It was concerned about the high number of low-paid jobs and said more should be done to reduce homelessness and reliance on food banks.  It also noted that the poor are now paying relatively more and the rich relatively less tax.

Three quarters (74%) of children’s services are rated ‘inadaequate’ or ‘requires’ improvement’ as reported in Ofsted’s third Social Care Annual Report.  Of the 87 (57%) of authorities inspected so far, 21 (24%) are rated as ‘inadequate’, 43 (49%) ‘requires improvement, 22 (25%) good and 1 (1%)  outstanding.  Child protection is said to be the greatest challenge.  The report says that an ‘inadequate’ judgement is not related to size, levels of deprivation or funding, rather that the quality of leadership is the single most important factor.  Ofsted Chief Inspector Sir Michael Wilshaw said there was a problem of poor managers moving round the system.  Once in the care system, children are well looked after, with nearly 80% of children’s homes now rated good or better.  There was a wide variation in caseloads, from 7 to 34 children per social worker.
Press release:
The report:

Leaving the EU may make staff shortages in health and social care worse, it is being warned.  Existing plans to recruit GPs from Europe will face more hurdles according to those involved and the NHS Confederation says doctors and nurses from Europe may be put off from accepting jobs in this country.  Leaders in both health and social care have been reassuring workers from the EU how much they are valued.
(29/06/16) (Rgn)
A useful summary of a range of issues for health from leaving the EU:

Public trust in charities is at its lowest level since 2005 when monitoring began, according to a Populus survey of a representative sample of more than 1,000 people for the Charity Commission.  There is concern about aggressive fundraising techniques and how charities spend their money following a number of high profile incidents, with 33% of respondents citing media coverage as the main reason for trusting charities less.  Charities’ trust rating fell to 57% from 67% in 2014.

The number of children in poverty has increased by 200,000 to 3.9m in 2014-15 from 3.7m a year earlier according to figures from the DWP (these are figures for relative poverty, i.e. less than 60% of median income, including housing costs).  The overall number of people living in relative poverty rose from 13.2m to 13.5m.

Two thirds (67%) of parents think their child would never recover if they developed a mental health problem, so facing a ‘life sentence’, according to a poll of 2,061 adults by YouGov, for charity MQ: transforming mental health.  In terms of how mental health might affect the child, 49% said they feared their child might never meet a partner or have a family, 48% that they might never get a job and 44% that their child might be taken away from them.  The charity is calling for more research into mental health.

NHS Improvement is consulting on a combined oversight and improvement framework to replace Monitor and the Trust Development Authority’s risk assessment and accountability frameworks.


27 June 2016

Diane Abbott replaces Heidi Alexander as Labour’s shadow Health Secretary following a series of resignations from the shadow cabinet.

E-cigarettes damaged the expression of 358 genes important for immune defence, in a study involving 13 non-smokers, 14 smokers and 12 e-cigarette users by the University of North Carolina, published in the American Journal of Physiology.  Smoking decreased the expression of 53 genes.  It is not known how the e-cigarettes were causing the change.  The researchers said the findings did not necessarily mean that e-cigarettes are worse than cigarettes and they were likely to have different effects from each other.

Alcohol marketing during England and Wales Euro 2016 group stage games was seen once every 72 seconds on average, according to charity Alcohol Concern.  Although French laws ban alcohol advertising on television and sponsorship of sporting events, Carlsberg put the word ‘probably’ – part of its well known slogan – in the brand’s font on pitch-side digital boards.

Weight loss surgery was found to be effective ten years later, with patients having kept off more than 25% of their body weight loss and more than half of the excess BMI they had lost according to research from the University of Virginia School of Medicine, involving 1,087 patients who had had the surgery of whom 651 were followed up ten years later.  The research was published in the Annals of Surgery.  There were other health benefits, with the percentage of patients with diabetes falling from 41% to 18%, of heart disease from 25% to 16% and high blood pressure from 59% to 47%.

Spending time on physical activity during school time does not come at the expense of educational performance according to 24 specialists, in a 21 point statement published in the British Journal of Sports Medicine.  They say that a single session of moderate physical activity benefits brain function, cognition and scholastic performance, in addition to the health benefits.

More women going out to work is associated with children being heavier, with the children of working mothers being more likely to be overweight than others, according to research from the Copenhagen Business School published by IZA, a German-based institute for the study of labour.  The researchers suggested that women working more would have less time to shop and cook, leading to poorer quality meals and more eating out.  There might also be an effect through reduced levels of sleep.  They suggested that this didn’t mean women should work less but that more support should be provided.


26 June 2016

Iain Duncan Smith distances himself from the claim that £350m a week could be spent on the NHS after leaving the EU.  Nigel Farage also said the claim was a mistake on the 24th.


24 June 2016

There is a vote to leave the EU in a UK-wide referendum. There are likely to be significant implications for health and wellbeing, as well as other areas of life.
Initial thoughts on implications for social care:

EU working time protections for NHS staff will have to be added into contracts if they are not to be lost, following departure from the EU, unions and employers have said.  Working hours for staff on the ‘Agenda for Change’ conditions are not protected in contracts.

High numbers of young people are using sports drinks, so risking their dental and physical health, with 68% of 12-14 year olds saying they consumed them at least once a week, in a survey of 160 children at four schools in south Wales by Cardiff University’s school of dentistry, published in the British Dental Journal.  The drinks are designed for use after vigorous physical activity, but half the children said they drank them socially.

A new NHS Improvement directorate to help increase efficiency has been launched, headed by Jeremy Marlow, on secondment from the Department of Health.  The role of the new unit will include implementing the Carter review.


23 June 2016

Childhood obesity could be combatted by banning takeaway deliveries to school gates, labelling food packaging by their entire fat, salt and sugar content and not just per portion, and providing free wi-fi in healthy places such as parks, since that is an attraction of takeaway restaurants young people visit, according to a survey of 570 schoolchildren.  A workshop was held with 19 young people aged 13-19, and the ideas put to the 570 schoolchildren and over 2,000 adults.  A quarter of the children surveyed had ordered takeaway food to be delivered to the school gates at some time.  74% of parents agreed that there should be restrictions on fast food restaurants serving children during school hours. The report was produced by the Royal Society for Public Health with the Youth Health Movement and Slimming World.

The BMA is calling on the Government to drop its cap on the pay of locum workers, arguing that it exacerbates the staffing crisis and threatens livelihoods.  Speakers at the BMA annual conference said that locums should be paid a premium to reflect the flexibility and urgency involved.  They said the new rates could leave locums paid less than driving instructors and personal trainers.  It was said that the cause of the problem was resource cuts and locum rates were the response to that rather than the cause of the problem.

The BMA votes to lobby for e-cigarettes to be banned from enclosed public spaces such as pubs, restaurants, concert halls and airports, because of the fears of the dangers of ‘passive vaping’, especially to children and pregnant women.


22 June 2016

Longer GP appointment times were found to be highly cost effective for patients with many problems, according to a study in eight GP practices in Scotland involving 152 patients with five chronic conditions each.  Patients in four practices were assigned ‘CARE Plus’ with 30-35 minute appointments, while the other four received standard care.  The additional service cost £929 more per patient than the standard GP service but taking into account the improved health and wellbeing, the cost of £12,224 per Quality Adusted Life Year (QALY) was well within the NICE £20,000 cut-off point for new interventions.

A quality standard on home care services for older people has been produced by NICE.  It highlights how social care providers can help older people maintain their independence as long as possible.  Home care plans should be tailored to meet the needs of the particular individual, rather than being standardised, and family members and carers should be involved in the decision process.  It says there should be continuity in who provides care so home care workers get to know the person they are caring for.  Visits should be for at least 30 minutes unless agreed in advance rather than the 15 minutes which most visits currently are.

Refuges to support children who have been victims of sexual abuse are to be opened, starting with two in London next year, funded by the Mayor of London’s office for policing and crime.  The NSPCC and NHS England hope to open more such ‘child houses’ across the country.  The refuges are inspired by the similar Barnahus in Iceland.  The houses are to provide a safe and supportive environment and be a place where much of the criminal justice work can be undertaken.

Exercise produces little weight loss but reduces more fat round internal organs than dieting alone, which has important health benefits, according to a review by Liverpool John Moores University and Radboud University in the Netherlands of 117 previous studies which was published in Obesity Reviews.  Two to six months of exercise training reduced weight by an average of 1%.  However, a 5% weight loss from exercising would reduce visceral fat by 21%, while the same weight loss from dieting would reduced visceral fat by only 13%.  Exercise tends to increase muscle, which weighs more, while dieting can reduce muscle.

Heart attack victims are 50% more likely to die if they have diabetes, according to research from the University of Leeds looking at 700,000 people admitted to hospital with a heart attack between 2003 and 2013.  The research was published in Epidemiology and Community Health.  The research took account of difference due to age, sex, other illnesses and differences in emergency medical treatment received.  Diabetics were 56% more likely to die if they had had a heart attack with a completely blocked artery and 39% more likely if the artery was partially blocked.

The Royal College of Nursing is to lobby the UK governments to introduce rent controls after a motion to that effect was passed at its annual congress.  Housing was identified as an important social determinant of health with private occupiers usually exhibiting better health than renters.

The BMA is to lobby for presumed consent for organ donation after a motion to that effect was passed at its annual conference. There is already such an opt-out scheme in Wales. Of the 31 people donating organs in the six months to the end of May, 10 had their consent presumed.  Those 10 people were responsible for 32 of the 60 organs donated during that period.

Self-certification for illness should be for up to two weeks, the BMA says.  This would reduce the number of unnecessary GP appointments.  Amongst other things cited as taking up GPs’ time were carrying out checks on people applying for firearms licences, parents wanting certificates to show their children were well enough to take part in school plays and tenants wanting proof that their damp houses were making their asthma worse.


21 June 2016

Funding for postgraduate nursing training could be under threat according to the Nursing Times, which says that roles such as health visitors, school nurses and district nurses could in future be paid for by a loans system or a levy on employers rather than by Health Education England as at present.  The Department of Health said there were currently no plans to change such funding but delivery models and funding options were being considered.

Continuing professional development for health staff is at risk from cuts of 50% to workforce development budgets.  Health Education England cut the fund paid to the 13 Local Education and Training Boards from £205m last year to £104m this, in March, but it has not been widely known.  The way the cuts are being dealt with varies between regions, leading to uncertainty and confusion.

Overweight pregnant women could pass on weight and metabolic problems down three generations, through mitochondrial DNA, according to studies with mice, by the Washington University School of Medicine in St Louis, published in the journal Cell Reports.  They found that the mother’s eggs can carry information that programmes ‘mitochondrial dysfunction throughout the entire organism.’  The mice mothers were fed a high fat, high sugar diet from six weeks before conception to after weaning.  Despite the offspring being given healthy diets they still developed metabolic problems such as insulin resistance.  The researchers suggested that the results may be even greater in humans.

Having the same GP for a longer period of time reduces mortality according to a Dutch study from researchers at the Vrije university in Amsterdam, published in the British Journal of General Practice, looking at 1700 people over 60 for 17 years, with 759 still alive at the end of the period.  They were put into four groups based on the degree of continuity of care.  It found that those having least continuity had a 20% greater risk of mortality than those with most continuity.  The researchers suggested that a number of different components could be involved and that further research should measure these separately.

GP surgeries with better access have fewer patients admitted to hospital for asthma attacks according to research which looked at seven measures related to access from the GP Patient Survey for over 7,000 practices (95% of them) in 2010/11.  It was published in the British Journal of General Practice.  While none of the measures individually was associated with reduced hospital admissions, a composite score was, with a 10% increase in access associated with a reduction in admissions of 32%.  The researchers said that while it was possible that better access was making the difference, it is possible that the association is the result of correlation with a third factor.

The Government should reinstate adequate funding for public health, the Royal College of Nursing has resolved at its annual conference.  Delegates said the cuts to public health were short-sighted and would have a negative effect on people’s health for years to come.

Babies who are breastfed for six months tend to be better behaved as children than those breastfed for a month, according to research led by Glasgow University on 1,500 children aged between 7 and 11 in South Africa and published in the journal PLOS Medicine.  It found that those who had been breastfed for a month had twice as many behavioural problems as those breastfed for six months.  It is suggested that, as well as health benefits, breastfeeding helps IQ, cognitive skills and behaviour.

GPs should redirect patients to community pharmacies to ease their workload, after initial diagnosis, for minor ailments and acute, self-limiting conditions, according to a report from the New NHS Alliance.  Under its proposals, GPs would work more in partnership with pharmacists, with patients sent back to the GP if necessary, if the situation deteriorated.


20 June 2016

Almost 8 in 10 (78%) members of the public are worried about the future of the NHS with less than 20% saying they trusted the Government with management of the health service, according to a survey of 1240 people, weighted by age, gender, religion and social class, commissioned by the BMA from research firm BritainThinks.  54% agreed with the Government’s focus on seven day services but 69% believed the NHS could not afford it and two thirds said the Government hadn’t done enough to explain what it meant.  81% said the Government should increase the amount of money for the NHS.

The BMA’s Dr Mark Porter has said the health service is not safe in the Government’s hands as promised, and that the year since the election had been wasted on creating a ‘corrosive dispute’ with the junior doctors over seven day working on which there was not disagreement of principle but a concern over how it was to be funded, rather than focussing on the real finance crisis in the NHS.  He was speaking at the BMA’s annual conference.  There were similar messages at the Royal College of Nursing annual conference, where the NHS was described as being in a state of “endless winter”.

The BMA has voted against the idea of a seven day service with current levels of funding while supporting seven day provision for urgent and emergency services and condemning ‘persistent misinterpretation by politicians’ of data on mortality by day of the week.

The government should stop the drive to reduce the number of hospital beds, the BMA says.  The NHS has half as many beds as France and Germany, with 2.8 beds per 1,000 population, compared to 6.3 in France and 8.3 in Germany.  The only EU country with a lower number is Sweden, at 2.7.

About 28m people could be living with chronic pain in the UK, or between a third and a half of the population according to a systematic review and meta-analysis from Imperial College, Arthritis Research UK and the University of Aberdeen, which combined data from 19 previous studies involving 140,000 people.  The study was published in BMJ Open.  However, there were few high quality studies and there was a lot of variation in the findings of the individual studies.  In general there were higher proportions of pain in older age groups (14% of 18-25 year olds and 62% amongst those over 75).

Student nurse bursaries are to be retained in Scotland, First Minister Nicola Sturgeon has said, speaking at the Royal College of Nursing annual conference.  She also said that it would be made a legal requirement to use safe staffing tools.

Enforceable safe staffing levels should be introduced in England, Scotland and Northern Ireland, to follow those in Wales, according to a motion passed at the Royal College of Nursing Annual Conference.

Guidance for women with epilepsy who become pregnant has been published by the Royal College of Obstetricians and Gynaecologists.  It says that such women should be treated by a specialist healthcare team to avoid unnecessary deaths.


19 June 2016

Many Government health policies have been criticised by the chief executive of the Royal College of Nursing, Janet Davies, speaking at the union’s annual congress.  They included plans to end student nurse bursaries, caps on pay for agency staff and cuts to public health which could lead to reductions in the number of health visitors.


18 June 2016

The plan to end student nurse bursaries should be dropped according to a coalition of 20 health bodies and charities, led by the Royal College of Nursing, the BMA, the Royal College of GPs and the Patients’ Association, writing in an open letter to David Cameron.  Consultation on the proposals ends on 30th June.

Just 10% of nurses think the health service is currently able to meet demand according to a survey of 10,554 members of the Royal College of Nursing, carried out between February and March.  75% of respondents said that NHS finances had got worse over the course of their career and 84% said they had noticed the impact of more older patients.

Nurses need more training on sickle cell disease according to the Royal College of Nursing, which discussed the issue at its annual conference. In a survey of 700 people with the disorder last year, only 45% felt emergency staff knew enough about sickle cell disease.


17 June 2016

The current year is critical for NHS finances, and it’s going to be tough over the next five years, Simon Stevens has said in a speech to the NHS Confederation Conference, given the U shaped funding settlement over the next few years. New money for things like mental health and cancer would not be available until 2019-20 and in 2016-17 the finances needed to be ‘reset’.  With a warning not to ‘rewrite history’, he gave a reminder that the Five Year Forward View said that the NHS would need between £8bn and £21bn a year by 2020, and the lower figure would require good access to social care, more effort on prevention and transformation support for both capital and revenue.  He said if any extra money was available in the next few years, it should probably go to social care.  He said NHS England is now ‘out of the strategy business’ and ‘in to implementation’.

The NHS is to make health apps and devices freely available to help manage conditions such as diabetes and heart disease, NHS England has announced.  A new tariff is to be created providing an incentive for hospitals to provide such new technology which is to be made available from next year under the NHS Innovation Accelerator Programme.  The devices will be able to do such things as detect and monitor atrial fibrillation and so prevent strokes and hospital admissions.

Plans to use surplus NHS land to provide 22,000 homes for NHS staff in the next few years are being worked on according to NHS Improvement Chief Executive, Jim Mackey, speaking at the NHS Confederation annual conference.
(15/06/16) Statistics on surplus land (not necessarily a direct cause of the comments):

A BMI of 20 in 18 year old men, led to a 22% increased risk of heart failure in middle age compared to those with a BMI of 18.5-20, according to research from the University of Gothenburg, using data on 1,810,348 Swedish men conscripted between 1968 and 2005, published in the European Heart Journal.  The risk continued to rise as BMI increased, with a ten-fold higher risk in those with a BMI over 35.  The researchers adjusted the figures for factors such as parental education, other diseases, IQ and fitness.  The study did not have any information on how body weight changed after conscription.

A report on how commissioners manage the interplay between competition and co-operation has been published by PRUComm (the Policy Research Unit in Commissioning and the Healthcare System, a collaboration between the universities of Manchester, Kent and the London School of Hygiene and Tropical Medicine, funded by the Department of Health).


16 June 2016

The number of women giving birth who were smokers has fallen to the lowest levels since records began in 2006/7, according to statistics from the HSCIC.  In 2015-16, 10.6% of women were recorded as smokers at the time of giving birth.  However there was wide variation between different CCG areas, from 1.5% in Westminster to 26% in Blackpool, with generally worse figures in the north.

The personal possession and use of drugs should be decriminalised, according to the Royal Society for Public Health and the Faculty of Public Health.  However, those producing and dealing in drugs should be prosecuted.  The RSPH commissioned a poll of 2,000 adults in which 56% agreed that drug users should be referred to treatment rather than being charged with a criminal offence, while 23% disagreed.  The bodies also say that drugs policy should be moved from the Home Office to the Department of Health.  They also say that drugs education should be mandatory, including in primary and middle schools.


15 June 2016

Seven day opening of GP surgeries led to a 10% reduction in A&E attendances and 18% at weekends, according to an evaluation of seven-day GP access pilots by the University of Sussex, published in the Journal of Health Economics.  It found that there was little reduction for minor injuries, but there was for older and for more affluent patients.  There was also a fall of 10% in admissions from A&E to hospital, almost entirely amongst those over 60.  Other studies have not shown these reductions.

Suspected breast cancer sufferers should have an examination, scan and biopsy on the same day according to an updated quality standard from NICE.  Charities expressed scepticism over whether there would be the necessary resources to meet these standards and noted that hospitals had been encouraged to offer tests on the same day for a decade.

A legal challenge to a cut in a man’s care package, based on the Care Act, has been allowed by the High Court.  A quadriplegic man with cerebral palsy, has been allowed to bring a judicial review of Oxfordshire County Council’s decision to reduce his care package on the basis that it fails to meet the Care Act’s wellbeing principle.

Volunteers will look out for victims of domestic violence and signpost them to sources of help in a pilot scheme launched by Women’s Aid and being run initially in three areas and funded by Comic Relief and the ‘tampon tax’ fund.  Typical volunteers might be hairdressers, priests, voluntary or public sector workers.

533 young people aged 19 or under have type 2 diabetes according to figures from the Royal College of Paediatrics and Child Health, even though the condition normally affects those over 40.  The first cases of type 2 diabetes in children were reported in 2000.

Millions of prescriptions cannot be traced back to the individual doctor that issued them, because the decades-old system links the prescriptions to doctors registered at particular practices, which misses locums using another doctor’s prescription pad.  This could cause problems in tracing individual GP prescribing, such as for antibiotics, and have implications for accountability in other circumstances.  An alternative would be to use doctors’ GMC numbers on prescriptions.  The Department of Health has resisted change saying there is no business case for it.

Plans to cut the nursing advisory unit in the Department of Health have been criticised by Nursing leaders including the Royal College of Nursing, Unison and the NHS Alliance.

A report looking at ‘a public health approach to mental health improvement’ has been published by the Faculty of Public Health and the Mental Health Foundation.

A report looking at what successful health and care integration looks like, has been published by the NHS Confederation, ADASS, the LGA and NHS Clinical Commissioners.  The report, ‘Stepping up to the Place’ (31pp) identifies ten features needed to make integration happen, under the broad headings of ‘shared commitments’, ‘shared leadership and accountability’ and ‘shared systems.’  They say that moves towards integration need to ‘go up a gear’.

A report on how six principles for engaging people and communities can be implemented has been published by the People and Communities Board, one of several boards set up to progress the Five Year Forward View.
Press release:

Examples of staff engagement in the vanguards piloting new models of care is explored in a publication from the NHS Confederation.  It looks at how those on the front line can be empowered to take forward improvement, in the case studies of: Dudley; Barking and Dagenham, Havering and Redbridge; Morecombe Bay; and East and North Hertfordshire.

A report on public and patient partnerships has been published (12pp) by the NHS Confederation, looking at how they can address the inequality and finance gap in health care.


14 June 2016

Work in NHS Improvement to revise safe staffing guidance risks undermining existing NICE guidance and confusing hospitals according to sources close to the work, reported by Nursing Times.  NHS Improvement has set up eight committees to look at ‘safe and sustainable’ staffing which critics fear will downplay safety in favour of financial considerations.  NICE published guidance relating to acute wards in 2014 and maternity services in 2015, but its work was stopped that year by the Government and NHS England.

The North Middlesex hospital could be the first to have its A&E closed in the NHS’s history, unless it responds to warnings from the General Medical Council and Health Education England.  The hospital blames its problems on a lack of A&E doctors.

78% of people with a neurological disorder believe there is a stigma attached to it, according to charity Sue Ryder, which is aiming to raise awareness of such conditions and end stigma.  When survey respondents were asked what potential illness they were most concerned about getting, a neurological disorder was the most common, at 45%, with 36% fearing cancer most.

The North Middlesex hospital could be the first to have its A&E closed in the NHS’s history, unless it responds to warnings from the General Medical Council and Health Education England.  The hospital blames its problems on a lack of A&E doctors.

78% of people with a neurological disorder believe there is a stigma attached to it, according to charity Sue Ryder, which is aiming to raise awareness of such conditions and end stigma.  When survey respondents were asked what potential illness they were most concerned about getting, a neurological disorder was the most common, at 45%, with 36% fearing cancer most.

The North Middlesex hospital could be the first to have its A&E closed in the NHS’s history, unless it responds to warnings from the General Medical Council and Health Education England.  The hospital blames its problems on a lack of A&E doctors.
(15/06/16) Local Labour MPs accuse Jeremy Hunt of letting the hospital descend into ‘meltdown’:

78% of people with a neurological disorder believe there is a stigma attached to it, according to charity Sue Ryder, which is aiming to raise awareness of such conditions and end stigma.  When survey respondents were asked what potential illness they were most concerned about getting, a neurological disorder was the most common, at 45%, with 36% fearing cancer most.

NHS sustainable initiatives like staff walking or cycling to work could save £414m by 2020 as well as improving health and benefiting the planet, according to a report, Securing Healthy Returns by the Sustainable Development Unit which is funded by NHS England and Public Health England.  The report looks at potential benefits from 35 initiatives such as providing mental health services for people in hospital for physical needs and the use of telehealth for people with long term conditions.

The quality of service GPs feel they can provide has fallen in the majority of constituency areas over the last 12 months with an improvement in only 8 areas, according to the BMA’s latest ‘heatmap’ based on data from the GP patient survey.  In only one area, Beverley and Holderness, GPs said their workload was ‘manageable’.

44% of countries experience serious levels of both obesity and under-nutrition according to the 2016 Gobal Nutritiion Report funded by a number of international bodies, including the Bill and Melinda Gates Foundation, the European Commission and a number of national governments.  Obesity is creating malnutrition through a poor balance of nutrients such as too much sugar and salt.  Prevention of malnutrition is said to deliver $16 for every $1 invested.


13 June 2016

The powers in the new children and social work bill to suspend legislation are too broad according to a number of senior figures from children’s organisations writing to the Guardian, and the Labour Party which is proposing a ‘privatisation lock’ to stop the Government using the legislation to allow private providers to run child protection services.  The Bill would allow the Government, through secondary legislation, to suspend any parts of most of the Children Act 1989 and all of the Children Act 2004 for three years with a possible extension of a further three years, for specific local authorities, to promote innovation.  The bill was also criticised in the House of Lords for introducing a new government appointed regulator, just years after closing one, the General Social Care Council and transferring its responsibilities to the Health and Care Professions Council.
The letter:

NHS England’s decision not to fund the HIV preventative drug Prep is to be challenged in a judicial review by the National Aids Trust.  NHS England has said the drug should be provided by public health which is now part of local government.

A link between air pollution and mental illness in children has been found, in research looking at details of 500,000 children in Sweden and records of medicines prescribed for mental illness.  The research was published in BMJ Open.

Mobile CT scanners to spot lung cancer are to be offered to shoppers in a pilot in North Manchester.  The NHS England and Macmillan project will offer smokers and former smokers aged 55-74 a free lung check and then, if necessary, a CT scan to look for lung diseases and cancers.  North Manchester has the highest incidence of lung cancer in England and double the national average mortality rate for it.

There is a higher reliance on GP locums in more deprived parts of England according to analysis by the BBC based on figures from the HSCIC.

The Scottish Government is extending the availability of fertility treatment, with the number of cycles increased from two to three and the procedure to be available to couples who have children from a previous relationship.


12 June 2016

The current shortage of anaesthetists will get worse on current trends according to research by the Royal College of Anaesthetists.  The number of consultant anaesthetists has been rising by an average of 113 per year between 2007 and 2015, but this is much less than the 300 per year that will be required according to a report from last year by the Centre for Workforce Intelligence, now part of Health Education England.  The RCoA report also found that 89% of anaesthesia departments were covering gaps in rotas more than once a week and half of departments reported consultants ‘acting down’ to cover trainee rota gaps.  The Department of Health said that they “don’t recognise the RCoA figures.”


11 June 2016

Considerable public concern over funding for mental health has been shown with over 95,000 personal submissions to the Public Accounts Committee inquiry into the funding of mental health services.  Also, a YouGov poll found that 74% of voters believe funding for mental health should be equal to or greater than funding for physical health (spending on mental health is currently 11.9% of the overall NHS budget).


10 June 2016

The NHS workforce crisis of morale is a greater risk than its financial problems according to the head of the Nuffield Trust, Nigel Edwards who said that disputes with the government, staff shortages and bullying were a toxic mix.  He said that the care and compassion of health workers was underpinned by a psychological contract and once broken, that would be very difficult to repair.  A majority of respondents in their latest survey of 100 health leaders reported worsening morale in their area in the last six months.  77% of respondents identified increased workload as the main reason for a decline in morale.

The number of patients thinking there are enough nurses on duty has increased slightly from 60% to 62% according to the NHS Adult Inpatient Survey 2015 by the Picker Institute for the CQC.  However only 67% of patients with a mental health condition had confidence in nurses caring for them compared to 80% without such a condition.

The average waiting time to get a GP appointment has risen from 10 to 13 days since last year according to an online survey by Pulse magazine to which there were 831 responses.  There were 26% respondents saying the average waiting time for non-urgent appointments was under a week, 33% said 1-2 weeks and 26.5% said 2-3 weeks.

The Department of Health’s policy unit for nursing, midwifery and allied health professionals is to be scrapped with the loss of seven staff as part of the department’s cost cutting, which is due to see staff numbers falling from 2000 to less than 1400 by 2017.

Survival rates for different sorts of cancer have been published by the ONS.

A review into NHS waiting time targets has been launched by the Scottish Government. There are concerns that political priorities are overshadowing clinical decisions.  The review is due to report later this financial year.


09 June 2016

The performance of the NHS in England improved slightly in April with 90% of people being seen in A&E within four hours.  The number of bed days lost to delayed transfers of care at 167,700 was lower than March’s figure of 169,928, but higher than the same month in 2015 when it was 138,030.  For the April 2016 delays, 60% were attributable to the NHS, 33% to social care and 7% to both.

Austerity and welfare policies are disproportionately affecting poorer children according to the United Nations committee on the rights of the child.  It calls on the Government to do more to meet children’s rights to adequate health, living standards, housing and education. They say that policies such as the benefit cap and two child limit on tax credits undermine children’s rights.   It says they should re-establish concrete measures to meet their UN poverty reduction commitments, strictly implement its ban on putting homeless families in B&B accommodation for longer than six weeks, and provide a comprehensive package of support for children with disabilities moving into adulthood.  The committee last reported on the UK in 2008.  The Government is a signatory to the UN Convention on the Rights of the Child, but compliance is voluntary and the UN decision is not binding on UK courts.

Too many reviews of deaths and brain damage in labour are not good enough, with 27% of 204 investigations found to be of poor quality according to a preliminary report by the Royal College of Obstetricians and Gynaecologists, ‘Each Baby Counts’.  Nearly three quarters of 599 investigations did not involve the parents in any meaningful way.  As well as the ‘immeasurable’ ’emotional cost’, each case costs the NHS £7m in compensation to pay for the lifelong complex support needed.
(10/06/16) (Rgn)
Press release:

A possible treatment for multiple sclerosis has been developed. The treatment is risky and although most of the 24 patients were able to walk, play sport and drive some years after the treatment rather than being confined to a wheelchair, one person died.  The procedure involves the destruction of the person’s immune system and then its reconstruction using stem cells.  The research was led from the University of Ottawa and was published in the Lancet.  Since the condition can already be controlled with existing drugs, this new treatment might only be suitable for 5-10% of patients.

The social class gap in parents support to their children in education and development is narrowing although significant inequalities remain, according to a report by the Social Mobility Commission.  The research, from Oxford University replicated an American study which found such differences, in things like reading to children and checking homework, had increased.
Press release:
The research;

LGBT patients often face discrimination in their end of life care according to a report from charity Marie Cure, ‘Hiding Who I Am’.  As well as describing individual experiences it involved a survey of over 230 older LGBT people and found that 74% did not believe health and social care services could provide sensitive and appropriate end of life care for LGBT patients.

The number of people playing sport at least once a week has fallen by 0.4% since 2012, despite the hope that the olympics would inspire a generation, according to figures from Sport England.  They say that the amount councils invest in sport has fallen by £389m since 2010.  The numbers still represent an increase of 1.75m playing sport since London won the right to host the games.

A report on service users’ views of mental health policy has been published by ‘Shaping Our Lives’, a network of service users and disabled people.


08 June 2016

Sustainability and transformation plans in London will not be fully formed by the June deadline for submission, with difficulties in collaboration and capacity, according to London Councils’ board papers.  However NHS England has indicated that the initial submissions will be a ‘staging post’ rather than the final plans.  The situation in other parts of the country is reported to be worse, though, with two thirds of local authorities said to be shut off from leadership discussions.

NHS health checks are less effective in reducing cardiovascular deaths than population wide initiatives such as policies to promote healthy eating and to cut smoking, according to computer modelling published in the BMJ.  It found that population approaches could cut deaths by 8,000 by 2030, while the health checks (universal screening) would cut deaths by 3,000.  They concluded that the most equitable approach was to combine population wide intervention with screening concentrated in the most deprived areas.

Using DNA from three patients to create a baby is safe according to research by the Wellcome Trust Centre at Newcastle University published in the journal Nature.  The law to allow the technique to be used was changed last year.  The Human Fertilisation and Embryology Authority will now decide whether to grant a licence enabling the treatment to be made available to women.

Adults receiving personal budgets for social care need to have their interests protected through stronger measures, the Public Accounts Committee reports.  The committee was not assured that local authorities could fully personalise care while trying to save money.  They said they did not believe that everyone who was being counted as having a personal budget actually had genuine choice and control over the services they received, and people were not getting the support they needed to get the most out of their care.  They also questionned whether local authorities should have to review care plans annually, as required under the Care Act 2014.

Only 1 of 14 antidepressants was effective for children and young people according to an analysis of 34 trials involving 5,260 participants with an average age of 9-18, conducted by Chinese researchers and published in the Lancet.  The only one better than a placebo was fluoxetine, marketed as Prozac.  However, the actual position was not clear because 65% of the trials were funded by pharmaceutical companies and only four were judged to have a low risk of bias.

13% of British people said they felt lonely most of the time with 84% saying they have been lonely at some point, according to a survey of 1,000 people aged over 16, by Censuswide for the Campaign to End Loneliness.  [It is not stated whether this is a representative survey, but the Censuswide website indicates that they use a panel of over 69,000 members who are polled online.]  It was also found that 92% were afraid to admit they were lonely.

A scheme in Lincolnshire to recruit GPs from Europe could be the basis for a national programme, NHS England has said.  The package of support includes help with language, learning about the NHS and providing an induction in England.

Married people are 14% less likely to die from a heart attack according to a study of the medical records of 25,000 people diagnosed between 2000 and 2013.  The research was reported to the British Cardiovascular Society conference.  Divorced people had a 7% greater risk of death from a heart attack than single people.


07 June 2016

A ‘weekend effect’ was discovered in deaths following admission to, or discharge from, hospital in relation to two different heart conditions analysed in two separate studies by Aston University, and reported to the British Cardiovascular Society Conference in Manchester.  Both studies looked at deaths up to five years later.  One, involving 42,687 patients with atrial fibrillation, found that those admitted out of hours had a 10% higher risk of dying in the following five years.  The other study looked at 31,760 heart failure patients and found a 32% increased risk of dying within five years.

A blood test that could identify which people with depression will respond to given antidepressants has been developed, led by scientists from King’s College London.  The research, on 140 volunteers, was published in the International Journal of Neuropsychopharmacology.  Antidepressants provide no benefit to start with for about half of those who take them, and never for about a third of people.  The test measures levels of blood inflammation.  All of those who the test classified as non-responders to treatment were accurately identified but it missed 39% of non-responders, falsely categorising them as responders.

Delays in initial universal credit payments are causing hardship according to new evidence.  A report from Citizens’ Advice Scotland says design problems are: the six week wait until first payment; the single monthly payment; sanctions; and the primarily online system.  In a separate report, social landlords, the National Federation of ALMOs, conducted a survey of landlords looking after 3,000 households on universal credit and found 79% were in arrears, half of whom had not been before they moved on to the benefit.  The overwhelming reason was tenants waiting for payment.

Delayed transfers of care from hospital could continue until 2020 because of social care pressures, Simon Stevens has told the House of Commons Health Select Committee.

NICE has been asked to assess the effectiveness of HIV prevention drug, PrEP, according to head of NHS England Simon Stevens, talking to the Health Select Committee.  NHS England had previously said it could not legally fund the drug as this was the responsibility of local authority public health departments.

General practice in Northern Ireland is on the brink of a crisis according to a BMA survey to which 65% of practices responded.  It found that the majority of practices in rural areas were at risk of closure.  75% of practices said they were struggling and a further 10% said they were ‘unable to cope’.

A judicial review against the government for not adequately funding new requirements on deprivation of liberty safeguarding is being taken by four councils.  They argue that there are additional costs following the 2014 ‘Cheshire West’ ruling.  However the government argues that these are as a result of the court decision rather than a change in their policy.

An inquiry into whether councils have enough money to meet their statutory duties under the Care Act has been launched by the Communities and Local Government select committee.

Calls for food firms to be forced to reduce sugar and salt content are among recommendations by a group of charities, the Richmond Group, which includes Diabetes UK, the British Heart Foundation, Age UK and Macmillan Cancer Support.  They also say there should be smaller portion sizes, limiting food company sponsorship of sports events, GP prescription of exercise and more controls on advertising of food and drink.  They said that mandatory reformulation to reduce salt and sugar and smaller portion sizes could save 26,000 lives by 2025.
Press release:
Link to publications:

Children wait an average of ten years for help with mental health problems after the first symptoms according to a report by charity the Centre for Mental Health.  The report, ‘Missed Opportunities’ reviews recent evidence about the mental health of children and young people and finds that most attempts by parents to get help for their children are unsuccessful.


06 June 2016

Women are twice as likely as men to suffer anxiety and people of both sexes under 35 are more likely to have it than older people according to a systematic review of 48 previous reviews (both systematic reviews and meta-analyses) led from Cambridge University and published in the journal Brain and Behaviour.  Those suffering from various diseases were also more likely to suffer anxiety that those who were healthy.  Little data was available on marginalised groups.

Music celebrities endorsing food and drink predominantly support products which are nutrient poor and high in sugar according to research which looked at celebrity endorsements in a US advertising database between 2000 and 2014 and was published in the journal Pediatrics.  They identified 65 celebrities who had directly or indirectly advertised 57 brands of food and drink.  The biggest category of endorsements was for full-calorie soft drinks.

People on a high fat Mediterranean diet did not gain weight, according to a Spanish randomised controlled trial on over 7,000 people aged 55-80, over 90% of whom were obese or overweight,  published in the Lancet Diabetes and Endocrinology.  The Mediterranean diet included high fat items such as fish, nuts and seeds but not those such as red meat or butter.  The participants were assigned to three groups: two were unrestricted-calorie Mediterranean diets, one with added olive oil and the other with added nuts, while the third group had a low fat diet.  Weight loss was 0.88kg amongst the olive oil group compared to 0.60kg on the low fat diet.

People living in some of London’s most deprived boroughs have twice as much chance of dying of lung disease than those from better off areas according to research by the British Lung Foundation.  Initial findings from the research were published a week ago, but these figures for London were published later.  The differences might partly be accounted for by air pollution but there are also likely to be other factors at play such smoking and working conditions.


05 June 2016

Cutting the welfare benefits of unemployed people made it less likely that they would find work, according to an evaluation of a one year, EU funded scheme run by Oxford City Council and the DWP.  For every £1 of income lost through housing benefit cuts, the chances of long term unemployed people finding work was reduced by 2%.  This contradicts the Government’s assertion that the benefit cap is a powerful incentive for workless claimants to get a job.


04 June 2016

Individualised cancer treatment can be six times as effective as a blanket approach and should be standard practice, according to researchers presenting at the world’s largest cancer conference in Chicago.  Targeting specific cancers was found to reduce tumours by 31% compared to 4.9% for those receiving conventional care.

The first head of the Healthcare Safety Investigation Branch is likely to be the UK’s chief investigator of air accidents, Keith Conradi, subject to a parliamentary hearing next week.

Overweight 4-18 month olds ate similar food but had bigger portions than healthier weight children in a UCL study of eating diaries parents kept for 2,564 children.  The research was presented at the European Obesity Summit in Gothenburg.  The overweight children were eating larger meals than healthy weight children, at 141 calories compared to 130.  It was not increased frequency of feeding that made the difference either.


03 June 2016

The number of fast food outlets within a five minute walk of a school has risen by 58% in the seven years since 2009, from 9,700 to 15,327, according to research for the Daily Mail by mapping firm Mapmechanics based on data from the Ordnance Survey.  Five minutes walk was equivalent to 400m.  Of the 55,499 fast food businesses in Britain, 28% were within five minutes walk of a primary or secondary school.

Jeremy Hunt has ordered an investigation into companies artificially raising drug prices after the Times reported that the firms were buying medicines no longer under patent, dropping the existing brand name and taking them outside NHS profit controls.  As a result the prices of 32 drugs had risen by over 1,000% in five years.  The Secretary of State has referred them to the Competition and Markets Authority.

Four out of seven National Obesity Forum board members have resigned following the publication of a controversial report recommending more consumption of fat.  The resignations were due to the publication going out without their knowledge and without them having seen drafts of it.  The NOF’s chairman Prof David Haslam apologised that other board members had not been given an input to the report, but stood by its content.
Initial report of two resignations:
Second report of four resignations:

A report on housing and mental health has been published by the Centre for Mental Health.  ‘More than shelter’ highlights the links between housing and mental wellbeing.  It says there is limited evidence for what sort of support is most effective, but most people prefer help in their own home rather than supported housing.


02 June 2016

BAME staff in the NHS are more likely than white staff to be bullied by colleagues, with higher proportions of black, asian and minority ethnic than white staff  reporting being harrassed, bullied or abused by other staff in 75% of acute trusts, and more reporting personal experience of discrimination by a manager in 81% of hospitals, according to an analysis of data from the annual NHS staff survey reported in the NHS Workforce Race Equality Standard.  However, there was little difference in levels of harrassment or abuse between white and BAME staff from patients, relatives or the public.

About half of midwives are afraid of making a mistake at work because of exhaustion according to a survey by the Royal College of Midwives of 1361 of its members across the UK.  It also found that 52% had observed an error, near miss or other incident in the preceding month.  48% said that stress was a daily occurrence for them.  84% said their workload had increased in the last year.  Only 22% said they had enough time to build a rapport with the women and families they work with.

The new Healthcare Safety Investigation Branch should have its independence guaranteed in primary legislation, the Public Administration and Constitutional Affairs Committee has said in a report on the new body.  The HSIB will sit within NHS Improvement and the Government has said it has made legal provisions for its independence, but the PACAC said the proposed non-statutory arrangement is disappointing and unacceptable.  The committee said there must be a credible ‘safe space’ to learn from mistakes.  However, the charity Action against Medical Accidents (AvMA) said a ‘safe space’ should not be prioritised above openness and honesty with patients and their families.

There were 2,650 people with learning disabilities receiving inpatient care at the end of February 2016, a fall of 6% from the 2,820 at the end of February 2015 according to figures from the HSCIC.  However, during that year there were 1,800 admissions or transfers in to inpatient care and 1,970 dischcarges.  895 people had been receiving continuous inpatient care for over five years.

Cases of heart failure have been increasing with a 36% rise in A&E attendances in the ten years to 2014-15 according to an analysis of NHS figures by the British Heart Foundation.  Those visits are estimated to cost £2bn a year.  A separate analysis of GP lists shows a 2% rise in the last year from 402k to 411k cases.  Part of the reason for the increase is thought to be more people surviving heart attacks.

Weight loss surgery led to 57% lower mortality with a rate of 2.1 deaths per 1,000 people amongst those who had had surgery compared to 7.7 in those who had not.  The research, from the University of Gothenburg in Sweden involved analysis of data on 49,000 obese patients, of whom about 23,000 had surgery and 26,000 did not.  The results were presented to the European obesity summit in Sweden.  The reduction in mortality was mainly related to cardiovascular disease and cancer.

Doctor trainee bursaries should be replaced with loans, which would then by repaid by the NHS if the recipient goes on to work in the NHS, the thinktank Civitas, has proposed.  They say this would enable the Department of Health to lift the cap on the number of doctors trained each year and would avoid the state paying for trainees who then move abroad.


01 June 2016

The GP vacancy rate appears to be increasing and to be at the highest level for five years according to Pulse magazine’s annual survey.  The online survey was a self-selecting sample of 690 GPs asking 24 questions on a range of topics.  The vacancy rate has steadily increased from 2.1% in 2011’s survey to 11.7% in the most recent one.  It also found that 73% of practices had had to recruit a GP in the last year and the average time to recruit a partner had increased in each of the last two years.

A fifth of people with motor neurone disease (MND) wait more than a year to see a specialist for help with diagnosis, according to a survey of 900 patients in England, Wales and Northern Ireland by the MND Association.  About 5,000 people in the UK have MND.

The new Social Work Bill could be used to exempt councils from child protection duties according to campaign group Article 39 based on an analysis of the wording used in the bill.

Five and six year olds eat an average of 75g of sugar a day, compared to the recommended 19g, with 40% coming from sugary drinks, according to research from Birmingham University which involved asking over 1,000 parents what their child had consumed in the previous 24 hours.  The results were presented at the European Obesity Summit in Sweden.

The risk of developing an aggressive form of prostate cancer increases with being overweight and having more fat, with a 4 inch increase in waistline raising the risk of developing the cancer by 13% according to research from the University of Oxford analysing data on 140,000 men across 8 countries over 14 years, presented to the European Obesity Summit in Sweden.

Examples of fire service prevention activities also benefiting health have been outlined in a document, Working Together (10pp) published by NHS England, the LGA and the Chief Fire Officers’ Association.  As well as providing examples of prevention work, the document provides advice on how commissioners can work in partnership with fire and rescue services.

A bulletin on the new models of care work has been published by NHS England.


31 May 2016

Around 100 trusts have not set their financial targets (or ‘control totals’) for this year according to NHS Improvement Chief Executive Jim Mackey speaking to the Health Service Journal.  He also said it would not be possible to bring NHS service providers back into the black this year after the £2.45bn deficit last year.  The underlying deficit was probably £3.2bn once one-off accounting measures were taken into account.

Jeremy Hunt has said full Sunday surgeries may not be necessary in all GP practices at the same level as on other days, in an interview with Pulse magazine.  He said he is not asking every practice to open seven days a week but is looking for solutions offered by networks of practices.

Almost 75% of 12-24 year old diabetes sufferers are not getting all 7 annual checks they should according to an audit on 27,682 children and young people by the Royal College of Paediatrics and Child Health.  More than 70% had Type 1 diabetes.  Those achieving ‘excellent diabetes control’ rose from 16% to 24% between 2012-13 and 2014-15.

Families of Winterbourne View patients have expressed anger at slow progress in closing such homes in a letter to the Prime Minister, also signed by various professionals who have been involved in the issue.  Around 3,500 people with learning disabilities were still inpatients in such institutions (according to the most recent statistics available at the time).  NHS England acknowledged that progress had not been quick enough but said that a ‘real difference’ should be seen in the coming months.

NHS England says it will not fund a drug treatment that prevents HIV, saying it is the responsibility of local authority public health departments.  The daily pill, known as ‘PReP’ – pre-exposure prophylaxis – lowers the chances of contracting HIV by up to 86%.  Charities described the decision as shameful.  NHS England confirmed a previous decision, based on legal advice that it did not have the legal power to commission the drug.

Labour is to appoint a shadow minister for neurodiversity after the idea was suggested by a blogger, Monique Craine, who has autism, dyslexia and dyspraxia.  About a fifth of the population have some form of neurological condition.

Children whose parents thought they were overweight then put on more weight than others, even if they were not actually overweight, according to research from Liverpool University and Florida State University using data on over 3,500 Australian school children and presented at the European Obesity Summit in Sweden.

Eating prepackaged, portion controlled meals led to greater weight loss than self-selection of meals in a randomised controlled trial of 183 adults over three months, published in the journal Obesity.  They were divided into three groups: two prepackaged portion controlled, one of which had higher protein, and one group which selected their own meals.  They found that 74% of those eating prepackaged meals achieved at least 5% weight loss compared to 53% of those who selected their meals, with the prepackaged group losing an average of 8% of body weight compared to 6% for those who self-selected.  The prepackaged group also reduced LDL cholesterol levels.

A third of 6-9 year olds in Europe are overweight or obese according to research based on data from 46 countries, by United European Gastroenterology.  The research also found that 20% to 30% of all inflammatory bowel disease begins in childhood.

Social value is being considered in procurement by a third of councils according to research by Social Enterprise UK, based on 306 responses to foi requests submitted to 353 councils.  The report is called ‘Procuring for Good’. The Public Services (Social Value) Act came into force in January 2013.  24% of councils had a social value policy.

A report of five case studies of new models of care and prevention from the vanguard sites has been published by the NHS Confederation, NHS Clinical Commissioners, NHS Providers and the Local Government Association.  They show examples of reducing emergency admissions for the over 65s, reducing delayed transfers of care and GPs spending more time with frail older patients.
News release:


30 May 2016

A cancer scientists’ pension fund has investments in tobacco companies with £211m of the Universities Superannuation Scheme invested in British American Tobacco, according to the fund’s latest annual report.  Scientists funded by Cancer Research UK are amongst many others whose pensions are invested by the fund.  The fund also has £344m invested with Royal Dutch Shell.

Welsh ambulance sickness levels have fallen to their lowest levels since 2012 following action by management and unions.  The average annual figure fell from a high of 8.3% in 2014 to just below 7% in 2015 but is still above the Welsh NHS average.  Issues addressed including bullying, inconsistent decision making and missing rest breaks.

Sound levels in intensive care units in Belgium did not meet WHO recommendations according to a study in one hospital, which suggested it was typical of other ICUs.  Measures taken so far to try and reduce noise levels had not been successful.  The WHO recommends that average sound levels on hospital wards should be below 30 decibels (dBA) but the researchers found the average was above 45 dBA and for half the time it was above 52 dBA.  The research was presented at a conference in London, Euroanaesthesia.


29 May 2016

The Taxpayers’ Alliance says the proposed tax on sugary drinks is arbitrary and unfair and will put a bigger burden on poorer people.  It analysed 49 different drinks and said that the 10 most sugary will not be subject to the tax.  The Treasury said that the levy is to be on soft drinks because they are the main source of added sugar in children and teenagers’ diets.


28 May 2016

Over a quarter (28%) of young people referred to mental health services received no support, including 13% with life-threatening conditions, according to a review by the Children’s Commissioner based on information from 48 of 60 CAMHS trusts, using the Commissioner’s legal powers to obtain such information.  The average waiting time for those who did receive treatment was more than 100 days.  Around 240,000 children were referred for specialist mental health support last year and 28% were refused help, mostly on the grounds that their illness was not serious enough.
Press release

There are 2.5m more patients registered with GPs than the population with 57.6m people in England registered with a GP compared to the population of 55.1m, according to figures from HSCIC.  The extra money paid out at £141 per person is equivalent to £43,750 per surgery.

The National Obesity Forum is said to be in inner turmoil after publishing controversial advice encouraging the consumption of more fats and less carbohydrates.  There is said to be anger amongst board members that they were not allowed to approve the report before publication.  The report received criticism from a number of other dietary experts.


27 May 2016

The details of the junior doctors’ contract have been published by NHS Employers.  [No doubt there will be much more on this when the various parties and media have had chance to analyse it.]

Approval to sell a gene therapy has been granted to GSK, the first such approval for a large, multinational drug company.  The idea for such treatment began thirty years ago, but the initial promise was not delivered and a number of early problems with trials led to the big companies withdrawing from the field.  With smaller companies having resolved some of the difficulties, the bigger companies are now getting involved again.

There has been a systematic neglect of lung disease by the NHS according to the British Lung Foundation.  They say that despite it being one of the largest killers, treatment lags behind what is available for other conditions, and the numbers dying have hardly changed in the last decade.

Statistics on the incidence rate of cancer by age, sex and region have been published by the ONS.  The region with the highest diagnosis rate was the north east, followed by the north west and Yorkshire and Humber.  The most common forms of cancer diagnosed were breast, prostate, lung and colorectal.

A compendium of statistics on smoking has been published by the HSCIC.  The number of hospital admissions estimated to be attributable to smoking has increased by 5% in 10 years, but the number of deaths from smoking of people over 35 has declined.


26 May 2016

The Government is to take action on antimicrobial resistance, including setting a target for doctors in the UK to reduce the inappropriate prescription of antibiotics by a half by 2020, David Cameron has said at a G7 meeting.  Other measures include the aim to halve the riskiest bloodstream infections by 2020, so reducing the need for antibiotics.  There are to be targets and increased oversight on the use of antibiotics in animals.  The Government is also to put £50m into a fund to help incentivise drug companies to develop new antibiotics.  Public Health England is to try to change behaviour on the use of antibiotics.

Delayed discharges from hospital are costing the NHS £820m a year according to a report by the National Audit Office.  They estimate that 85% of delayed transfers of care are for patients aged 65 or older.  The number of bed days lost rose by 31% between 2013 and 2015 to 1.15m, and the NAO says the real figure could be even higher; they estimate it as 2.7m days.  The main driver for the increase is people waiting for appropriate social care support.  Staff shortages were thought to be a factor in the increased number of delays.  It is estimated that for each extra day in hospital older patients can lose as much as 5% of their muscle strength.

The system of serious case reviews is to be overhauled, to be replaced by  new ‘local learning inquiries’ and some ‘national serious case inquiries’.  A new, independent national body will be set up to oversee the new framework.  This follows a review of local safeguarding children’s boards by the former president of the Association of Directors of Children’s Services, Alan Wood.  The legal requirement to have local safeguarding children’s boards is to be replaced by a duty for councils, the police and the NHS to set up multi-agency child protection arrangements.
(02/06/16) Comment:
The Wood review:
The Government’s response to the Wood review:

A new role of ‘nursing associate’ is to be introduced following a consultation that was largely in favour of the idea, Health Education England has said.  The role would bridge the gap between healthcare assistants and registered nurses.  HEE said the role should not be a substitute for increasing the supply of nurses.  Training could start for 1,000 students in 2017. Of 1,384 responses to the consultation, 750 said there should be statutory regulation of the role while 240 said it should just be registered.
(27/05/16) (Rgn)

The ban on legal highs, or ‘new psychoactive substances’ (NPS) comes into force on 26th May.  It is thought likely to lead to a quick reduction in high street availability but a move to underground and illegal sources.

NHS spending on private emergency ambulances has trebled in three years between 2011-12 and 2015-16, from £22.1m to £68.7m according to BBC research.  The number of emergency calls a day was 22,400 in March 2015 but 27,800 by March 2016, a rise of 24%.  The contractors include charities, such as St John Ambulance, as well as private firms.

The number of student suicides has risen to its highest level since 2007 in England and Wales, according to figures from the ONS.  There were 75 suicides in 2007 and 130 in 2014.

The risk of getting breast cancer could be reduced by 30% through lifestyle changes such as diet, exercise and reduced alcohol consumption, according to research from the John Hopkins Bloomberg School of Public Health, which analysed the records of 17,000 women with and 20,000 women without breast cancer.  The research only involved white women.  The research examined how genetic screening could be used to identify those at most risk.

Food companies should be required to meet targets for the amount of sugar, salt and fat contained in their products according to the Obesity Health Alliance, a coalition of 30 health and food organisations.


25 May 2016

A range of factors that are associated with suicide in young people have been identified in an analysis of 130 of the 145 suicides of young people aged 10-19 who killed themselves between January 2014 and April 2015, undertaken by the National Confidential Enquiry into Suicide and Homicide by People with Mental Illness and summarised in a paper in the Lancet Psychiatry.  70% of those who died were male.   54% of the 130 had self-harmed and 27% had expressed suicidal thoughts in the week before.  43% had not been in contact with the health or other services, although 36% had sought help for some sort of medical condition, the most common being acne or asthma.  27% were dealing with academic pressures and 22% had been bullied in previous weeks.
Link to report:

There was a big fall in the prescription of antibiotics last year according to the latest figures from NHS Improvement.  The number of prescriptions for all types of antibiotics fell by 2.6m to 34m in 2015-16, a reduction of 7% compared to a target of 1%.  The fall in prescriptions of broad-spectrum antibiotics fell from 3.9m to 3.3m, a fall of 16% compared to a target of 10%.  CCGs received funding for reducing prescriptions which was passed on to GPs in different ways in different areas.

Unemployment and austerity following the 2008 recession led to hundreds of thousands of cancer deaths worldwide, but not in those countries with universal healthcare and a history of public health spending, such as the UK, according to a study led by Imperial College published in the Lancet.  The study analysed data from 70 high and middle income countries.  There were 260,000 more deaths from cancer in the 35 OECD countries than would have been expected without the recession.

Scrapping the student bursary for nurses, midwives and others could reduce the number of trainees rather than increase them as the Government claim, according to an analysis by research group London Economics for Unison and the National Union of Students.  Its modelling suggested that the numbers starting courses could fall by 6.5% from 31,000 to 29,000 a year.  If there was a smaller number of graduate nurses, trusts could have to find another £100m for agency staff.  The RCN said they would like the Government to pause its plans and do a risk assessment of the likely impact.

Nearly three quarters (73%) of care homes rated as inadequate in 2014 have since improved according to the CQC.  Of the 372 care homes, out of those still operating, 205 had improved to ‘requiring improvement’, 68 to ‘good’ and 99 showed no change in their rating.  34 homes had gone out of business.

The number of young people not in work, employment or training at some time is higher than official statistics suggest according to an analysis by the youth employment and education charity Impetus-PEF, which says that the official figures provide a snapshot and ignore long periods spent ‘Neet’.  While official figures show that 11.8% of 16-24 year olds were Neet in the final three months of 2015, the charity found that on average 17% of that group were spending six months Neet.

Independent oversight of cases where people are being ‘deprived of their liberty’ could be lost creating concerns that human rights protections for vulnerable groups could be weakened, under proposals being developed by the Law Commission on the replacement for the Deprivation of Liberty Safeguards (DoLS).  A statement from the Commission suggests the independent oversight role could be cut back or scrapped altogether.

Health staffing agencies that don’t stick with the cap on fees could be removed from the marketplace by being taken off the three national frameworks with which agencies must be registered, NHS Improvement has said.  From 1st April, the cap has come down to 55% above the equivalent NHS pay rates.

Artificial sweeteners were found to increase the risk of diabetes by worsening glucose management, according to research from York University in Toronto involving over 3,000 adults and published in the journal Applied Physiology, Nutrition and Metabolism.


24 May 2016

The CQC is to undertake fewer, more targeted inspections of hospitals, it has said in its new five year strategy.  Inspections will generally focus on core services such as A&E and critical care.  Hospitals which have already been assessed as outstanding or good will be inspected less often, but those classed as requiring improvement or inadequate will be visited more frequently.  It will make more use of unannounced inspections and make use of other information such as feedback from the public and others.  It is scaling back its approach in part because of cuts, which mean it will have £32m less by 2019.
Press release:
The strategy:

Lessons from the UK’s teenage pregnancy reduction strategy are to be shared internationally, as the leader of the ten year programme, Alison Hadley, is asked by the World Health Organisation to pass on the learning.  The programme led to a 51% reduction in teenage conceptions over a 16 year period, and the WHO says few programmes in other countries have been so successful.  A paper identifying lessons from the strategy is being published in the Journal of Adolescent Health.  A study in the Lancet shows the conception rate for 15-17 year olds falling from 47 to 25 conceptions per 1000 between 1998 and 2013.

Very few GP practices use email or Skype for consultations or are planning to introduce them according to a survey of 400 practices, published in the British Journal of General Practice.  Only 6% said they regularly use e-mail for consultations and none used online video such as Skype or Facetime.  53% said they had no plans to introduce email consultations and 86% did not plan to use online video.  Two thirds said they regularly carried out telephone consultations.

Birmingham City Council is to transfer its children’s department to a trust, after having been rated as ‘inadequate’ since 2008.  A formal decision now needs to be made by the council’s cabinet.

Bariatric surgery should be considered for anyone with Type 2 diabetes who is obese if drugs and lifestyle changes do not control their glucose levels, according to a statement by 45 international organisations, doctors and researchers in diabetes published in Diabetes Care.  They say that metabolic surgery changes what happens in the gut, impacting on hormones that regulate insulin.  Some patients no longer have to take insulin and other medications within weeks.  About 30% to 40% of patients relapse after five years.  The operations cost about £6,000 but it is argued that they would pay for themselves within two years through reduced treatment costs.

The proportion of people who have tried e-cigarettes has risen faster in the UK than the European average, having increased from 8.9% to 15.5% between 2012 and 2014, compared to a rise in the European average from 7.2% to 11.6%, according to an analysis of 53,000 people in the EU by Imperial College published in the journal Tobacco Control.  The highest usage was in France and the lowest in Portugal.

The transfer of NHS staff to the independent sector has increased in recent years, the Nursing Times reports, based on statistics published by the HSCIC on 30th March.  It says that 17,000 staff have moved since 2010.  It says that there were 664 whole-time equivalent staff registered as working for the independent sector in 2010, which increased to 1,807 the following year and 17,876 in 2015.

Gas filled gastric balloons led to almost twice as much weight loss as a control group, with those using the Obalon balloons losing an average of 6.8% of their body weight, compared to 3.6% in the control group.  The research, funded by Obalon Therapeutics, was led by a St Louis medical school, involved 387 participants on 15 study sites and was reported at Digestive Disease Week 2016.

Physical health checks for people with serious mental illness were almost doubled in a pilot scheme involving four mental health trusts in a two year improvement programme evaluated by the Royal College of Psychiatrists Clinical Care Quality Improvement Unit.

Funding for green transport schemes is being provided to 23 initiatives across the country, the Government has announced, with a total of £21m to be provided to local authorities.

An association between flu vaccination and hospitalisation of patients with heart failure has been found in research led by Oxford University analysing data on 59,202 heart failure patients.  Being vaccinated for flu was associated with a 30% lower risk of admission for cardiovascular diseases, 16% lower risk for respiratory diseases and 4% lower risk of hospitalisation overall in the period 31 to 300 days after vaccination.

The genetic processes through which lower socioeconomic status can lead to depression have been explored in research from Duke University which studied 132 white adolescents aged 11-15 from households with a range from low to high socioeconomic status.  The process by which chronic stress could lead to depression involved the build up of a chemical which altered the expression of genes that control the amygdala which coordinates the body’s reaction to threat.  The research was published in Molecular Psychiatry.


23 May 2016

The NHS could be facing a deficit of £10bn a year by 2020 according to CIPFA, which says spending should be set at a proportion of GDP, with an independent commission set up to set the ratio.  It says the deficit will be at least £5bn, quite likely £10bn and possibly up to £16bn.  The report, ‘More Medicine Needed’ says that new pressures have emerged since the Five Year Forward View was published and the additional funding being provided for the NHS is being used to make ends meet instead of being invested to save money in the future.,-as-nhs-retreats-to-quick-fixes

The agency staff pay limits in the NHS has been exceeded on an increasing number of occasions, according to foi responses from Monitor.  The so-called ‘break glass’ clause that allows trusts to pay over the prescribed amount rose from around 30,000 times a week in November to over 50,000 times in April.

The number of people caring for someone with cancer has increased by almost a third in five years according to Macmillan Cancer Support.  Friends and family spend an average of 17.5 hours a week caring for someone with cancer according to a YouGov survey of 6,000 carers in the UK aged 16 or over.

Axa is to withdraw its £1.3bn of investments from tobacco companies. Axa is one of the largest insurers in the world.  It said its role was increasingly about prevention rather than cure and the move would cost money in the short term but save it in the longer term by producing fewer claims for tobacco-related diseases.

Government cuts closing pharmacies could lead to more people seeing GPs according to Pharmacy Voice which represents high street chemists.  The Government is proposing to cut funding for pharmacies by £170m which could lead to the closure of up to 3,000 pharmacies.  Consultation on the proposals closes on Tuesday 24th May.

Government targets to double cycling trips by 2025 will not be met because of insufficient funding, according to an analysis by Sustrans.  They calculate that £17.35 per person per year would be required to meet their targets while the current plans are for £1.35 per person per year, compared to its own promise of £10.  It is estimated that each £1 invested produces an £8 economic return.


22 May 2016

Many homeless people are being relocated miles away according to a study by Shelter based on freedom of information requests.  It found that almost half of homeless families placed in temporary accommodation by London councils were sent out of area.  Most went to a neighbouring borough but 26%, although placed in London, were beyond a reasonable travelling distance for local services and schools, and 10% were outside London.  There were also examples of homeless people being forced to accept unsuitable placements.  A third of London councils had not complied with a court judgement from last year that they should revise their policies so that relocation does not disrupt education, medical needs, caring responsibilities and employment.

Official dietary advice to avoid fat is claimed to be wrong by the National Obesity Forum and the Public Health Collaboration who say that commercial influences have distorted dietary advice.  Half of the reference group which decided on the Eatwell graphic were industry representatives.  They say that a diet rich in full-fat dairy can lower the chance of obesity and protect the heart.  They say that sugar should be avoided, people should stop counting calories and that exercise could not ‘outrun a bad diet’.  Other experts said that this advice was based on limited studies and was not peer reviewed.
PHE response:

Problems with ambulance services have been linked to 35 deaths in the last five years, often due to a shortage of vehicles and staff, according to coroners’ reports.


21 May 2016

The new limit of child tax credit to two children unless a further child is the result of rape has been referred to the UN by SNP MP Alison Thewliss.  The complaint is to be examined by the UN’s official committee on the rights of the child before hearings next week on the impact of Britain’s welfare policies.  The UK Government delegation will have to explain how its welfare reforms conform to its UN obligations on child poverty.


20 May 2016

NHS trusts had a deficit of £2.45bn in 2015-16 according to figures from NHS Improvement.  Of all 240 trusts, 65% are in deficit.  The figure is nearly three times the £822m overspend the year before.  Nearly 90% of hospital trusts overspent by a total of £2.6bn on a £56.1bn budget.  It is possible the books can still be balanced by savings in other parts of the health system such as training, public health, DH and CCG spending.  It is claimed that the scale of the deficit has been masked by various accounting devices such as selling assets and transferring capital to revenue, which could lead to increased costs in future years. The IPPR says the underlying deficit could be as high as £3.5bn.  NHS trusts were said to have made efficiency savings of £2.9bn during the year.
The decline in finances is mirrored by the extra costs of agency staff:
The IPPR view:

The number of mental health patients treated out of their area has risen in each of the last three years and in 2015-16 was  5,411 according to figures obtained from freedom of information requests by the BBC and Community Care Magazine from 42 of the 56 English NHS mental health trusts.  The number was 13% higher than the 4,093 last year.  Data from 28 trusts shows the number placed out of area rose from 1,215 in 2011-12 to 4,093 in 2015-16.  More than 90% of out-of-area placements were because of local bed shortages.

GPs are to be balloted on taking industrial action and signing undated resignations, following a decision at the BMA’s annual LMC conference of GP representatives, in response to what is regarded as an inadequate package of support in the General Practice Forward View.  The motion was supported by Dr Chaand Nagpaul, the chair of the BMA’s GP Committee.

Privatisation of back office services in the civil service has cost £4m more than it has saved according to a report from the National Audit Office.  The outsourcing of HR, payroll and accounts to two companies, Arvato UK and Steria, has so far saved £90m, instead of the £128m planned.

Physical inactivity cost the NHS in England at least £455m in 2013-14 or £8.17 per person, according to a PHE analysis.  This is likely to be an underestimate because it only counts the effect on five health conditions and only accounts for CCG spending rather than the whole health budget.  The estimate for 2010-11 based on PCT spending was a total of £701m for England.

27% of CCGs do not have an end-of-life strategy for their area, according to a report from Hospice UK.  They also said that 34% of Health and Wellbeing Boards do not consider the needs of dying people in their JSNAs.


19 May 2016

Proposals to tackle antimicrobial resistance have been set out in Lord Jim O’Neill’s final report. It sets out ten areas for global action, including: requiring pharmaceutical companies to pay for relevant R&D if they don’t do it themselves and a reward of $1bn for those successfully developing a new drug; banning doctors from prescribing antibiotics without first testing to see if they are needed, by 2020; a global awareness campaign; and reducing unnecessary antibiotic use in agriculture.  The cost of the proposals would be $40bn over 10 years.  However this compares to the cost of inaction of $100 trillion between now and 2050 and 10m people a year dying by then, more than die from cancer. Further action is to be mobilised through meetings of the World Health Assembly, the G7, G20 and United Nations.
Comments from the Chief Medical Officer:
Link to press release:
Links to the report and supporting documents:

The high court has ruled against a number of tobacco companies in their attempt to halt legislation coming into force on 20th May which will require standardised packaging of cigarettes and some restrictions on e-cigarettes.  The case was brought by Philip Morris International, British American Tobacco, Imperial Tobacco and Japan Tobacco.
(20/05/16) Government guidance on the law on advertising of e-cigarettes:
Government guidance on packaging of tobacco products:

Over half of health finance directors think the quality of patient care has got worse in the last year, a view held by 65% of NHS Trust FD’s and 54% of those from CCGs, according to a King’s Fund survey of 87 NHS Trust finance directors and 42 CCG finance leads.  The review also found that 67% of NHS trusts, including 86% of acute hospitals, ended the year in deficit.  More than half expect their trust to end next year in deficit.
The report.  See headings on lef hand sidebar for the different sections [I find the graphics in the centre a bit confusing].

The potential harm to the NHS of the TTIP (Transatlantic Trade and Investment Partnership) has been accepted by the Government, in agreeing to support an amendment regarding its legislative programme that expressed regret that there was no bill to protect the NHS from the deal.  The amendment was signed by 25 Eurosceptic Tory backbenchers and backed by Labour, SNP and Green MPs.

The Children and Social Work Bill has been published and had its first reading.  It allows ministers to create offences relating to the regulation of social workers and to directly regulate social workers or to create a body to regulate the profession on ministers’ behalf.  The Bill also lets the Government free up councils from some social work duties and subsequently to make changes to the legislation itself.

30,000 child sex abuse cases could be identified by the Goddard enquiry and passed on to the police, according to the head of the national co-ordinating unit, Operation Hydrant.

Forcing GP seven day, 8-8 opening, is an immoral use of scarce NHS resources that could damage patients’ health, Dr Chaand Nagpaul, chair of the BMA’s GP Committee told the BMA’s annual conference of local medical committees.  He also said it was indefensible and inhumane to be foced to offer only 10 minute appointments for all patients.  He also said that NHS England should be held accountable for any practice closure.

Aspirin should be taken immediately after a minor stroke, Oxford University scientists are recommending, following a meta-analysis of data from 15 randomised controlled trials.  The research was published in the Lancet.  They say that the benefits of taking it early on – in the hours and days after an attack – have been underestimated.  Taking aspirin could reduce the risk of then having a major stroke from 1 in 20 to 1 in 100.  NHS England said they would consider the research.  There is a risk that if the stroke symptoms are caused by bleeding in the brain, aspirin could make the situation worse.  Those who think they may have had an attack should still seek medical help.

A healthy lifestyle could cut the risk of cancer by between 20% and 40% with deaths from the disease dropping by half, according to a study led by Harvard Medical School based on the health records of 136,000 white Americans, published in the journal JAMA Oncology.  They looked at the effects of not smoking, exercising for at least two and a half hours a week, not having more than one drink a day for women or two for men and having a BMI of 18.5-27.5.  This would reduce the rate of deaths from lung cancer by 80%, prostate cancer by 21% and breast cancer by 12%.  Only 18% of women and 25% of men had all four healthy lifestyle characteristics.

Cancer is more likely later in life if as children they have a poor diet and poor living conditions according to a review of 22 studies by Cancer Research UK published in the Journal of Epidemiology and Community Health.  There was a link between poor housing and having a father with a low status job and a higher lifetime risk of bowel cancer and also a greater risk of stomach cancer and families being less well-off.

Indicative figures for NHS funding growth have been published by NHS England, showing how much each part of England could see its budget grow by 2020, including funding for transformation.

A report on how people are being involved in their own care has been published by the CQC.  The report, ‘Better Care in My Hands’ is based on the CQC’s national and thematic reports, its inspection findings and its NHS patient surveys.

A review of the public health workforce and its future capabilities and skills has been published by PHE.  It looks at how to meet future workforce needs.  A complementary report from the Centre for Workforce Intelligence has also been published.  The report is called, ‘Fit for the Future: Public Health People.’

The first release of the UK Health Accounts for 2014 has been published by ONS.  This is a new healthcare expenditure analysis consistent with international guidelines.


18 May 2016

Agreement in the junior doctors’ dispute has been reached following the extension of negotiations.  Junior doctors who work seven or more weekends a year will get premium pay, receiving a percentage of their pay which will vary depending how many they work.  Extra pay for nightshifts (starting after 8pm and lasting at least eight hours) is to be reduced from 50% to 37%.  There is to be an average pay increase of 10-11%, slightly less than the 13.5% previously offered.  Extra support is to be available for those who take time out, such as to go on maternity leave.  The Government has said the deal is cost neutral. Criticisms of the deal were expressed by some junior doctors.  There is concern from medical royal colleges that without extra staffing, weekend working will lead to shortages during the week.  The full details are to be published at the end of May and the deal is to be put to a ballot of the BMA’s 45,000 junior doctor members on 17th June for two weeks with the result announced on July 6th.
Details of the agreement:
(19/05/16) Labour blames Hunt for prolonging the dispute:
Jeremy Hunt’s statement to Parliament:
ACAS statement and link to draft agreement:

The 2016 Queen’s speech set out the legislative agenda for the next parliamentary session. It includes a Children and Social Work Bill [covered in a separate item], an NHS overseas visitors charging bill and a levy on the soft drinks industry (as announced in the budget).  Other measures include: a prison and courts reform bill giving more independence to prisons; the extension of academies in an education for all bill; a counter-extremism and safeguarding bill; a higher education and research bill making it easier for new universities to set up; consultation on a bill of rights to replace the Human Rights Act; a policing and crime bill to promote co-operation between police, fire and ambulance services; protection of children from online pornography in a digital economy bill; speeding up planning in a neighbourhood planning and infrastructure bill; implementing the promise for councils to keep 100% of their business rates in a local growth and jobs bill; a national citizen service bill; and a bus services bill with new powers for local mayors.
The Government’s background briefing:

A Children and Social Work Bill was announced in the Queen’s speech. It will aim to tip the balance in favour of adoption, requiring councils and courts to take better account of a child’s need for stability when making adoption decisions.  It will introduce more demanding professional standards for social workers and set up a new specialist regulator for the profession.  It will give more help to children leaving the care system, including the right to a personal adviser up to the age of 25.  The British Association of Social Workers says the Government should stop its unsubstantiated criticisms of social workers and engage them in reforms.
Feature article by Edward Timpson, the Children and Families Minister:

The GPs’ QOF scheme (quality and outcomes framework) does not produce any discernible reduction in mortality, despite £5.86bn being spent on the scheme in the last seven years (an average of £837,000 per year), according to research from the universities of Michigan, Manchester and York, published in the Lancet comparing the resutls of the scheme with outputs in similar areas in 26 countries.  The scheme was introduced in 2004.  The authors say that research has yet to show patient benefits from pay-for-performance programmes.

The commitment in the Queen’s speech to an assault on the root causes of poverty is insufficient without considering child poverty and low income, according to the responses of a number of charities.  A briefing on the speech said that a strategy is to be produced on transforming the life chances of disadvantaged children and their families, with a set of indicators.  There is concern, though, at too much focus on such things as addiction, family breakdown and mental health while not recognising the importance of low income.
The Government’s background briefing:

Health Education England is reorganising how it is structured locally to more closely match the new sustainability and transformation plan areas.  The 13 local education and training boards (LETBs) are to be reduced to 4, but with new local workforce action boards (LWABs).  About 38 of these LWABs are currently planned, which don’t exactly match the STPs

The number of carers in their 80s and older has increased by 40% since 2009 from 301,000 to 417,000 according to a representative household survey of 15,000 people aged 60 or over, according to Age UK.  The increase is thought to be partly because of an ageing population but also because of lack of state support.  It is estimated that over-80s carers save the health and wellbeing system £5.9bn a year.

A four year plan for nurses, midwives and care workers has been launched by the Chief Nursing Officer, Jane Cummings.  The plan, ‘Leading Change, Adding Value’ includes ten commitments such as increasing the visibility of nursing and midwifery leadership, focussing more on prevention and having the right staff in the right place at the right time.  The framework does not have any funding attached to it.
Blog from Jane Cummings:
Link to the document:

The NHS tariffs for 2016-17 have been published by Monitor and NHS England.


17 May 2016

Nurses, pharmacists and paramedics should be given training so they can take some of the workload from doctors according to a report by the Nuffield Trust for NHS Employers.  The report highlighted a number of examples where this was already happening.  It identified four areas for action. 1.  Increasing the number of support staff such as healthcare assistants could reduce demands on others.  2. Growing the skills of existing registered healthcare professionals such as nurses could help in the management of chronic diseases. 3. Advanced practice training for nurses could could help fill gaps in the medical workforce.  4. The impact of physician associates is limited because of low numbers and a lack of a regulatory framework. However unions said the proposals should not be seen as a quick fix for the NHS’s problems.  It was also pointed out that there is also a shortage of nurses so there would not be a ready supply to fill other gaps.
Feature article:
Press release:
The report:

Many stroke victims do not receive the recommended care after they leave hospital according to a report based on interviews with 1,200 stroke patients led by the University of Leeds for the Stroke Association.  NICE guidelines say that stroke survivors should have a health and social care plan before leaving hospital, but 39% of respondents said they didn’t have one.  45% said they felt abandoned on leaving hospital.

Gardening should be prescribed more often for people with cancer, dementia and mental health problems according to a report by the King’s Fund commissioned by the National Gardens Scheme.  It says that gardening can also help patients with heart disease and obesity, and it can reduce depression, loneliness, anxiety and stress.  There are already a number of social prescribing schemes round the country which direct people to non-clinical support.  The idea was supported by public health minister Jane Ellison.
The report:

The latest abortion statistics show a gradual rise in the age of those having an abortion, with an increase amongst women aged 30-34 by 18% between 2005 and 2015 and by 15% amongst those aged over 35, while those to women under 20 have fallen.  92% of terminations were carried out at under 13 weeks of pregnancy.  Medical abortions (where women take a pill to end the pregnancy) was used in 55% of terminations, the highest ever proportion for the method and an increase from a quarter ten years ago.

The rate of stillbirths fell slightly in 2014 compared to the previous year, but there remain big differences across the country, according to the second Perinatal Mortality Surveillance report by the MBRRACE-UK collaboration based at the University of Leicester.  Rates varied from 4.9 to 7.1 deaths per 1,000 births, across the country.  Around two thirds of stillbirths and neonatal deaths were born preterm.  The researchers also said there was a wide variation in the quality of investigations following deaths.


16 May 2016

The UK has relatively low levels of persistent povery but high levels of those moving in and out of poverty compared to other EU countries according to ONS statistics.  In 2014, 6.5% of the UK population or 3.9m people, were in persistent poverty (below 60% of median income in the current year and at least two of the previous three years), the lowest rate since records began in 2008 and the third lowest rate in the EU. The overall poverty rate, at 16.8% was the 12th highest in Europe.  Between 2011 and 2014, 32.5% of people had experienced relative poverty at least once.  The ONS said that in the UK the chances of getting into poverty are relatively high, but there is also a high chance of getting out of it.

Half of people seeking a potential dementia diagnosis have waited over a year because of unwarranted fears about the effect on their life according to a survey of 2,000 people by the Alzheimer’s Society which found that half were concerned they might have to stop driving immediately and a quarter afraid they would no longer be able to go for a walk on their own.  A separate poll of 1,000 GPs found that 56% had diagnosed someone with suspected dementia whose symptoms had been present for at least seven months.

All schools should have a mental health professional on site at least once a week according to a report by the IPPR which says that secondary schools should be put at the heart of early intervention for children and young people with emerging, low level mental health problems.  They say that by 2020-21 each school should have at least one day’s support funded by CCGs.  The report also says that Ofsted should assess schools’ mental health provision.

Fifteen cancer charities have expressed concerned about changes to the Cancer Drugs Fund, in a letter to the Prime Minister.  They say the NICE methodology used for assessing drugs needs to be reviewed and they are concerned that many clinically-effective drugs will struggle to gain approval under the new arrangements where the fund will assess drugs not approved by NICE but which are innovative and with potential.

Outsourcing of failing children’s services has been hampered by a lack of independent organisations willing to take them on, which is frustrating for the Government, according to market experts Laing Buisson.  Independent trusts have been set up in Doncaster and Slough while Kingston and Richmond delegated their services to a council owned community interest company.  The report suggests that pressures for more efficiency could force other councils to outsource their children’s services and that the involvement of more sectors is likely to increase innovation.
PDF of the report:

Women who worship once a week have a 33% lower risk of dying over a 16 year period according to a study by the Harvard TH Chan School of Public Health, of 74,000 women enrolled on the Nurses’ Health Study, with questionnaires collected between 1992 and 2012.  The research was published in JAMA Internal Medicine.  The benefits come from social support (23% of the association), smoking rates (22%) and having a more optimistic outlook on life (9%).  The research was limited in involving mainly white, female christian nurses with similar socio-economic status.

Exercise reduces the risk of getting 13 different types of cancer with an average reduction of 7% according to research pooling the data from 12 US and European studies between 1987 and 2004, involving 1.4m people, and published in JAMA Internal Medicine.  Most of the associations remained regardless of BMI or smoking.  The largest reductions were for oesophagael (42%), liver (27%) and lung (26%) cancer.  The reduction for breast cancer was 10%.  The risk for prostate cancer was increased by 5%.

A briefing on active travel has been published by Public Health England.  It is aimed at transport planners and public health practitioners.

Seven case studies of collaborative working by GPs have been published by the Royal College of GPs.


15 May 2016

A report on the reasons for excess mortality in Glasgow has been published by the Glasgow Centre for Population Health.  Previous research has shown that Glasgow suffers 30% higher premature mortality than other similar cities.  This report takes an historical view looking at how political decisions have impacted on poverty and deprivation.
(10/06/16) Feature article:
Press release:


14 May 2016

NHS care for young people with mental health problems is inadequate, according to a survey of 302 GPs by a charity, ‘stem4’. 86% of the GPs said they were worried that children were coming to harm while waiting up to a year for help.  61% of GPs said they were seeing more cases of self-harming than five years ago and 83% say services are either inadequate or totally inadequate.

More restrictive laws on the sale of cigarettes come into force on 20th May, including standarised packaging, 60% of packaging carrying health warnings and a ban on them being sold in packs of ten, following a European Court of Justice ruling allowing the EU Tobacco Products Directive to go ahead.


13 May 2016

Talks between the junior doctors and the Government are to be extended to Wednesday next week (18th May).  Both sides have been asked not to make any public statements while the negotiations continue.
(14/05/16) The junior doctors say they are keen to rediscover common ground with ministers:

Integration of health and social care is being hindered by spending cuts according to an evaluation of 14 pilots in the integrated care and support pioneers programme, based on 140 interviews with staff from various organisations, by the Policy Innovation Research Unit.  It found that engaging staff in integration was difficult when they were firefighting to keep existing services running.  Ambitions had become more limited, focussed on short-term financial goals.  The range of initiatives used had narrowed to setting up multidisciplinary teams, improving care planning, creating a single point of access for services and using care navigators.

49 internal DWP reviews on deaths of people claiming social security have been published following a long running freedom of information campaign.  40 of the ‘peer review’ reports followed a suicide.  The reports identify a number of flaws in handling claims by people with mental illness or learning difficulty.  The reports showed frontline officials unable to identify potentially vulnerable clients, failing to deal with them sensitively or anticipating their problems.   A DWP spokesman is reported as saying no suicide should be linked solely to a person’s benefit claim.

The number of cancelled operations not rescheduled within 28 days is the highest for 10 years, with 74,086 cancelled on the day and 5,063, or 6.8%, not rescheduled.  The number of operations cancelled at the last minute remained under 1%.  Since warning was given for the junior doctors’ strikes, they would not be included in the figures, although they may have affected the underlying situation.  Under the NHS constitution, operations should be rescheduled within 28 days.

30% of adults drink above the minimum alcohol guidelines, 39% (3.5m) of men and 20% of women, according to a quota survey of 2,303 adults aged 18-75 using an online panel by Ipsos MORI for the charity Drinkaware.  Of middle-aged men drinking above low risk guidelines, 53% believe their drinking won’t harm their health, leading the charity to call for health warnings on alcholoic drinks.

A complete ban on advertising unhealthy food to children is being considered by the Committee of Advertising Practice, a self-regulatory body.  There is already a ban on t.v. advertising but this would extend it to all media including online.
Response of the Obesity Health Alliance:

90% of GPs think Jeremy Hunt should step down as Health Secretary and 95% did not have confidence in his ability to manage the health service in a self-selecting sample of 817 GPs in an online survey by Pulse magazine.

Women with gestational diabetes tend to have babies that gain weight early in life according to research from Imperial College on 42 mothers with gestational diabetes (a temporary form of diabetes) and 44 healthy mothers.  The research was published in Diabetes Care.  At the age of ten weeks, the babies of mothers with gestational diabetes had 16% more body fat, as measured with MRI scans.  This is despite the majority of the babies being breast fed.  Gestational diabetes affects about 120,000 women each year in England and Wales.

Depressed patients can be treated remotely effectively according to a study of 600 over 18 year old patients using a telehealth service where non-clinical staff used scripts to give advice and direct participants to online resources.  The research was published in The Lancet Psychiatry.


12 May 2016

The NHS has had the busiest year in its history with March being another record month for missed targets, according to the latest figures.  The March four hour A&E target results were the worst since it was introduced in 2004, at 91.9% for all emergency departments and 87.3% for hospital A&Es.  However the number actually seen within 4 hours was the highest ever.  Delayed discharges reached a record 170,000 days.  The response of ambulance services to the most serious, Red 1, calls within eight minutes was 66.5% compared to the target of 75%.  March was particularly busy, partly because of a late spike in flu cases.  The junior doctors’ strikes were also thought to have had an impact.

NHS England says it will hold Capita to account for disruption to support services for primary care which is took over in September 2015.  There have been problems with transferring records of patients moving surgery and the supply of such things as prescription pads and sterile supplies, Pulse magazine reports.

The number of suicides in 2015 was the highest since 1995 according to figures from the Ministry of Justice.  The number of women recorded as killing themselves rose last year by 70 to 902.  The number of male suicides fell by 23 to 2,997.

WHO air pollution standards are not being met in 40 UK towns and cities according to a WHO study.  It found that 80% of people in urban areas round the world were exposed to harmful levels of pollution.  Data was collected from 795 towns and cities in 67 countries between 2008 and 2013.

Plans to improve cancer outcomes have been published by NHS England.  They take forward the strategy built on the work of a taskforce that reported last year.  The plans include building alliances of clinicians across primary, secondary and tertiary care, and the launching of an integrated cancer dashboard.  £15m is to be made available to find ways to improve access to diagnostics.  The taskforce estimated that 30,000 lives a year could be saved by 2020, through earlier diagnosis and better treatment.

The time to treat TB is to be reduced from up to two years to nine months with a consequent reduction in costs, under new WHO international guidelines.  This follows trials of a new treatment in Bangladesh and nine African countries.  Currently many patients fail to complete the course of treatment because it is seen as too burdensome.  Under the current treatment less than 50% of patients are cured, but it is over 80% in the new regimen.

Proposals for the new Healthcare Safety Investigations Branch’s establishment and operation have been made by an expert advisory group.  A new Chief Investigator is expected to be in post by summer 2016.  The 13 recommendations to the HSIB include: it must be, and perceived to be, independent; it should be about improvement, not apportioning blame; patients, families and staff should actively participate in investigations; and hiding or interfering with evidence should be an offence.  NHS Improvement is to provide back-office services.
Press release:
The report:

The benefits of new walking and cycling routes are highlighted in a report from Sustrans, which summarises recent research on the effectiveness of such routes and provides examples to illustrate the benefits in practice, drawn from its work to create new routes between 2009 and 2013.

Guidance on commissioning place-based services of care has been published by Public Health England. [It is not clear what this adds.  There appears to be a short amount of text linked to some existing documents]

A report looking at how policy can encourage higher levels of wellbeing has been published by the New Economics Foundation.  It combines contributions from City University London, the New Economics Foundation and the University of Cambridge.

The proportion of deaths from different causes through a person’s lifetime are shown in a new presentation by UCLA statistician Nathan Yay.  The graphs show what is most likely to kill you at different ages, by sex and ethnicity.


11 May 2016

The Department of Health does not know if the current supply of clinical staff can meet demand in the health service in England, according to a report by the Public Accounts Committee.  It also says there has been no coherent attempt to assess how many staff will be needed for a ‘seven day NHS’.  The report said pressure to make efficiency savings, with unrealistic targets, had led to a reduction in training posts for core staff such as nurses, leading to higher levels of spending on agency staff.  The committee says they are not convinced that the DH know whether the increase in funding of £10bn p.a. by 2020 will be enough to meet all of its policy objectives. They said that HEE had not assessed whether the removal of the nurses’ training bursary would deter people from applying.  The Department of Health said the report had not properly taken into account increases in the workforce since 2010.

Two more studies have undermined claims about the ‘weekend effect’, (that more people admitted to hospital at the weekend die, than those admittted during the week.).  Both studies were published in the Lancet.  One paper, from Birmingham University found there were fewer senior doctors providing emergency care on a Sunday than a Wednesday and there were slightly higher mortality rates associated with weekend admission, but the two were not related: hospitals with fewer consultants on duty did not have higher death rates.  The other paper from King’s College London and UCL looked at acute stroke care and found that there were many variations in quality throughout the day and the week but no weekend effect.

Benefit sanctions on low paid workers could be counterproductive according to the House of Commons Work and Pensions Select Committee.  It says the Government should proceed cautiously with plans to impose sanctions on universal credit claimants earning less than the equivalent of 35 hours at the ‘national living wage’, if they don’t meet conditions such as attending job centre interviews and looking for more hours, better pay or second jobs.  It warns that the conditionality could be counter-productive and leave people worse off.
Press release:

Jeremy Hunt’s claim that increased spending on the NHS this year is the sixth largest in its history is misleading, according to the King’s Fund and the Health Foundation.  In fact, they say, it is the 28th largest out of 46 years.  They argue that: accurate figures are only available from 1975-76; the figures should be looked at in real terms (i.e. after adjusting for inflation); the percentage increase is more meaningful than a value increase; the whole DH budget and not just NHS England’s should be included (meaning the increase this year was £1.8bn rather than the £3.8bn usually quoted) to allow like-for-like comparisons, and to include factors such as workforce and public health spending; the comparisons should include capital as well as revenue.

Benefit sanctions are having a detrimental effect on many people according to research led by the University of York based on nearly 500 detailed interviews with claimants and other stakeholders.  The research shows that extension of sanctions to people in work, but who are receiving universal credit, can produce disincentives to work.
Feature in advance of publication:

Wrong advice to those at risk of heart problems may have been given to 300,000 people as a result of an IT system fault, in software produced by IT company TPP.  Pulse magazine reports.  The Medicines and Healthcare products Regulatory Agency (MHRA) says the risk to patients is low and that a ‘limited number’ of patients is affected.  It could mean that some people will have been put on statins when they don’t need to have been and some have not been given them when they should have.  GPs will now have to check the records of those possibly affected.
The risk tool has been disabled for use by Ps:
(13/05/16) (Rgn)

The number of bariatric operations should be dramatically increased, from 6,000 to 50,000 a year, according to weight loss surgeons writing in the BMJ, who say this would be cost effective in the long term.  They say that less than 1% of people who would benefit from surgery are getting it and the number of operations fell by 31% between 2011-12 and 2014-15, from 8,794 to 6,032.

The effect on action on climate change of the move of public health to local government is examined in a report from the Joseph Rowntree Foundation.


10 May 2016

There were 33,000 avoidable deaths from heart attacks because of inadequate follow up between 2003 and 2013, according to researchers from Leeds University and UCL, who looked at 389,057 cases in 247 hospitals in England and Wales.  The research was published in the European Heart Journal: Acute Cardiovascular Care.  They found that six out of seven people (87%) missed at least one of 13 recommended treatments or pieces of advice following a particular type of heart attack, which have been proven to reduce further risk.  However, it is possible that some data were miscoded and where advice was not given, it would not necessarily have been taken, so it is possible that the numbers are overstated.

Levels of tooth decay among five year olds have fallen to their lowest level since 2008, with a fall by a fifth from 31% to 25%, according to figures from Public Health England.  However there was considerable regional variation, from 20% in the South East to 33% in the North West.
Press release:

48% of low income households are not claiming all the benefits to which they are entitled, with £15bn unclaimed each year, according to a survey of 1,512 adults by market research company Research Now, for charity Turn2Us.  57% had not claimed because they thought they would not be eligible, 22% of households with children said they were unsure where to find help and 25% of people with disabilities said recent welfare benefit changes made it too difficult to apply.

Too many elderly patients are being discharged from hospital too soon, sometimes without the necessary support at home, according to a report from the Parliamentary and Health Service Ombudsman which investigated 221 complaints about early discharge last year, upholding or partly upholding over half of them.  The number of discharge related investigations increased by 36% last year.  Four issues were identified: patients being discharged before being clinically ready; patients not being assessed or consulted properly before discharge; relatives and carers not being told the person was being discharged; and patients discharged or kept in hospital with no home-care plan in place.

Being overweight may not be as unhealthy as it was 40 years ago according to Danish research which looked at the relationship between BMI and death rates at three different periods since the 1970s.  The research was published in the journal JAMA. The average BMI at which the fewest number of people died of any cause was 23.7 in 1976-8, 24.6 in 1991-94 and 27 in 2003-13. The increased risk of death associated with being obese (BMI of over 30) reduced over this period to zero.  It is thought that the reason may be improvements in healthcare and it is not suggested that advice on weight should change.

Many cases of post-natal depression go undiagnosed and untreated according to a review of previous research published in the Harvard Review of Psychiatry.  The authors suggest that women should be regularly screened for a year after giving birth.

Child obesity rates are affected by social factors early in the child’s life, with smoking during pregnancy and being overweight before becoming pregnant accounting for about 40% of the social divide in child obesity rates according to research from the University of Liverpool using data from the Millennium Cohort Study, published in the Archives of Disease in Childhood.


09 May 2016

The ‘weekend effect’ of higher mortality of people admitted to hospitals at the weekend, may be due to coding errors according to an Oxford University paper which looked at hospital admissions for stroke of 90,000 people from nine GP practices in Oxfordshire between 2012 and 2014.  They found that a third of the people admitted for stroke were actually in for other things, often low-risk, routine procedures carried out from Monday to Friday.  Without those mistakes, there was no ‘weekend effect’.

The end-of-life needs of vulnerable groups are not being considered and they are often excluded from wider health services, according to a CQC review, ‘A Different Ending’, which looked at groups such as black and ethnic minorities, homeless people, travellers, frail and dementia sufferers, people with a learning disability, people with mental health problems and LGBT people.  The CQC said that 67% of the CCGs it surveyed had assessed the end-of-life care needs of their populations, meaning a third had not.  They said that not all CCGs and providers were fulfilling their duties under the Equality Act 2010 to consider the needs of those groups in the delivery of end-of-life care.  The CQC is to start assessing the contribution of adult social care to end-of-life-care.
Press release:
The report:

Plans for GP practices opening 8 till 8 at weekends are to go ahead, even on Sunday, Jeremy Hunt has said to the House of Commons Health Select Committee.  This is despite apparent lack of demand for it on Sundays from the public in pilots so far.  He said there was a clear manifesto commitment for it so the Government would push ahead.

Only 52% of mental health trusts received a real terms increase to their budgets in 2015-16 and only 25% were expecting an increase in 2016-17, despite promises of increased funding for mental health and commitments to ‘parity of esteem’ according to a report by NHS Providers and the Healthcare Financial Management Association, which suggests that promised funding is not reaching the front line.  The research found confusion amongst commissioners and providers about what services were covered by ‘parity of esteem’ and how much needed to be spent.
Feature article:
Press release:
The report:

A yellow fever epidemic in Africa requires urgent action with fears that it could spread to become a global health emergency, according to two U.S. academics writing in the journal JAMA.  The threat of a vaccine shortage could lead to the rapid spread of the disease.  They say the WHO should set up an emergency committee to deal with the crisis.  They also said that a permanent body should be set up to monitor new diseases.

The technical evidence underlying the Five Year Forward view has been published by NHS England following a request from the Health Select Committee.  This explains how the £30bn funding gap was identified, how the funding requirements for the NHS in England were estimated to be £8bn to £21bn and how the £22bn efficiencies are to be realised.  Of the £22bn to be found (following the financial settlement of £3.8bn in 2016-17 and £8.4bn in 2020-21), around £7bn is to be delivered nationally, and of the £15bn to be found locally, £9bn is to come from ‘conventional provider productivity.’  That means that the likes of NHS Trusts will have to find 2% annual efficiency savings.  The Health Foundation noted that the NHS made only £1bn savings last year, meaning it was off target, with too much reliance on one-off savings.
Feature article:

Protection for mental health patients could be damaged by withdrawal from the European Convention on Human Rights, according to Prof Simon Wessely, president of the Royal College of Psychiatrists.  Either dropping out of the ECHR, which was suggested by Home Secretary Theresa May in a speech last month, or abolishing the Human Rights Act, which was a Conservative manifesto commitment would reduce the opportunities for people will mental illness to challenge decisions about their care.  They had been used in the past for such things as challenging detention under the Mental Health Act.

NHS England is to recommission a pharmacy flu vaccination scheme despite concerns from some GPs about fragmentation of the service, making it harder for GPs to plan and leaving them with stocks of unused vaccines.  According to Pulse magazine, the take-up of the vaccination fell amongst target groups last year when the scheme was introduced.  It is also being suggested that increasing provision of services by pharmacists is leading to creeping privatisation within the NHS.  However NHS England says an increased number of vulnerable groups and those at most risk and received the vaccine.

Controls on NHS agency spending are having an effect according to NHS Improvement, which says they have so far saved the NHS £300m.  However other experts have questionned the claims, saying more data is needed, as it is possible places have been left unfilled to avoid the cost of agency staff but increasing safety and quality risks.

The health and wellbeing of children and young people is the focus of a series of reports in the Lancet, the result of its Commission on Adolescent Health and Wellbeing.  Self-harm is the largest cause of death among 20-24 year olds in theUK, followed by road injuries, although both had fallen since 1990.  Deaths from drug use, though, had increased by 36%.  Depression was the cause of the largest amount of ill-health worldwide in 2013, affecting more than 10% of 10-24 year olds.

An audit of falls prevention services has been published by the Royal College of Physicians.  It says that it “provides the first detailed mapping of current service provision for secondary fracture prevention within the NHS in England and Wales.”


07 May 2016

The BMA has said it will re-enter negotiations with the Government on the junior doctors’ contract, including the issue of Saturday pay which the Government insisted should be the focus of negotiations, but also to include other issues.  They said they would call for a contract offer, whether agreed or not, to be put to a referendum of junior doctors.

A campaign to name and shame the most sugary drinks is being launched by Liverpool City Council, with displays in GP surgeries, children’s centres and hospitals showing seven popular drinks and how much sugar they contain.  This is said to be the first such campaign by a British local authority and is different from national campaigns in naming specific drinks.

Many unpaid carers are struggling to get the support they need according to a report from Carers UK based on an online survey to which 3,076 current carers responded.  Of the carers who had received an assessment in the last year, 68% felt their need to have regular breaks was not considered thoroughly or at all.  Only 35% felt that support to look after their own health was thoroughly considered and 21% said they had received little or no helpful information or advice.  29% of carers had to wait more than six months for an assessment and for those caring for people near the end of life, the figure was 39%.   22% of people had to ask for an assessment, rather than being offered one as required by law, while 28% were offered one.
Press release:


06 May 2016

The death rates of people admitted to hospital at the weekend are higher because a lower proportion, of sicker patients are admitted according to research from Manchester and York Universities which looked at patients attending A&E between April 2013 and February 2014, published in the Journal of Health Services Research and Policy.  It found that overall there were 7% fewer admissions at the weekend, 5% fewer via A&E and 61% fewer from GP referrals.  Overall, they say, patients attending A&E at the weekend are no more likely to die than those attending during the week.  This means that extending services will not reduce the number of deaths but will increase costs, significant in relation to the Government’s argument for a ‘seven day NHS’ and the dispute with the junior doctors.
(09/05/16) Press release:

8.4m people in the UK did not have enough food, at some point in 2014, according to a UN survey of a representative sample of 1,000 people analysed by the Food Foundation.  In the UK, 10.1% of people suffered food insecurity which put it in the worst half of European countries or 11th highest out of 28.  The lowest levels were in Sweden (3.1%), Germany (4.3%) and Denmark (4.9%).  The highest were in Lithuania, Romania and Greece, respectively 19.6%, 18.9% and 17.2%.  The Foundation called on the Government to start measuring food insecurity which it said could be done relatively cheaply by adding questions to existing surveys.

Increased intake of red meat, and particularly processed red meat is associated with increased all-cause mortality according to a review of six previous studies covering 1.5m people, by researchers from the Mayo Clinic, Arizona, published in the Journal of the American Osteopathic Association.  Those who were vegetarian for 17 years lived an extra 3.6 years on average.  However, representatives of the meat industry noted that the rationale for selection of these articles was not given, and, without evidence of a causal mechanism by which red meat was affecting health, it was possible that the results were due to a correlation with other factors such as vegetable consumption or unhealthy activities.

Putting on too much weight in pregnancy increases the risk of the child becoming overweight even if the child’s weight is normal at birth, according to research by the Kaiser Permanente Centre for Health Research which followed over 24,000 mothers and their children. It was published in the Maternal and Child Health Journal.  The mothers gave birth to normal weight babies between 1995 and 2003.  Children of mothers who gained 40lbs or over during pregnancy were at least 15% more likely to be overweight or obese between the ages of 2 and 10.  The lead author said increased weight and elevated blood sugar seems to ‘imprint’ the baby for childhood obesity.

The Government has allocated £433 to local authorities to help implement the Care Act in the 2016-17 financial year.

A guide to help Patient Participation Groups (PPGs) operate more effectively has been published by the National Association for Patient Participation.  All GP practices now have to have a PPG.  The guide was developed with the involvement of 50 PPG members and practice managers.


05 May 2016

The Government has agreed to re-enter negotiations on the junior doctor’s dispute, ‘pausing’ the imposition of the contract for five days, meaning that talks can resume next week.  However, they said they wanted a written guarantee that the BMA would be prepared to negotiate on Saturday pay.  The BMA had already said, in response to a proposal from the Academy of Medical Royal Colleges, that it was prepared to hold off from calling further strikes to enable the talks to resume.
Jeremy Hunt’s letter to the Academy of Medical Royal Colleges:

The growing GP crisis was not spotted early enough because of lack of data collection by the Department of Health and NHS England, according to a report from the King’s Fund.  They analysed data on 30 million patient contacts from 177 practices between 2010-11 and 2014-15.  Growing demand on GPs has come from an increased workload, greater complexity and intensity of work, the report says.  The research finds there has been a 15% increase in patient contact.  Only a tenth of GP trainees expect to be doing full-time clinical work in five years time. The amount of data available on general practice is very poor compared to other areas of health such as A&E.  Recommendations include using technology to reduce demand, enhancing the workforce, including with new roles, and reducing the bureaucratic burden.

The benefits of exercise outweigh the harm from air pollution even in quite polluted cities like London, according to research from the University of Cambridge and the University of East Anglia using computer simulations on pollution and activity data, and published in the journal Preventive Medicine.  At average air pollution levels you would need to cycle for more than 7 hours or walk for more than 16 hours a day for the harms to outweigh the benefits.  The authors emphasised that this was not an argument for inaction on air pollution, which is estimated to contribute to 40,000 early deaths a year in the UK.  For Delhi, the most polluted city on the WHO database, the point at which harms outweighed benefits, was after 45 minutes cycling or six and a quarter hours walking.

Four Seasons Health Care is ‘likely to be taken over by its creditors’ according to the credit ratings agency Moody’s which says the company, that has 440 care homes, is in an unsustainable financial position.  Moody’s said that the firm was unlikely to be able to generate enough cash to service its debt, so a debt-for-equity swap with lenders was the most likely option.  The company refuted the judgement and said it had medium-term flexibility in its finances.

The ending of the bursary for student nurses and midwives was debated in Parliament, but the labour motion was defeated.

E-cigarettes in the U.S. are to come under the oversight of the Food and Drug Administration, with existing brands having to undergo federal reviews to stay on the market, put health warnings on packaging and restrict sales to those under 18.


04 May 2016

E-cigarette advertising will be banned on television, radio and websites from 20th May under a new EU directive which can go ahead following a decision by the European Court of Justice to reject a legal challenge by a British vaping firm Totally Wicked.  The European Tobacco Products Directive also means that e-cigarette packaging will have to contain a warning saying that the contents contain a ‘highly addictive substance’, and they must not contain more than 20mg of nicotine per millilitre of liquid.  A separate challenge on plain packaging was also dismissed, meaning that cigarettes will have to be sold in brown or green with 65% of the surface carrying a health warning.

A quarter of UK care homes are at risk of closure according to research for BBC Radio 4’s You and Yours programme by business risk analysts Opus Business Services.  They say there are 5,000 homes at risk of closure because their profits do not cover loan repayments.

A bid to resolve the junior doctors’ dispute has been made by the Academy of Medical Royal Colleges which has proposed a five day ‘pause’ by both sides, dropping preconditions for talks, to allow negotiations to be renewed.  The BMA has agreed to the proposal.  As well as the 22 medical royal colleges and faculties, the proposals were supported by the NHS Confederation and the GMC.

The role of mental health champion for schools is to be cut. This follows criticism by the current postholder, Natasha Devon, of educational policies such as testing.  The DfE denied that she was being dropped because of her criticisms and said it was because there was now to be a new cross-government mental health champion.  The post was created last August, with Natasha Devon the first appointee.  Her role was not paid.
(06/05/16) Natasha Devon says that axing her role silences young people and teachers:
(13/05/16) Interview with Natasha Devon:

Embyros have been grown in the lab for 13 days, past the point they would normally be implanted in the womb in US and UK research published in Nature and Nature Cell Biology.  Previously, fertilised eggs would have to be implanted into the womb after a week.  The research was halted before reaching the current legal limit of 14 days.  It provides insight into the early stages of embryo development.  There are now calls for the legal limit to be extended though there is also strong opposition to that.

The rates of alcohol related hospital admissions have been rising for over 40 year olds but falling for under 40s according to figures from Public Health England.  Between 2008-9 and 2014-15, the number of admissions per 100,000 rose from 261 to 275 (5.4%) for over 65 year olds and from 278 to 300 (7.9%) for 40-64 year olds.  There was an 8.6% fall for under 18s, to 37 per 100,000.  Overall, since 2008-9 the rate of admissions linked to alcohol increased by 29%.

A fifth of care homes are being wrongly charged for GP services according to a report based on a survey of 285 care homes, by the Alzheimer’s Society and Care England.  Seven in ten care home residents suffer dementia.  The Alzheimer’s Society estimates that the unnecessary cost of GP visits could be £26m annually in England.  GPs can charge for ‘non-standard’ primary care if it is agreed in a contract.  Two fifths of respondents felt the NHS was not providing quick access to services such as physiotherapy, continence and mental health.

A type of thyroid tumour is being reclassified as not a cancer following research led by the University of Pittsburgh School of Medicine on 268 tumours by 24 working groups, published in the journal JAMA Oncology.  This would mean that those people no longer have to undergo radiotherapy and other unpleasant treatments.  The same approach could be applied to other cancers.  The type of tumour being reclassified accounts for about 10-20% of thyroid cancers in Europe and North America.  Thyroid tumours account for less than one per cent of cancer cases in the UK.  About 2,700 people are diagnosed with thyroid cancer each year in the UK.

There has been an increase in screening for alcohol problems of people attending emergency departments, with the number of adults routinely questionned about alcohol use having increased from 48% in 2011 to 64% in 2015 according to research by the University of Surrey for Alcohol Research UK.  However screening of under 18s is much more limited and rose from 9% in 2011 to 12% in 2015.   Separate qualitative research by King’s College London found that people regularly presenting at emergency departments with alcohol problems typically have multiple and complex needs and require personalised support.
Press release:
The report:

People are happier while drinking alcohol but it does not make them happier longer term according to researchers from the Universities of Kent and Sussex, publishing in Social Science and Medicine.  They used two data sets, a cohort study of people born in Britain in 1970, using responses at ages 30, 34 and 42 (10,107 individuals and 29,145 responses) and iphone responses on subjective wellbeing between 2010-13 (31,302 individuals and 2,049,120 observations).  Although large, neither sample is necessarily representative.  While there was generally no link between alcohol consumption and happiness longer term, after taking account of factors such as illness, where alcohol became a problem it did lead to feelings of lower wellbeing.

Diets have become more Europeanised, with more eating out, in the last 40 years, according to data from the Expenditure and Food Survey released by Defra and analysed by the Open Data Institute.


03 May 2016

Universal credit has been reduced to an exercise in cost cutting and could leave millions of working families worse off, according to a report by the Resolution think tank.

The gap in lifespans is growing for the first time since the 1870s, particularly for men. For those dying over the age of 30, the gap between the 10% dying at the youngest age and the 5% at the oldest, was 33 years in 2010.  The gap for men was at its narrowest in 1993 but increased by 1.7 years by 2009.  This was largely because of some men dying much later, starting to catch up with women, which was not matched by those dying youngest.  The gap for women was at its narrowest in 2005 but has since levelled out. The research was undertaken by the Cass Business School and the International Longevity Centre UK based on data from the Human Mortality Database.  Whereas improvements in life expectancy in the past were to do with such things as clean water and medical advances, the differences now are more about personal choices such as tobacco and alcohol consumption and lack of exercise.

Google is being given access to 1.6m NHS patient records in an agreement with the Royal Free NHS Trust covering the Royal Free, Barnet and Chase Farm Hospitals.  It will include records going back over the last five years and on to 2017.  The aim is to use the data to create an app to provide an alert when someone is at risk of developing acute kidney injury.  The Trust said that this is a standard information sharing agreement and patients can opt out by contacting the trust’s data protection officer.  Acute kidney injuries contribute to 40,000 deaths a year in the UK.

Ministers are trying undermine trust in doctors according to the chair of the BMA, Dr Mark Porter, speaking to a BMA emergency summit.

Medical error is the third biggest cause of fatalities in the US, accounting for 9.5% of deaths or about 250,000 a year, according to research from the John Hopkins University’s school of medicine, published in the BMJ.  It is based on research studies since 1999, since such a cause of death is not included in the American coding structure, which is also used by 117 countries including the UK.  It is suggested that most of the problems are systemic rather than the fault of individuals.

A briefing on ‘early action’ (aka ‘prevention’) has been published by Community Links, with the New Economics Foundation.  It sets out lessons from the Southwark and Lambeth Early Action Commission which aimed to embed a preventive approach across the two Boroughs.


02 May 2016

In 16% of cases of ‘do not resuscitate’ (DNR) orders being put on patients, their families were not told, according to an audit covering a range of issues in end-of-life care,  by the Royal College of Physicians, based on 9,302 cases from May 2015.  In 81% of cases where a DNR was put in place a senior doctor did discuss the case with the family (up from 72% in the 2013 audit published in 2014) and in 4% of cases there were no relatives or they could not be contacted.  There was a documented discussion about the impending death between the dying person and a healthcare professional in 25% of cases, with no discussion possible in 63.4% of cases because of factors such as dementia or unconsciousness, with 12% of cases undocumented.

NHS health checks reduce the 10 year risk of cardiovascular disease by only 0.21% according to research led by Imperial College, commissioned by the Department of Health, analysing data on a representative sample of 138,788 people having the checks between 2009 and 2013, published in the Canadian Medical Journal (there is interest in Canada in starting a similar programme).  One heart attack or stroke is prevented for every 4,762 people who have a check up.  There were small improvements in blood pressure, cholesterol levels and weight loss.  The check ups are offered to everyone between the ages of 40 and 74, but only 21% of people took up the offer.  The researchers suggested more work is needed to explore the reasons for the poor results suggesting that the scheme should be better planned and implemented.


01 May 2016

A petition against cuts to local pharmacy services has been signed by a million people. The petition is organised by the ‘Support Your Local Pharmacy’ campaign.  The Government has indicated that they think there are 3,000 too many pharmacies and are reducing funding, although the full details are not clear.  The petition is to be delivered to Downing Street this month.


30 April 2016

72% of UK votes are fearful that health services will deteriorate in the future according to a survey of just over 1,000 people by the polling firm Populus, commissioned by lobbyists Incisive Health.  This was the highest proportion of six European countries surveyed.

Many vulnerable people are being refused registration with GPs because of lack of paperwork according to the charity Doctors of the World.  The claim is based on a survey of 849 of their clients that they tried to help register with GPs between March and October 2015.  Their clients include homeless people, drug users, destitute nationals, asylum seekers and Roma communities.  The charity says that everyone living in the UK is entitled to free primary care and GPs do not need to ask for documentation to prove identity or residence.  Of the 849 clients they tried to help, 61% were successfully registered.  Of the remaining 331, in 32% of cases the GP practice could not provide an immediate response, 39% were refused because of no proof of ID, 36% were refused because of no proof of address, 13% because their immigration status was queried and 23% for multiple reasons. [It is not clear why percentages add up to more than 100]
(28/04/16) Guidance on recovering costs from migrants. [Not a source for the story but useful background information and updated around the same time].


29 April 2016

45% of GPs would be willing to participate in a mass resignation due to the current state of general practice, despite the General Practice Forward View recently published, according to a self-selected sample of 524 English GPs by Pulse Magazine.

Over half of GPs in Northern Ireland are planning to leave their job or reduce their hours in the next five years according to ComRes poll commissioned by the RCGP Northern Ireland.  99% thought that workloads had increased in the last five years with 90% saying this had led to rising levels of fatigue and 94% saying morale had been damaged.  A similar survey was undertaken recently in Scotland.

Labour has called a Commons debate on scrapping bursaries for trainee nurses and midwives. The opposition day debate is to take place on 4th May.

A report, “Behavioural insights and healthier lives” has been published by the Victorian Health Promotion Foundation in Australia.  Written by the Chief Executive of the UK’s Behavioural Insights Team, David Halpern, it summarises a range of initiatives undertaken during his residency with VicHealth.


28 April 2016

Looked after children are not receiving the mental health treatment they need, the Education Select Committee says in a report.  They often do not receive care because of moving round a number of different foster homes or because they do not meet the thresholds for treatment.  Statutory guidance says that looked-after children should never be refused a service on the grounds of their placement.  The report also says a significant number of local authorities and health services do not identify mental health issues when children enter care.  Almost half of children in care have a diagnosable mental health disorder and they are four times more likely to have a mental health condition than their peers.  The committee recommends that looked after children should have priority assessments and should never be refused treatment on the basis of their placement or severity of the condition.
Press release:
The report:

E-cigarettes should be promoted as a substitute for smoking, according to a report from the Royal College of Physicians.  They argue that e-cigarettes are more popular than other nicotine replacement therapy (NRT) and are an effective way to help smokers quit.  They say that e-cigarettes are probably more hazardous than NRT but probably less than 5% as harmful as smoking tobacco and that to date there is no evidence of them acting as a gateway to smoking.  They say that there is a need for regulation, but that shouldn’t stop the development of harm reduction products.  They warn that the tobacco industry has got involved in the e-cigarette market and can be expected to use that to market tobacco products and undermine wider tobacco control work.  A government impact assessment (published on 18th April) also notes the risks from regulation, such as increasing a black market in e-cigarettes.
(Also covers the government’s impact assessment on new regulations enshrining the EU Tobacco Products Directive into UK law.
Feature and comment:

The new junior doctors’ contract is potentially discriminatory to women, according to the Equality and Human Rights Commission, in a submission to the UN.  They say the contract could be inconsistent with Article 7 of the International Convention on Economic, Social and Cultural Rights (ICESCR) and that the Department of Health needed to do more to show it was not discriminatory.  The Department of Health rejected the suggestion.

There have been 6 murders and 100 suicides in English and Welsh prisons in the last year, the highest levels for 25 years, according to statistics from the Ministry of Justice.

A court has ruled that the UK Government can face legal action over its failure to tackle illegal levels of air pollution. The request was granted by the High Court to environmental lawyers ClientEarth.  The hearing is likely to be in the summer.

Nearly 60% of Scottish GPs plan to quit or cut their hours according to a ComRes survey of 150 GPs commissioned by the Royal College of GPs.  90% of respondents said that morale had fallen over the last five years.

A report, “Statistics on Obesity, Physical Activity and Diet, England 2016” has been published by the HSCIC.  Amongst other things it reports that the majority of hospital admissions where the primary diagnosis was obesity was for women at 73% of cases or 6,630, compared to 2,500 for men.  The number of hospital admissions where obesity played a role increased ten-fold in the decade from 2004-5 to 2014-5, from 40,741 to 440,288.  58% of women and 65% of men are overweight or obese.

Public health faces pressures from decreasing resources according to a report (62pp) from the Nuffield Trust, based on an analysis of quantitative indicators and a survey of 37 public health professionals and 11 other organisations.


27 April 2016

The junior doctors strike for a second day. No major problems are reported.  Both sides say that they will fight on.

At least 1.25m people were destitute in the UK at some point last year, according to research commissioned by the Joseph Rowntree Foundation.  Destitution was defined as going without at least two basic essentials in the month, such as: sleeping rough; having fewer than two meals a day for two or more days; being unable to heat or light their home for five days or more; going without weather appropriate clothes or basic toiletries.  The research was based on a survey of people coming into voluntary crisis services in nine areas in a week in 2015.  It does not include people who got help from local councils or government programmes, or who did not seek help, meaning the total is likely to be higher.
Press release:
The report:

The cost of commissioning specialised services has not been controlled by NHS England which will put pressure on other services, according to a report by the National Audit Office.  Between 2013-14 and 2015-16, the budget for specialised services, such as treating rare cancers, increased by 6.3% a year, compared to an increase of 3.5% in the budget as a whole. The number of full time equivalent staff involved rose from 287 to 489.  It says that NHS England has controlled costs by reducing the prices it pays for services but this may have affected providers’ financial sustainability.  It says that NHS England still does not have consistent information from all providers on costs, access to services, outcomes or how efficiently services are being delivered.
Press release:

Clean air zones should be extended to more English cities than the six which currently have them, to reduce the health impacts of high-polluting vehicles, the House of Commons Environment Select Committee has said in a report on air quality.  It says that 40-50,000 people a year die early from air pollution-related illnesses.  It says that local areas should have more flexibility in setting controls to tackle vehicle pollution.  The Committee also recommends a vehicle scrappage scheme for older diesel vehicles and actions to reduce pollution from farming.

Britain’s biggest care home provider, Four Seasons Health Care, reports a £264m annual loss, highlighting the financial problems facing the sector.

The number of GPs has fallen by 2% between September 2014 and September 2015, according to HSCIC figures.  Excluding locums there were 34,100 full time equivalent GPs in 2015.  Of other staff in GP practices, the number of nurses rose by 2.2% to 15,400, other staff who provide direct care to patients fell by 1.4% to 9,150 and the number of administrative and non-clinical staff fell by 0.5% to 63,700.
There were only 11 fte physician associates working in GP practices:

Gay or bisexual men under 26 are twice as likely to suffer from depression or anxiety than those over 45, and are six times more likely to have attempted suicide or self-harm, according to research by the London School of Hygiene and Tropical Medicine, funded by Stonewall, based on an analysis of 5,799 men living in the UK and published in the Journal of Public Health.  It is thought this may partly because older men were more mature and better supported when they came out, and class, ethnicity and income may also play a role.  Those living with a partner were 50% less likely to suffer from depression compared to those living alone.

Mindfulness based cognitive therapy was found to be as helpful as common anti-depressant drugs, with those suffering from depression given MBCT being 31% less likely to suffer a relapse in the next 60 weeks.  The research was published in the journal JAMA Psychiatry.
Editorial accompanying the report in JAMA Psychiatry:

Seeing a soap opera character with mental health issues helps public understanding according to a survey by Mind of 2,000 people, which found half of respondents who had seen a storyline involving mental health saying it had helped their understanding of the issues.


26 April 2016

The junior doctors’ strike, the first ever all-out strike in the NHS’s history.  A majority of the public still support the junior doctors, at 57% but this has fallen from the 65% in March, according to a poll by Ipsos MORI.  Jeremy Hunt said, ““No trade union has the right to veto a manifesto promise voted for by the British people.”  It is reported that the Government is taking an uncompromising position because backing down might encourage other public sector unions.  Hunt implied that in future A&E doctors could be banned from going on strike.  Ambulance workers are balloting on possible strike action.  Hunt says this will be his last major job in politics.  There were no major emergencies on the first day, with 78% of junior doctors not reporting for work.

The Zika virus could spread to Europe as the summer arrives, according to a WHO official speaking at a conference in Paris.  The virus can be spread by the Aedes albopictus mosquito, found in Europe, but it is less likely to cause outbreaks than the Aeses aegypti mosquito found in the tropics.

Flu injections given in the morning produced a stronger immune response than those given in the afternoon, in a trial involving 276 healthy adults aged over 65 in the 2011, 2012 and 2013 flu seasons, by the University of Birmingham published in the journal Vaccine.  More antibodies were produced for two of the three flu strains in the injection.  There are a number of changes in daily rhythm which could be responsible but it is not known for sure which.  Larger studies are now needed to confirm the results and that it does lead on to fewer people contracting flu.

Too few children are having their MMR jabs on time, according to Public Health England.  According to the WHO, 95% of children need to be vaccinated for ‘herd immunity.  In 2014-15, only 92.3% had their first dose of MMR vaccine by their second birthday and 88.6% had received both doses by their fifth birthday.  It is estimated that 24,000 children each year are getting their MMR jab too late.

The number of care homes going into liquidation has increased in each of the last three years, from 35 to 40 and then 47 respectively in the years 2012-13 to 2014-15, according to an analysis by accountancy firm Moore Stephens.

A briefing paper on new models of service delivery in local government, such as outsourcing, shared services and local authority trading companies, has been produced by the House of Commons library.


25 April 2016

71% of nurses were worried that staffing levels would get worse and patient safety would suffer as a result of NICE work on safe staffing levels being stopped last year, according to the annual Unison survey, of 2,708 nurses in February.  Across all ward types, 55% of respondents said they had cared for eight or more patients that day, the level at which research suggests harm occurs.  This had increased from 40% in last year’s survey.

The junior doctors are trying to bring down the Government according to a Government source, an accusation the BMA described as ‘ridiculous’.  Thirteen senior organisations, including 10 royal colleges have written to David Cameron asking him to intervene to bring both sides back to negotiations.  The royal colleges said the Government should halt the imposition of the contract to allow talks to continue but the Government ruled out any compromise.  The Health Secretary claimed that some GP practices would be opening longer to cope with demand and NHS England said there would be ‘extra primary care … availability’ although the BMA’s GP Committee said it was not aware of any extra resource for general practice to cover the strike days.
Jeremy Hunt’s statement to Parliament:

A mediterranean diet was found to reduce the risk of heart attacks and strokes in a study of 15,482 people who already had heart disease, in 39 countries with an average age of 67, led by Aukland City Hospital in New Zealand and published in the European Heart Journal.  It found that there were 3 fewer heart attacks, strokes or other deaths per 100 people for those eating the highest proportion of Mediterranean foods compared to those eating the least amount, during a three-and-a-half year period.  It found no evidence that a Western diet caused any more harm to these participants.  The study was observational so could not establish causation and was based on self-reports.

The Health and Wellbeing System Bulletin for April 2016 has been published by the LGA.

A briefing on electronic records in the NHS has been published by the House of Commons Library.


24 April 2016

The new junior doctors’ contract should be piloted and independently evaluated which could lead to the BMA calling off next week’s strike, according to a letter signed by a cross-party group of MPs.  The letter was organised by Labour shadow health secretary Heidi Alexander and signed by Conservative Dr Dan Poulter, Lib Dem Norman Lamb and SNP Dr Philippa Whitford.  A government spokesman said this was ‘ill-informed political opportunism’.


23 April 2016

The junior doctors have been supported by 2,500 consultants, GPs and senior doctors in a letter to David Cameron and Jeremy Hunt, supporting their colleagues and saying that patients will be kept safe in the following week’s strike.  They say that they understand the junior doctors’ frustrations as stretching an already limited resource across seven days will diminish patient care and demoralise an entire generation of junior doctors.

The junior doctors’ strike will lead to over 100,000 patients having treatment disrupted, in the period between 18th April and 2nd May, according to NHS England.  The full scale strike, including emergency cover takes place on 26th and 27th April.

Restaurants should offer free tap water to families eating out rather than waiting to be asked for it, the LGA says.  All licensed premises in England, Scotland and Wales (but not Northern Ireland) have a legal obligation to provide free tap water, but a fifth of people are not aware of this.


22 April 2016

Smokers and obese people are wrongly being denied surgery when clinical commissioning groups impose blanket bans, according to the Royal College of Surgeons which obtained data through foi requests from 200 of England’s 209 CCGs and all 7 Welsh health boards.  It said that treatment should be based on clinical guidance and decided on a case by case basis.  It suggested that such people were soft targets in attempts to save money.  They also said that such bans were in breach of NICE guidelines.  It found that 34% of CCGs have at least one policy that denies patients surgery if they either smoke or have a high BMI, and 22% restrict knee and hip surgery for obese people.

The latest survey of bereaved people has been published by the ONS finding that 75% felt the care for their relative was outstanding, excellent or good, with 10% saying it was poor.  Hospitals got the lowest ratings for being outstanding, excellent or good at 69%, with hospice care at 79%, care at home 79% and care homes at 82%.  33% of respondents said that hospitals did not work well together with GPs and out of hospital services.  13% disagreed that the patient had support to eat or drink in their final two days.  Patients were never or only occasionally treated with dignity and respect by 20% of hospital nurses and 15% of hospital doctors compared to 5% of hospice doctors and nurses.

Forcing people in employment to work longer hours or lose benefits will be hard for jobcentres it is suggested in this feature on a developing DWP policy, universal credit in-work progression (IWP).

Regular meditators had brains seven years younger on average than non-meditators, according to researchers from Germany, Australia and the USA who scanned the brains of 50 American men and women who regularly meditate and 50 who do not.  The research was published in NeuroImage.  However it is possible that those who took up meditation also had healthier lifestyles or that differences in brain structure make some sorts of people more likely to meditate.

Staff whose bosses encouraged them to work longer hours had higher sickness rates over three years according to research from the University of East Anglia, looking at 155 postal workers in Denmark, published in Work and Stress.


21 April 2016

A support package for GPs, with £2.4bn a year extra by 2020, has been launched by NHS England.  The plan, ‘General Practice Forward View’ was developed by NHSE with Health Education England and in discussion with the Royal College of GPs and other GP representatives.  The budget for GP services will rise from £9.6bn in 2016-17 to over £12bn by 2021, a 14% rise after allowing for inflation, but this will be from the already promised £8bn for the NHS rather than being new money.  Among the measures proposed are: more self-help by patients; doubling the number of trainee GPs so the workforce rises by 5,000 over five years; recruiting 500 GPs from abroad; incentives to attract GPs to areas of shortage; 5,000 more non-medical staff to ease the load on GPs; and less frequent CQC inspections for better performing practices.  There is £500m for seven day access, but to be rolled out depending on local demand.  The BMA’s GP Committee said the document contained important elements of support but that it was not the final package that GPs needed and they wished to see more detail.
Press release:

Junior doctors are considering an indefinite strike as one of a number of options in their ongoing dispute with the Government according to leaked emails seen by the Health Service Journal.  Other options included accepting the new contract, negotiating on lower rates of pay on Saturdays or a mass resignation of trainees.

Bringing mental health services up to the standard of physical health will be a struggle for the Government to achieve, as it has promised, according to a report by the National Audit Office.  It says that though the Department of Health and NHS England have started to make progress with implementing access and waiting time standards for people with mental health conditions, much remains to be done and the full cost of meeting the standards is ‘not well understood.’  Although NHS England has made £120m extra funding available for the two years 2014-16, most of the cost of implementing the new access standards will fall on CCGs’ already overstretched budgets.
NAO press release:
The report:
(25/04/16) (Rgn)

A report by the Health Select Committee says that primary care is under strain and struggling with rising demand. It says that there is a need for better access, longer appointments and care by a wider range of professionals.  It said there should be a full evaluation of seven-day GP access pilots before any system is rolled out.

The murder rate rose by 11% to 573 homicides in 2015, although crime overall continues to fall, according to the latest crime figures.  There were also increases in knife crime and sexual offences including rape, but that may be partly because of better recording.

A new quality standard on antimicrobial resistance has been published by NICE. There are six statements to help guide healthcare professionals, such as delaying the use of antibiotics for conditions that may get better on their own, fuller recording of antibiotic prescribing, where feasible and taking microbiological samples to determine which antibiotics would be useful.
Press release:
The standard:

People were happier when they had available cash in their bank account, but the effect lessened above £1,000 according to research by the University of Cambridge and the University of California Riverside analysing data from 585 customers of a UK bank.  This effect was found regardless of a person’s income, spending or total indebtedness.

Weekend admissions to psychiatric hospitals are not associated with a higher risk of death according to research by King’s College London looking at data on 45,000 admissions to a south London psychiatric hospital between 2006 and 2015, of which 7,300 were at the weekend.  The research was published in the British Journal of Psychiatry.  However those admitted at the weekend had on average 21 fewer days in hospital and were more likely to be readmitted within 12 months.

A new children’s mental health website, ‘MindEd for Families’ has been launched, having been created by a consortium of experts and charities, developed with families and funded by the DfE with support from Health Education England and accredited by the NHS Information Standard.
The website:


20 April 2016

Indoor air pollution kills as many people globally as outside pollution according to research by European and Australian researchers led by the University of Surrey and published in the journal Science of the Total Environment.  About 4.3m people were killed worldwide by outdoor pollution in 2012 and a similar number by indoor pollution.  Both forms are linked to the deaths of about 40,000 people each year in the UK.

The Health and Social Care Information Centre (HSCIC) is changing its name to NHS Digital from July 2016.  A new chair, Noel Gordon, has been appointed to it.  He was formerly Managing Director of the Global Banking Practice at Accenture.

Funding for GP 7 day access pilots by NHS England is to continue after April 2016 when they were supposed to be paid for by CCGs, using savings from reduced use of A&E.  NHS England confirmed that it will continue to fund all 20 schemes in the first wave of what was then called the Challenge Fund.

The Government’s approach to devolution deals should be strengthened by providing more confidence that the deals will produce the intended benefits, clarifying the core purpose of the deals and who will be accountable for the devolved services, the NAO says.

A fifth of adults had drunk at home, before or after going out, in the previous week suggesting the practice of ‘pre-loading’ is relatively common, according to research analysing weekly diaries of drinking habits of 60,200 over 18’s between 2009 and 2011 by Sheffield University and published in the journal Addiction.  Such ‘mixed location drinking’ made up 11% of occasions when the participants had drunk alcohol, with 14% of occasions being at home only, when an average of 11.6 units were drunk.  The research identified a typology of eight different kinds of drinking ‘occasions’.

Eating disorders are more common in all-girls schools and among girls with more educated parents according to research led from the University of Oxford using data on over 55,000 girls from the Sweden Youth Cohort, born after 1982 and published in the International Journal of Epidemiology.  Where only a quarter of pupils were female and a quarter of parents had degrees, the chance of developing an eating disorder between the ages of 16-18 were 1.3%, but where three quarters were female and three quarters had parents with a degree, the odds were 3.3%.

Almost half of nursing home residents had at least one transfer to A&E over the course of a year, in U.S. research by the Indiana University Center for Aging Research and the Regenstrief Institute published in the Journal of Post-Acute and Long Term Care Medicine.  The study looked at 4,491 long-stay nursing home residents aged 65 and above.  At the first transfer to A&E, 36% of participants were admitted while 63% were not.  Dementia was not a predictor of time to transfer, but other factors were, which could be used by care home providers to avoid sending people to A&E.

The NHS Innovation Accelerator Programme has reached 3m patients in its first 9 months with access to new apps, safety devices, online networks and other services.


19 April 2016

The Zika virus could pose a risk for 2.17bn people worldwide, according to research led by Oxford University, mapping the areas of the world which have similar environmental and socioeconomic characteristics as places where the virus has already been reported, published in the journal eLife.  Five million births could occur during the next year in these areas at risk of the Zika virus.  Pregnant women with the Zika virus are at greater risk of giving birth to babies with microcephaly.

The rate of new dementia cases is not as high as past trends suggested it would be according to research in which about 7,500 people in Cambridgeshire, Nottingham and Newcastle were interviewed in the early 1990s, then again twenty years later. The research was published in Nature Communications. The rate had remained steady among women but had fallen among men.  If the results were replicated across England, there would be 40,000 fewer cases than might have been expected twenty years before.  The changes suggest that preventive action can be taken to help avoid the condition.  However, other factors like obesity, could reverse the changes.

The junior doctors say they will call off their all-out strike if Jeremy Hunt drops his threat to impose a new contract. However Hunt said there would be no retreat on his plans.

Junior doctors could be struck off if their strike causes patients serious harm according to guidance from the General Medical Council which asks them to pause and consider the possible implications for patients.  The GMC said they would not take action against a doctor for exercising their legal right to take industrial action.

Loneliness is associated with a 30% greater risk of having a stroke or coronary artery disease, according to research from York, Liverpool and Newcastle universities, using pooled data on 181,000 adults from 23 previous studies published in the journal Heart.  The size of the effect is similar to that for anxiety or stressful jobs.
(20/04/16) (Rgn)
(20/04/16) University of York press release:

The number of infants dying before their first birthday is at the lowest rate ever in England and Wales according to figures from the ONS.  The most common cause of infant deaths was respiratory and cardiovascular problems, responsible for 41% of the total.  Cancer and diseases of the nervous system are the most common cause of death for children under 16.  The number of stillbirths rose in Wales from 4.5 to 5.2 pers 1,000 births, but remain unchanged on average in England.

Internal DWP investigations into the deaths of 49 patients may have to be published following a tribunal ruling finding against the DWP’s decision not to release the ‘peer reviews’ and the Information Commissioner’s Office upholding of the Government’s decision.  Neither the DWP nor ICO have yet said whether they will appeal the tribunal ruling.

A levy on nurses employed from outside the European Economic Area will have to be paid by NHS bodies as by other employers, from April 2017, according to a parliamentary written answer.  The levy is a flat rate of £1,000 a year (but £364 for small and charitable organisations).

Every health visiting team should include a mental health specialist to support new parents, new guidance for healthcare commissioners published by Health Education England says.


18 April 2016

Over a third of people with Parkinson’s disease feel the need to hide their symptoms or lie about having the condition according to a survey of 1,868 people in the UK who have it, by Parkinson’s UK.  About 127,000 people in the UK have Parkinson’s.

Prostate cancer patients doing 5 hours moderate exercise a week were 34% less likely to die of the disease than those who did less than an hour a week, according to US research tracking more than 10,000 men with prostate cancer for 20 years and presented to the American Association for Cancer Research meeting in New Orleans.  Four hours a week walking before diagnosis reduced mortality rates by 37%.  Prostate cancer kills 10,900 men in Britain a year.

Guidance on transferring between hospitals and care homes has been published for consultation by NICE.


17 April 2016

Jeremy Hunt has now said he is ‘introducing’ rather than ‘imposing’ the junior doctors’ new contract according to language used in a five page letter sent in response to the judicial review initiated by five junior doctors who have formed a company, Justice for Health.  It is suggested that if he has said he has the power to impose the contract when in fact he can only make recommendations to the NHS bodies and others who employ junior doctors, then he may have misled Parliament and acted unlawfully by purporting to exercise a power he never had.  Hunt subsequently repeated in the Commons that he is ‘imposing’ the contract and said there had been no change of policy from imposition to introduction.  The Government has not identified the powers under which it is imposing the contract.

A strain of gonorrhoea resistant to antibiotics is emerging with concerns it could spread rapidly through the population.  The strain emerged last year and is now resistant to one of the two antibiotics used to treat it.  It started in straight couples but is now being seen in gay men too, which leads to a faster spread as they tend to have more partners.  There have been 34 confirmed cases since November 2014.
(18/04/16) (Rgn)

GP appointment waiting times have been worsening according to Labour, who say that the number of people having to wait at least a week to see their GP rose by 500,000 last year, up to a total of 14.2 million patients last year.  The analysis from the House of Commons Library commissioned by the party also found that funding for general practice fell in real terms by £245m between 2009-10 and 2014-15, and as a proportion of DH spending from 8.8% to 8.1%.

The SNP is to offer new parents a free ‘baby box’, containing clothes, nappies, toys and a built in mattress with the box being usable as a cot.  A similar scheme has been operating in Finland for 80 years and has been credited with cutting the infant death rate there from 10% to 0.2%.  Scotland’s infant death rate is 0.37%. The boxes would cost about £100 each.  It is part of a policy to tackle infant deprivation, support poorer mothers and improve under-attainment in deprived areas.
SNP press release:

Boots may be investigated by the General Pharmaceutical Council, which is calling in evidence on allegations that it is encouraging staff to carry out more medicine-use reviews (MURs) than needed.


16 April 2016

Plans to better target the fuel scheme were vetoed by George Osborne according to leaked emails.  The Department of Energy and Climate Change wanted to use DWP data to target the warm home discount better at those who needed it, but the Treasury blocked it because of concerns about how many people would lose out from the changes.

The number of antibiotic prescriptions issued by each GP surgery will be viewable online through a new tool called ‘Fingertips’, managed by Public Health England, which aims to encourage GPs to prescribe fewer antibiotics.


15 April 2016

The cost of removing rotten teeth from under 18 year olds in hospital has increased by 61% in the last five years from £21.9m to £35.3m between 2010-11 and 2014-15, according to the Local Government Association.  The number of extractions rose by 26% from 32,457 to 40,970.  The LGA wants the Government to target reducing sugar consumption in drinks and food in its forthcoming childhood obesity strategy.
Press release:

The junior doctors have rejected a call to maintain paediatric cover during the forthcoming strike, despite the suggestion having come from Dr Johann Malawana, the chair of the BMA’s junior doctors’ committee.

Problems with treatment in private hospitals leads to around 6,000 people a year needing NHS care, around 2,500 of whom are emergency cases, according to a BMA report.  It is not known what proportion were private patients or were outsourced from the NHS, or what the costs are to the health service.  The independent sector should be subject to the same standards as NHS providers, the report says, and managers should be wary of the service becoming fragmented.

Reliance on food banks is in danger of becoming ‘the new normal’, according to the Trussell Trust, which has seen a 2% rise in referrals over the last year, despite economic growth.  The main reason for foodbank use was problems with benefits (such as delays, changes and sanctions) accounting for 42% of referrals, with low income accounting for nearly a quarter.
(20/04/16) Feature article:

There has been a large increase in the number of children referred to Social Services since the 1989 Children Act was introduced which has traumatised families, but without a corresponding increase in the number of child abuse cases detected according to a statistical analysis by the University of the West of England.

The families of people with learning disabilities and autism are planning to take legal action against local authorities and health providers about the use of inpatient treatment rather than provision of services in the community.  A firm of solicitors acting for around five families is exploring avenues for legal action under the Care Act, the Children’s Act and the Human Rights Act.

A report on ‘Britain’s not-so-hidden hunger’ has been published by the All-Party Parliamentary Group on Hunger.

Blood pressure should be tested in both arms as differences could indicate a heart risk. Those with a difference of 5mm/HG in the systolic pressure were twice as likely to have died from heart disease in the following eight years.  The research from the University of Exeter tested 3,000 people between the ages of 50 and 70.  It was published in the British Journal of General Practice.  The current guidance suggests a difference of 10mm/Hg can be considered normal.

A report on the impact of devolution deals on the English NHS has been published by the Health Foundation.


14 April 2016

A&E 4 hour waiting time figures were the worst since 2004 in February beating the previous low in January, at 87.8% compared to the target of 95%. The figure for just hospital A&E departments was 81.6% treated within four hours.  The figures were worse in Wales and Northern Ireland but better in Scotland at 93%.  Other targets were missed in NHS 111, the ambulance service and one cancer waiting time target.  There were improvements in referral to treatment and diagnostic waiting times compared to January.  Social care related delayed hospital discharges were up by 40% compared to the same month in the previous year.
Press release:

Britain has the biggest gap in children’s healthy eating between the wealthy and disadvantaged of 37 countries assessed in a UNICEF report on child inequality, looking at health, education, income and life satisfaction.  It criticised the UK for failing to reduce inequality in child well-being and said it was unlikely, in the near future, to realise its ambitions to eradicate child poverty.  The UK also had one of the largest gaps in physical activity.  Overall, the UK was ranked 14 out of the 37 countries but was 19th in relation to health.

The threat of antimicrobial resistance is highlighted by George Osborne in a speech to an IMF meeting in Washington, saying that it presents a greater threat to mankind than cancer, and the cost of doing nothing is too great.  By 2050 it could reduce global GDP by 3.5%.  He says that incentives are needed for pharmaceutical companies to develop new antibiotics.  Labour’s shadow environment secretary Kerry McCarthy said that more needed to be done to reduce the unnecessary use of antibiotics in farming.
Background on the issue:
Press release:

The BMA has produced a manifesto for the future of general practice, including proposals for a limit to the number of patients a GP can see in a day, a simpler CQC regulation process, a nationally defined contract for GPs who are employed (rather than being self-employed partners) and the introduction of 15 minute consultations.  It is part of the BMA’s GP Committee’s ”Urgent Prescription for General Practice” campaign.

Depression, diabetes and urinary tract infections in people with dementia could be costing nearly £1bn a year because they are not prevented, diagnosed or treated, according to a report from the International Longevity Centre – UK.  Four of the five most common conditions for which people with dementia are admitted to hospital are preventable.

Mars Foods says some of its pasta sauces should not be eaten more than once a week because of the high sugar, salt and fat levels, and it is to start labelling its products as either ‘everyday’ or ‘occasional’.
Suspicion over the timing (whether it is to pre-empt the childhood obesity strategy) and concerns it does not go far enough:

Teenagers with a BMI over 20 had a greater risk of death as an adult from coronary heart disease, stroke or sudden death, with the risk rising as the BMI increased, according to research on 2.3m Israeli 17 year olds from 1967 to 2010, by the Hebrew University of Jerusalem, published in the New England Journal of Medicine.  There were thought to be two causes: the harmful effects during the teenage years, and the tendency of overweight teenagers to become overweight adults.

Maintaining a lower weight for a year after dieting makes it easier to maintain that weight according to research from the University of Copenhagen, on 20 obese adults looking at hormones that make you feel hungry.  They were put on an 8 week diet, losing an average of two stone each and then maintained at that weight for 44 weeks.  At the end of the year they were producing less of a hunger inducing hormone and more of one which suppresses appetite.

The actual food choices of overweight people did not match what they knew and valued in research from Cambridge University, published in the journal eNeuro, involving 23 lean and 40 overweight people who first rated images of 50 common snacks for healthiness and tastiness, and were then offered a buffet with healthy and unhealthy alternatives.  The overweight participants ate more of the unhealthy food than lean participants.  The researchers concluded that just trying to educate people about healthy food choices is not enough.

People living in urban areas had a 12% higher death rate than those with access to green spaces according to research from Harvard University assessing the wellbeing of 108,630 women, published in the journal Environmental Health Perspectives.  Those in the greenest areas had a 34% lower rate of respiratory disease-related mortality and a 13% lower rate of cancer mortality.  Green spaces also reduced depression and boosted mental wellbeing.

The best ways to recruit and retain GPs have been identified in a systematic review of 51 studies into such strategies, published in BMC Health Services Research.  It includes a suggestion that medical schools should have their funding linked to achieving targets on the number of GPs produced.


13 April 2016

The Zika virus does cause microcephaly according to a review of the evidence by the US Centers for Disease Control and Prevention published in the New England Journal of Medicine.  A key piece of evidence was finding signs of the virus in the brain tissue, spinal fluid and amniotic fluid of microcephaly babies.  Other questions addressed included: were the women affected with the virus at a stage in their pregnancy when it could have caused microcephaly; the rarity of the defect and of the Zika virus infection (reducing the chances of them happening together without a causal relationship); and whether the association makes biological sense.

Depression and anxiety disorders cost the global economy £651bn a year according to the WHO.  It found that every £1 spent on treatment produced a £4 return in terms of productivity.  The results of the research were published in The Lancet Psychiatry.
Press release:

Boots has been accused of pressuring staff to carry out unnecessary ‘medicine-use reviews’ (MURs) to boost profits.  MURs are carried out by accredited pharmacists with people taking multiple medicines, particularly for long term conditions, to discuss how the patient is getting on with the medicines and whether they are working.  The NHS pays £28 per MUR with a maximum of 400 per pharmacy per year.  It is alleged that Boots put expectations on pharmacists to see that maximum as a target to be reached (rather than only offering them when needed).

The junior doctors are urged not to go on all-out strike by Dame Sally Davies, the Chief Medical Officer, who said it would put patients’ lives at risk.

More than two thirds of foster carers felt that access to social workers had been harmed by budget cuts, in a survey of 760 carers across the UK by the Fostering Network.

The rise in womb cancer over the last two decades could be linked to increased obesity, according to figures from Cancer Research UK.  The number of women developing the disease over that time has increased from about 19 to 29 women in every 100,000.  However, while the number of diagnoses has risen from about 4,800 a year in the early 1990s to 9,000 today, the number of deaths has only risen from about 1,500 to 2,000 as new treatments have improved survival rates.

The HSCIC is consulting on which statistics it should no longer publish over the next three years as its funding is cut by 30% by 2020.  One proposal is to stop publishing general practice list sizes every quarter.—201819

Transport services for transferring babies between hospitals were under-staffed in 2015, according to charity Bliss, which found that 6 out of 11 transfer services that provided data had gaps in their rotas.  Prof Neena Modi, leader of the Royal College of Paediatrics and Child Health said that staff shortages were a long term issue and were unacceptable.
Press release:

Guidelines for diagnosing asthma vary between NICE and clinical experts, as the British Thoracic Society and the Scottish Intercollegiate Network consult on advice which differs from NICE’s.

Public Health England’s Strategic Plan has been published, setting out how it will achieve its objectives over the next four years.


12 April 2016

Replacing saturated with unsaturated fats reduced cholesterol but not the risk of heart attacks according to a reanalysis of data from a 45 year old randomised controlled trial, involving 9,423 residents of state mental hospitals and nursing homes in Minnesota, led by the US National Institutes of Health, reported in the BMJ.  More research is said to be needed.
(13/04/16) (Rgn)

Locating GPs in urgent care increases demand and does not save money overall, with the set up costs being greater than the marginal savings made, according to research from the University of Sheffield which reviewed 20 previous studies published between 1980 and 2015 published in the Emergency Medicine Journal.  They also said that co-located services could increase staff dissatisfaction and reduce the quality of care.

The CQC is to review how trusts investigate deaths in hospitals and the community in an inspection of 12 NHS trusts.  This follows criticism of the Southern Health NHS Foundation Trust following the death of Connor Sparrowhawk, when it emerged that only 272 of 722 deaths that had occurred at the trust over four years had been investigated by it.

The number of care order applications reached an all-time high in 2015-16 to reach 12,741 applications involving 21,666 children, according to statistics released by Cafcass.

New rules for cosmetic surgery and other treatments have been introduced by the General Medical Council.  They include avoiding irresponsible advertising and aggressive inducements such as two-for-one offers.  The new guidance comes into force in June and applies across the UK.

A report on the future of general practice has been published by the think tank Reform, based on semi-structured interviews with 22 private and public sector stakeholders.  It argues for bigger practices, making better use of technology and with greater integration within the wider health system.  While practice nurses currently see about a third of patients, the report says that they could safely see half of patients which would save £700m a year.  However the Royal College of GPs said that the shortage of nurses meant this was not currently an option.  Reform also propose a more pro-active model, monitoring the needs of all patients under the GP’s care, emphasising prevention for the healthy majority of patients and focussing on the wider determinants of people’s wellbeing.  It also says patients do take up appointments when surgeries are open longer, quoting the experience of Herefordshire.

80% of people having a heart attack don’t realise it at first with half of victims waiting an hour before seeking help and a tenth of people waiting for two days, according to a poll of 500 heart attack victims by the British Heart Foundation


11 April 2016

The number of deaths of young people in mental health units is under-recorded according to a charity for bereaved families, Inquest.  Through freedom of information  requests it has found that at least 9 young people have died as in-patients in England since 2010 although the Government has said there have been only 4 and last year said there was only 1.  Figures collected by the CQC, used by the Government in previous answers, only count people who have been sectioned, not voluntary inpatients.  Also, the NHS uses private psychiatric units for nearly half its patients, and they are not subject to foi requests.

A report on the state of children and young people’s mental health has been published by CentreForum.  It says that 23% of under-18s are refused treatment by mental health providers, often because of high eligibility thresholds.  The longest waiting times have doubled in the last two years with the maximum being two and a half years.  The north of England was spending more on care for under-18s while the south had serious capacity issues.

The number of deprivation of liberty cases in the Court of Protection increased almost threefold last year from 525 in 2014 to 1,499 in 2015.

An A&E self-service check-in system may have to be overhauled or scrapped because of too many patients exaggerating or faking symptoms to jump the queue.  The CareExpress check-in system is being used in Hull Royal Infirmary and Castle Hill Hospital.  Less seriously ill patients can be diverted to the next door minor injuries unit staffed by GPs and practice nurses.

Only 26% could work out their recommended daily sugar consumption from the information given on a chocolate bar label, which gave the amount of sugar in the bar in grams and as a percentage of the daily total allowance, according to a YouGov survey of 2,000 people commissioned by National Numeracy.  Half gave the wrong answer and 24% declined to answer.  It was answered correctly by 36% of men and 18% of women.  It is suggested that this could affect people’s ability to manage their food intake.
Press release:
The question:


10 April 2016

Concern about antibiotics in the food chain has been raised by a group of city investors in a letter to leading fast food, pub and restaurant chains.  They urge them to take urgent action to reduce antibiotic use because it could affect customer loyalty, sales and shareholder value as well as human health.


09 April 2016

The junior doctors risk irreparibly damaging the trust between the medical profession and the public if they go ahead with their all-out strike, according to NHS England Medical Director Prof Sir Bruce Keogh, writing in the Observer.  The Chair of the GMC, Prof Terence Stephenson says the strikes are increasingly hard to justify because they are causing suffering for patients.


08 April 2016

Children should drink more water rather than fizzy drinks, to help tackle the problems of obesity and diabetes, the LGA says.  They say that water should be made more available in schools, nurseries and children’s centres and hydration should be part of the forthcoming childhood obesity strategy.  Young people between the ages of 11 and 18 drink an average of 453ml of water a day rather than the recommended 1.8 litres.


07 April 2016

The Government has ruled out new talks to resolve the junior doctors’ dispute, saying that the BMA had had its chance to negotiate and had blown it.  The BMA has indicated that it is willing to resume talks.  (The comments were originally reported by the HSJ on 23rd March.)

The NHS is looking to bring in GPs from India to tackle the shortage in this country, with a memorandum of understanding having been signed between Health Education England and the Indian Appollo Hospitals chain.  Details are still to be worked out, but it is thought the NHS could be looking to recruit 400 GPs.  There is concern that, so as to get them in post as soon as possible, they may not be required to undergo the normal three years GP speciality training and to pass the GMC’s professional and linguistic board test, with a consequent risk to patient safety.

Consultation starts on replacing student nurse burseries with loans. The consultation runs from 7th April till 30th June 2016.  Health Minister Ben Gummer is quoted as describing this move to make student nurses pay for their training as a ‘benefit’.

Waiting times for eating disorder treatment vary from 20 to 180 days in different parts of the country according to responses from freedom of information requests obtained by BBC Breakfast from 41 of the 55 mental health trusts.  They found that since 2012, there were 1,576 people who had waited 18 weeks to see a specialist, 742 who had waited 26 weeks and 99 who had waited a year.  Adult eating disorders were not included in the mental health waiting times that came into operation on 1st April.

The number of deaths in England Wales rose by 5.6% in 2015, the largest year on year percentage increase since 1968, to 529,613 deaths, which was the highest number of deaths in a year since 2003, according to figures from the ONS.  However, the age-standardised mortality rate, which takes account of population size and age structure, was 20% lower in 2015 than 2003.   There was an increase of 28,189 deaths between 2014 and 2015.  The peak was in early 2015 and flu, particularly amongst older people, was thought to be a significant cause.  86% of the extra deaths occurred in people aged 75 or over.  The flu vaccine was less effective that year (protecting only 3% of those receiving it) because of a mutation in the virus.

The Government’s plans to improve patient safety are under threat from insufficient funding and Jeremy Hunt should examine his conscience about staying in the Cabinet, according to Prof Chris Ham, Chief Executive of the King’s Fund, writing in the Guardian.  Cutting hospital workforces to balance the books could endanger patient safety, he says, and it is not credible to expect the heatlh service to survive in its current form with the the budget pressures from 1% budget rises.

Women consuming full-fat dairy products were less likely to become obese than those consuming low fat according to research from Harvard University and Karolinska Institute looking at data on 18,438 women from the Women’s Health Study, published in the American Journal of Nutrition.

Those who had had more high fat dairy products were 46% less likely to develop diabetes according to a study by Tufts University analysing the blood of 3,333 participants in the Nurses’ Health Study and Health Professionals Follow-up Study, looking for bio-markers of high fat dairy consumption, which was published in the journal Circulation.

Food labels should show how much activity is needed to burn off the calories, the Chief Executive of the Royal Society for Public Health, Shirley Cramer, has said.  As well as encouraging people to eat less unhealthy foods, it could also increase the chances of them being more active.

The Colostomy Association is campaigning for better facilities in toilets for people to change their colostomy bags.  About 1 in 500 people have a ‘stoma’, the opening on the side of the abdomen through which bodily waste is diverted.  The lack of proper facilities leads to many people being reluctant to leave the house.

Making purchases that matched personality was associated with higher levels of happiness in research from Cambridge University which analysed almost 77,000 transactions by 625 people published in Psychological Science Today.  Spending categories were matched with the five main personality types: opennes to experience; conscientiousness; extraversion; agreeableness; and neuroticism.  Purchases were compared to personality types and those spending more on things that matched their personality tended to be happier.

The term ‘overdiagnosis’ is understood by less than 3% of the public according to a survey of 390 UK adults aged 50-70 with quota sampling used to balance by education and gender, by researchers from UCL and published in BMJ Open.  30% of respondents said they had heard of the term but only 2.6% correctly defined it as ‘detection of a disease that would not cause symptoms or death’.  Definitions commonly given included an ‘overly negative or complicated diagnosis’, ‘false-positive diagnosis’ or ‘misdiagnosis’.  The authors suggest there may be a need for more public education about the term.


06 April 2016

The junior doctors go on strike for 48 hours. The Patients’ Association says it is glad to see the imposition of the contract challenged (but without directly backing the strike).  Over 5,000 non-urgent operations have had to be rearranged.

The number of diabetes cases increased nearly fourfold between 1980 and 2014, from 108m to 422m globally, with the prevalence having risen from 4.7% to 8.5%, according to a WHO report.  Diabetes is the eighth biggest killer, accounting for 1.5m deaths a year.  It is no longer a problem of affluent countries, with low and middle income countries also badly affected.  The increase in the numbers with Type 2 diabetes has been driven by growth in those who are overweight or obese.
Press release:

Alcohol related deaths fell in six successive years when alcohol duty was increased but could rise again following the drop in duty in 2014 and as income grows faster than the taxation on drinks, according to a study published in the BMJ.  The number of alcohol related deaths increased by three times between 1980 and 2008 but then reduced as the affordability of alcoholic drinks fell.  It is likely that the introduction of minimum pricing in Scotland will reduce the number of alcohol related deaths.
University of Southampton press release:

GP workloads have increased over the last seven years according to an analysis of over 100 million GP and nurse consultations at 398 general practices in England between 2007 and 2014, led by researchers from the University of Oxford and published in The Lancet.  The average number of consultations with GPs rose by 12% over that period when standardised for age and sex.  The average length of consultations rose from 8.65 minutes to 9.22.  The number of GPs per patient fell slightly from 60.9 to 60.6 per 100,000.
(Rgn)  There is a call for more of the workload to be shared with practice nurses:

63% of 21 month olds eat too many calories and 99.9% get more than the recommended amount of protein, largely from cows’ milk and other dairy products, according to research from UCL, Oxford and Bristol universities, looking at data on 2,335 children and published in the British Journal of Nutrition.  The average daily calorie intake was 1,035 compared to the recommended 968.  Protein input was 40g a day compared to the recommended 15g, while fibre intake was half that recommended at 8g.

Leaving the EU would put the NHS at risk because of the TTIP trade deal currently being negotiatied between the EU and US, according to David Owen.  He says that increasing marketisation makes it harder to treat the NHS as an exception to free market rules and the Transatlantic Trade and Investment Partnership would make it harder to restore services to public ownership.


05 April 2016

Asthma is being overdiagnosed in children with the consequent risk from unnecessary treatment, according to a leading article by researchers from Imperial College in the Archives of Disease in Childhood.  Objective diagnosis of asthma is currently difficult and NICE is consulting on new guidelines.

Staffing at the Department of Health is to be cut by 35% from 2,000 to 1,300 people, prompting concern (from the nursing profession) that a reduction in representation at senior level may mean the voice of nurses is not adequately heard in policy making.

Four in ten teachers had noticed children looking less healthy on returning from their summer break and 39% knew of pupils who come to school hungry, with no money for lunch and do not receive free school meals according to over 400 members of the Association of Teachers and Lecturers who responded to a survey.
Press release:

A new national occupational health service for GPs is to be provided with GPs able to refer themselves for an assessment on their fitness to work.  It will not include other practice staff.  The BMA said that while this will be an improvement in areas that currently do not have such a service, it will be a ‘retrograde step’ in areas that currently have a good service.

46% of GP practices frequently find it difficult to find locums and a further 40% struggle occasionally, according to a BMA survey of 2,814 GP practices.  Only 10% of practices say they cope without locums.

Cognitive deterioration with age starts early and is faster in men than women according to research by the National Institute on Aging looking at a range of measures on nearly 2,000 people aged 50 to 90 over nine years from the Baltimore Longitudinal Study of Aging published in the journal Psychology and Aging.  There were no measures on which women showed significantly higher rates of decline than men.

Singing in a choir reduces stress and boosts the immune system which could help fight cancer, according to research on 193 members of five different choirs in Wales by researchers from Imperial, UCL and the Royal College of Music, funded by Tenovus Cancer Care and published in the journal ECancer Medical Science.  Saliva from the participants was tested before and after an hour’s singing for levels of hormones and immune proteins.

Brexit campaigners say the UK pays out £700m more for the medical costs of Britons in the EU than it receives for the treatment of EU citizens in the UK, in what the Vote Leave chair, Gisela Stuart, calls ‘health tourism’.  [However, ‘health tourism’ would usually be taken to mean paying for the medical costs of people from other countries coming here for treatment.  These figures suggest that there are actually more Britons getting treatment while abroad (for instance pensioners who have retired to Spain) than people from overseas getting treatment here.  In any case, the costs are recouped, so paid for by the patient’s home country.]


04 April 2016

A second legal challenge to the junior doctors’ contract imposition is being made by Just Health, an NHS staff campaign group which raised £100,000 online in four days through a crowdfunding website.  This judicial review is on the grounds that the decision to impose the contract did not allow enough time for consultation.

A coalition of 36 charities has called for both sides in the junior doctors’ dispute to resume talks. The charities, that include Mind, Action for Sick Children, Epilepsy Action, Bliss, Men’s Health Forum and Sue Ryder, ask Jeremy Hunt to withdraw his imposition of the contract and the BMA to call off its strikes.

The number of suicide attempts at immigration removal centres is the highest ever having increased by 11% between 2014 and 2015 to 393 attempts out of over 30,000 people held in detention according to figures obtained through freedom of information requests by the organisation No Deportations.
The detailed figures:

An increase in pay led to a decline in symptoms of depression for at least 22 months afterwards, equivalent to prescribing antidepressants, according to research led from Oxford University, analysing data from the British Household Panel Survey (covering about 10,000 people) from the introduction of the minimum wage in 1999, published in the journal Health Economics.
(08/04/16) Press release:
The journal article:

Women are 27% more likely to be prescribed antibiotics than men, according to a meta-analysis of 11 previous studies, including data on 44m people round the world, led by Tubingen University Hospital in Germany, published in the Journal of Antimicrobial Chemotherapy.  Women aged 35-54 were 40% more likely than men to be prescribed antibiotics.


03 April 2016

Jeremy Hunt’s tactics in the junior doctors’ dispute have been criticised by Sarah Wollaston MP, who said he had misrepresented statistics and that the ‘seven-day NHS’ was not achievable within the current workforce and financial pressures.  Sarah Wollaston is the chair of the Health Select Committee but was writing in the Guardian in a personal capacity.  She also criticised the BMA for their decision to hold an all-out strike.  She said that rather than imposing the contract, the problem of higher death rates among patients admitted at the weekend would be better dealt with by having more senior doctors in hospitals at the weekend, more nurses on duty and diagnostic tests such as CT scans more readily available.
News story:
Article by Sarah Wollaston

Claims that leaving the EU could save the NHS are a ‘dangerous lie’ according to four former Labour health secretaries.  ‘Brexit’ campaigners had argued that leaving the EU would free the NHS of burdensome immigration.


02 April 2016

New mental health waiting time targets may not be met if funding is not ring fenced, according to Prof Sir Simon Wessely, president of the Royal College of Psychiatrists, writing in the Independent.  Former minister Norman Lamb has been told that there is no guaranteed funding to implement the waiting time standards.


01 April 2016

The Healthcare Safety Investigation Branch comes into being on 1st April, with the aim of learning from accidents to improve safety.  The new body was welcomed by the Public Administration and Constitutional Affairs Committee (PACAC), which had championed the idea, but it said to be fully effective new legislation was required to ensure its independence (rather than it being domiciled with NHS Improvement) and to provide a safe space where patients, their families, clinicians and NHS managers could speak freely.
Feature article:

A fifth of adults globally will be obese by 2025 on current trends, with the probably of meeting the global obesity target (to keep below 2010 levels) as virtually zero, according to statistical research led from Imperial College, London, using data on 19.2m adults from 186 countries from 1975 to 2014 and published in The Lancet.  It predicts that the UK will have the highest obesity levels in Europe amongst both men and women, at 38%.  A fifth of the world’s obese adults live in six high-income, English speaking countries: Australia, Canada, Ireland, New Zealand, the UK and the US.  There was no increase over the 40 years in the BMI of women in some countries, including Singapore, Japan, Belgium, France and Switzerland.  However, one in nine people do not have enough food to lead a healthy, active life.

The richest 20% of earners will take almost as much in tax breaks as the poorest 20% get from welfare benefits by 2020 if the Tories deliver on their manifesto promises, according to an analysis  by the Fabian Society.  The top 20% of households by income will receive £9,400 in tax allowances and welfare payments, while the bottom 20% will receive an average of £10,200.

The whistleblowing policy for the NHS in England has been published by Monitor, the NHS Trust Development Authority and NHS England.  Each NHS provider (e.g. GP surgery or hospital) should appoint an individual, independent of the line management chain, to be the Freedom to Speak Up Guardian.  NHS England has also published draft guidance for consultation on whistleblowing in primary care.
(04/04/16) (Rgn)
(06/04/16) (Rgn) Regulations to prevent NHS organisations from blacklisting whistleblowers are to be brought in later this year:

The Government’s failure to collect sufficient mental health data amounts to negligence according to the shadow minister for mental health, Luciana Berger after having over 50 freedom of information requests dismissed because the data was not collected centrallly.  It includes questions such as how many new mums have committed suicide because of mental health problems, how many people diagnosed with mental health problems go to prison and how many children have died in NHS mental health units.  The concerns were echoed by former minister Norman Lamb.  Current minister Alistair Burt said work is going on and a five-year plan for mental health data is to be published by the end of the year.

Awareness of the link between alcohol and cancer is worryingly low with only 13% mentioning cancer when asked which health conditions they thought could result from drinking too much alcohol, in a representative sample of 2,100 people conducted on behalf of Cancer Research UK.  When probed further, 80% knew that alcohol raised the risk of liver cancer but only 18% knew it raised the risk of breast cancer.

The national living wage comes into effect. Care England warned that lack of proper funding for the changes could make this the last straw for some organisations.

NHS Improvement comes into being on 1st April. It is the result of a merger between Monitor and the Trust Development Authority (which dealt mainly with the financial aspects of NHS trusts which had and had not yet achieved foundation status, respectively).

Paid maternity leave reduces the risk of the baby’s death by 13% for every month of leave, according to research from McGill University and UCLA Fielding School of Public Health, looking at statistics relating to 300,000 children born in 20 countries in Africa, Asia and Latin America, and published in PLoS Medicine.  The association held when controlled for variables such as GDP and health spending per person.  The authors said that while this study focussed on low and middle income countries, the effects were also thought to hold for higher income countries.

Five new standards of proficiency for social workers have been proposed for consultation by the Health and Care Professions Council.

‘DevoManc’ starts on 1st April 2016 as local authority and health budgets are aggregated from CCGs and local authorities and devolved through the NHS area team, producing a £6bn budget under the control fo the Greater Manchester Strategic Partnership.  While the arrangement should provide for a more strategic and integrated approach to meeting local priorities, there is a challenge in 38 bodies (10 boroughs, 12 CCGs, 15 NHS trusts and NHS England) working together and addressing financial pressures as £2bn needs to be saved from the budget as a result of Government cuts and increasing costs.
BMJ briefing:
LGA publication on early lessons from Greater Manchester

The new chair of the Equalities and Human Rights Commission is to be David Isaac, a city lawyer, whose appointment is being criticised as his firm carries out significant work for the government.

The single data list for 2016-17 has been published by DCLG, showing all the datasets that local government has to submit to central government.

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