2016 Q3 July-September
Health and Wellbeing Policy Update: July-September 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 September 2016
A fifth of carers went to A&E because they could not get hold of a GP or district nurse for the person they were looking after, according to a survey for a report, ‘Presure Points’ by Carers UK. About a third of carers said their use of A&E could have been avoided. More than half said the person they cared for had been discharged from hospital too soon.
Press release: http://www.carersuk.org/news-and-campaigns/press-releases/lack-of-community-services-to-support-carers-is-piling-pressure-on-nhs-emergency-care
The report: http://www.carersuk.org/for-professionals/policy/policy-library/pressure-points-carers-and-the-nhs
A sixth of 16-20 year olds eat fast food on average twice a day, according to the BBC Good Food Nation Survey of over 5,000 people. It also found that the ‘typical adult’ eats meat twice a day and only has six meat-free days a month.
29 September 2016
A seven yearly survey of adult mental health found a rapid rise in mental problems amongst young women, aged 16-24 with the number screening positive for PTSD having trebled from 4.2% in 2007 to 12.6% in 2014, while just 3.6% of men in that age group had it. The Adult Psychiatric Morbidity survey, of 7,500 people, was undertaken for NHS Digital by the National Centre for Social Research in collaboration with Leicester University. Of those with a common mental disorder, 37% were accessing treatment (up from 24% in 2007). Overall, 17% of adults had a common mental disorder in 2014. Women in the 16-24 age group are more likely to have experienced a common mental disorder (CMD) in the last week, with 26% having had anxiety, depression, panic disorder, phobia or obsessive compulsive disorder. Overall, 19% of women of all ages had one of those, while 12% of men did. Self-harm among 16-24 year old women trebled to 19.7% between 2007 and 2014. It was suggested that social media might partly be behind the changes.
A framework for establishing ‘primary and acute care systems’ (PACS) has been published by NHS England. It sets out the steps needed to move towards a single provider for all local health and care services, with general practice at its core, including the need to develop new contractual, funding and organisational form. Pulse magazine reports that GP practices will be encouraged to get involved in the new organisations and could, for instance, be part of a new joint venture involving other local health providers such as an acute trust.
A new model for health in care homes which would see them paired with GP practices has been set out by NHS England. The enhanced health in care homes (EHCH) model is currently being piloted in six areas but a plan is to be published later in the year on how it could be rolled out to the whole country. Under the framework there would be a weekly multi-disciplinary round (like a ward round) in each care home. However, the BMA’s GP Committee said there are currently not enough doctors to provide such a service and it would not allow for patient choice.
The number of children adopted in England has fallen for the first time in five years, from 5,360 to 4,690 in 2015-16, a fall of 12%. It is thought that this is a result of two legal judgements from 2013 seeming to suggest that adoption should be a last resort. It is being suggested that there have been misinterpretations of the court rulings.
The cost to the NHS of negligence claims rose to its highest level for eight years, at more than £1.4bn last year, compared to £583m in 2008 according to figures from the NHS Litigation Authority (NHSLA). Premiums paid by NHS trusts to the NHSLA rise according to expected payouts. New claims fell last year by 4.6%, although the scale of payouts resulting from this may not be known for some years.
Links to the data: http://www.nhsla.nhs.uk/Pages/Publications.aspx?library=currentactivity%7cfactsheets%7cfactsheet5trustandhealthauthorityclaimsdata
Six million working families on low incomes are worse off than they were a decade ago, because of a squeeze on incomes and higher costs of housing and childcare, according to the Resolution Foundation.
GP practices are to be categorised by whether they allow access outside normal hours, according to answers to a survey to be conducted every six months, starting from October. They will have to say whether patients can pre-book appointments on Saturdays, Sundays, early mornings and evenings. There will also be a question about extended access across groups, or networks of practices.
A mediterranean diet was found to reduce the risk of heart disease, in what is said to be the first study of its kind on Britons. Those eating the diet, high in fruits, vegetables, whole grains, nuts and olive oil, were 16% less likely to suffer from cardiovascular disease than those didn’t. It could reduce deaths from heart attacks and strokes by 12.5%, which is 19,000 out of the 155,000 such deaths each year in the UK. Led from the University of Cambridge, the research involved data on 23,902 healthy Britons who were monitored for an average of 12-17 years. The results were published in BMC Medicine.
Opposition to the ‘exemption’ clause in the Children and Social Work Bill is to be furthered by a new campaign group, Together for Children, made up of twenty bodies including the British Association of Social Workers. They are objecting to Clause 29 which would allow the Secretary of State for Education to excuse authorities from certain legal duties under various children’s Acts for up to six years. The aim is to allow room for innovation, but campaigners warn of potential risks of ignoring protections built up over many years. The Bill is currently going through the Lords and is due to be debated again next month.
A report on how to organise the UK’s research environment to meet the health challenges to be faced by 2040 has been published by the Academy of Medical Sciences. It says there will be a need to move to a more inter-disciplinary, and ‘health of the public’ approach.
28 September 2016
A group of junior doctors has lost their case against Jeremy Hunt in the High Court. The case was brought by a group, Justice for Health, arguing that the contract was unsafe and unsustainable and that the health secretary did not have the power to impose it. However it was ruled that the Secretary of State acted squarely within his powers in what he did, which was to push NHS trusts to introduce the contract rather than compelling them. ‘In principle’ the trusts could decide not to enforce the contract. The objectors suggested this opened up a new avenue to resisting imposition of the contract and that it allowed employers and employees to negotiate in the interests of patients and staff.
The number of nursing homes in England has fallen for the first time in five years, dropping from 4,697 to 4,633 in 2015-16. While 72 cancelled their registration to operate as a nursing home in 2015, there were 73 cancellations in just the first six months of 2016. It is thought that a shortage of nurses is the main reason.
Unsafe discharge from hospital is more common than it should be, according to a report from the Public Administration and Constitutional Affairs Committee (PACAC). It says that the structure of health and social care being independent from each other, which counts as ‘political maladministration’, must bear substantial responsibility, Discharge practices may be poor if they are premature, delayed or inappropriate, such as at night. It says a fifth of patients are at risk of premature or delayed discharge but more accurate figures are needed. The committee was responding to a report from the Parliamentary and Health Services Ombudsman in May on unsafe discharges.
The number of ‘deprivation of liberty safeguards’ (DoLS) requests has increased significantly, from 137,540 in 2014-15, to 195,840 in 2015-6, a rise of 30%. They are now at the highest since the system began in 2009. The main reason is legal judgements which in effect changed the criteria for when requests have to be made. However, campaigners say that since a large number of requests are rejected (27% last year), people will have been deprived of their liberty for some time, inappropriately. Councils should respond to requests within 21 days, or 7 for urgent cases. However, those applications not signed off by the end of the year were outstanding for an average of 205 days (nearly 7 months) for urgent cases and 223 for standard cases. The requests are usually to avoid someone harming themselves and could include being locked in, restrained by straps or given behaviour controlling drugs.
The planned number of new nursing associates to be trained has been doubled for the first year from 1,000 to 2,000 places, Nursing Times reports.
A fifth of bowel cancer patients had ‘red flag’ symptoms in the year before dignosis, meaning their condition could have been caught earlier, according to research led from UCL and the London School of Hygiene and Tropical Medicine, based on data on 1,600 patients from 200 GP practices, over the age of 25, diagnosed with colon or rectal cancer between 2005 and 2006, published in the British Journal of Cancer.
A panel to “challenge bureaucratic red tape” in the NHS and social care has been set up by the Department of Health in partnership with NHS Providers, the NHS Confederation and Care England.
27 September 2016
Air pollution is above safe levels for over 92% of the world’s population, according to a report from the WHO. Most of England is above the safe limit level (except for areas such as Devon and Cornwall and parts of the north west), whilst most of Scotland and Northern Ireland are under the limits. The report says over 16,000 people died in Britain in 2012 as a direct result of air pollution.
Press release: http://www.euro.who.int/en/health-topics/environment-and-health/air-quality/news/news/2016/09/release-of-who-data-on-air-pollution-exposure-and-its-health-impact-by-country
Interactive map: http://maps.who.int/airpollution/
Standards of specialist neonatal care have improved little over the last two years on many measures according to an audit by the Royal College of Paediatrics and Child Health based on over 95,000 admissions to 179 neonatal units across England, Wales and Scotland. It found that 28% of premature babies admitted to the units were too cold, risking hypothermia, 7% did not have the recommended eye screening and 12% of parents did not have a recorded consultation with a senior member of staff within 24 hours of admission
The number of GPs in England rose by only 108 in the six months to March 2016, (with an increase by 65 full time equivalents, excluding trainees, retainers and locums) despite the Government’s promise to have 5,000 more GPs by 2020, according to figures from NHS Digital. The number of GP practices in England was 7,613 at March 2016, a fall of 61 from September 2015.
An additional £25m for children’s mental health is being allocated by NHS England to CCGs in the current financial year, 2016-17. It is intended that the money should be used to help reach the target of 35% of children and young people’s mental health needs being met in the community by 2020-21.
The NHS needs 20 more hospitals to cope with the ‘tsunami’ of rising demand, according to the Royal College of Emergency Medicine. They said demand was increasing because of a rising and ageing population. As well as increasing the overall number of beds available to match levels in other developed countries, it was suggested that flows within hospitals should be improved.
A further 30% more GPs are needed to staff out-of-hours services, the chair of Urgent Care UK said at the King’s Fund Urgent and Emergency Care Conference. He also outlined a number of the barriers to recruitment and retention of GPs.
There could be 3m ‘ghost patients’ on GP lists, as Capita undertakes cleansing exercises on behalf of the NHS. At March 2016, there were 57m people on GPs’ lists, but census figures suggest the correct figure should be 54m according to NHS Digital.
Labour would fight against STPs (sustainability and transformation plans) where they are purely about cuts, Diane Abbott told the Labour Party conference. She also said Labour would halt privatisation of the NHS, repeal the Health and Social Care Act 2012, support junior doctors in their dispute over a new contract and reinstate nurse student bursaries.
An interactive map showing happiness and life satisfaction levels by local authority area has been published by ONS, as part of its latest report on wellbeing. It says wellbeing levels have plateaued in the last year, for the first time since the survey begain in 2011.
A new mapping tool for perinatal mental health has been launched, allowing local services to be compared against national standards, in seven themed areas. It was developed by the Mums and Babies in Mind, lottery funded project.
26 September 2016
Patients are being detained under the Mental Health Act after refusing voluntary admission to out of area hospitals because there are no beds locally, according to a survey of AMHPs (approved mental health professionals). It found that 48% had had to detain patients compulsorily compared to 32% who had to do so in the last survey in 2013. The survey found a number of other indicators of bed shortages.
Retention of older GPs is necessary to ensure sufficient numbers, the Royal College of GPs says in a letter to Jeremy Hunt, setting out five initiatives they say the Government should adopt. The RCGP says 594 practices, 467 in England, are at risk of closure because three quarters or more of their GPs are aged 55 or over.
Smoking should be banned anywhere children play or learn, such as playgrounds, theme parks or zoos, the Chartered Institute of Environmental Health (CIEH) has said. The aim would be to stop smoking seeming normal and to protect children from second hand smoke. A YouGov poll commissioned by the CIEH suggests the public would support such a ban, with 57% wanting smoking to end in public parks and 89% backing a ban in children’s play areas.
A report on ‘Growing Older in the UK’ has been published by the BMA. It says that the UK’s ageing population is being failed by a flawed and fragmented health and social care system
Patients’ main motivations for enrolling on cancer research trials was to help them get better, with 84% saying possible tumour shrinkage was the most important motivation, followed by there being no alternative treatments at 56%, physician’s recommendation at 44% and the fact that the research might benefit others at 38%. Researchers from the Royal Marsden NHS Foundation Trust surveyed “newly referred adult patients considering their first phase 1 oncology trial”, (typically involving those with advanced disease) with 396 questionnaires received before and 301 after their consultation clinic. The research was published in the journal Cancer. Before the consultation, 43% predicted tumour shrinkage, while after the consultation 47% predicted it, whereas the typical ‘response rate’ is actually only 4-20% in such trials. The researchers noted that 84% were still willing to participate in the trial when they had heard more about it.
25 September 2016
40% of the expected 3,000 closures of community pharmacies are likely to be in the top fifth deprived neighbourhoods, with less then 5% of them in the fifth most affluent areas, according to an analysis by the National Pharmacy Association.
Women’s mental health needs are not being adequately considered according to Agenda, an alliance of more than 60 groups for females at risk. Of 35 mental health trusts that replied to a freedom of information request (out of a total of 57 trusts), only one, Surrey, had a gender specific strategy.
All new vehicles will automatically call 999 in the event of a crash by April 2018, under EU rules that have already been accepted, but there are concerns about the impact on emergency services and it is claimed the government isn’t properly prepared.
Illnesses associated with lifestyles cost the NHS £11bn a year, according to Public Health England.
24 September 2016
The junior doctors’ strikes planned for the next three months have been called off, following feedback from doctors, patients and the public, the BMA has announced. There has been widespread concern about patient safety. There was also said to be concern that the protests might divide the union’s membership and lose public support. The BMA said they still opposed the imposition of the contract and are planning a range of other actions to resist it.
23 September 2016
42% of children did not see a dentist last year according to figures from NHS Digital. 52% of adults saw a dentist in the two years up to the end of June 2016.
24% of healthcare assistants have been asked to perform tasks beyond their competence, according to a survey of 2,300 HCAs by Unison. A further 39% said they hadn’t had any training to perform many daily tasks.
Unison press release: https://www.unison.org.uk/news/press-release/2016/09/health-care-assistants-being-used-as-nurses-on-the-cheap-says-unison/
22 September 2016
NHS Operational Planning Guidance for the next two years has been published by NHS England and NHS Improvement. There is £100m of incentives to tackle delayed discharges from hospital. There will be funding to reduce the number of people attending A&E with mental health problems, by identifying those who do so most frequently. There is extra funding for general practice of £138m by 2017-18 and £258m by 2018-19 to build capacity and provide for additional access, including an extra hour and a half of evening appointments each day and more time at weekends based on local demand. That money will initially go to those areas already piloting extended access, but will be gradually extended, reaching the whole country by 2018-19. There is also a requirement to implement the GP Forward View by 2018-19, including increasing the number of GPs and other staff, extending online consultations and setting up new arrangements working alongside secondary care (MCPs and PACS). STP areas will be able to apply for their own system-wide financial control totals, so that commissioners and providers will essentially be able to pool their resources, with the aim of co-operating for the overall good of the area rather than the specific interests of individual bodies.
Nuffield Trust’s response: http://www.nuffieldtrust.org.uk/media-centre/press-releases/our-response-nhs-planning-guidance
Implications for mental health: http://www.nhsconfed.org/news/2016/09/nhs-shared-planning-guidance
Press release: https://www.england.nhs.uk/2016/09/next-steps-fyfv/
Press release on the general practice elements: https://www.england.nhs.uk/2016/09/improving-general-practice/
Press release relating to mental health: https://www.england.nhs.uk/2016/09/improve-mental-healthcare/
The guidance: https://www.england.nhs.uk/ourwork/futurenhs/deliver-forward-view/
Spending on mental health is to be reduced in 57% of CCGs, despite guidance from NHS England that it should be increased and assurances from the Government that it would, according to figures obtained from foi requests by Labour MP Luciana Berger.
Britain is the fifth healthiest country in the world, according to an analysis based on the UN’s health-related sustainable development goals, using data from the Global Burden of Diseases study, published in the Lancet. It reports on how far targets are being met in the 188 countries studied.
A drug for post-menopausal women with breast cancer is not being routinely used, in large part because of confusion over who should fund it, according to a poll of 125 breast cancer specialists by the charity Breast Cancer Now. It found that 59% had not prescribed the drugs and 17% had done so partially. When asked about barriers, 45% said they were waiting for funding decisions. The drugs, bisphosphonates, which cost about 43p a day, including doctors’ time, have been found to cut the chance of the cancer returning by 28% and reduce the risk of dying within ten years of diagnosis by 18%. It is said that it could prevent one in ten deaths from breast cancer.
Provision of the recommended three cycles of IVF on the NHS has been steadily falling and is now at the lowest levels since guidelines were introduced in 2004, according to the charity Fertility Fairness. In England, fewer than a fifth of CCGs offer the recommended treatment. Scotland has said it will continue to provide three cycles. Fourteen areas are currently considering whether to reduce provision or remove it altogether.
Children’s mental health can be worsened by their families’ debt, and more time should be given to repay debts, the Children’s Society says in a report, ‘Damage of Debt’. The effects come from missing out on social activities, not having the same material possessions as other children and family arguments.
The report: http://www.childrenssociety.org.uk/what-we-do/resources-and-publications/the-damage-of-debt-the-impact-of-money-worries-on-childrens
More operations are cancelled 1-3 days before an operation than at the last minute, although the former do not have to be recorded while the latter do, according to information obtained by the BBC from foi requests. In the 74 out of 156 trusts that provided data, 33,400 operations were cancelled at the last minute while 41,474 were cancelled one to three days before. For last minute cancellations, another date must be found within 28 days, but that does not apply to those cancelled 1-3 days before. According to official figures, less than 1% of operations are cancelled at the last minute. It is not known how many cancellations are patient, and how many hospital initiated. The main reaons for cancellations by the hospital are lack of beds and staff shortages.
47% of 18-30 year olds say they lack confidence and 51% feel worried by the future with young women particularly affected, according to a poll of 4,000 young people, by Populus Data Solutions, commissioned by the Young Women’s Trust. The report, ‘No Country for Young Women’, suggests that because of financial pressures many young people are having to put their lives on hold, with 48% saying they may have to put off having children, 43% still living at home and 24% having moved back in with their parents. 38% of young men and 29% of young men said they were worried about their mental health.
Press release: http://www.youngwomenstrust.org/what_we_do/media_centre/press_releases/468_major_survey_reveals_a_generation_in_crisis
Vaccinations for under two’s are down for the third year in a row according to figures from NHS Digital. There has been a reduction for most routine vaccinations, including MMR.
Mental health services in universities are not keeping up with rising demand, according to a report from the Higher Education Policy Institute, which says some universities need to treble what they spend on support. One of the problems is continuity of care between term times and holidays and it suggests students should be allowed to register with a GP in both places.
Changes to national wellbeing, as recorded by ONS, are reported in the Mail and several other news outlets [but I can’t find any record of it on the ONS site. Some wellbeing pages have been updated in the last week, but the latest report I can find is from July.]
A report on the digital agenda in the NHS has been published by the King’s Fund. It looks at the key commitments that have been made and progress to date.
21 September 2016
Government must do more to improve mental health services if parity of esteem is to be achieved, the Public Accounts Commttee says. Currently only a quarter of people who need mental health services have access to them. The report says:
– it is sceptcal whether the Government can achieve its ambitions within the existing budget without compromising other services
– systems for working across government are weak, with inconsistency in services for people leaving prison, counselling in schools and helping people with mental health problems get back into work
– more needs to be done to ensure continuity of care
– mental health services are ‘complex, variable and difficult to navigate’
– there is no clear plan to develop the workforce needed.
A fifth of elderly care home residents are being given antipsychotics to control their behaviour despite a review in 2009 calling for their use to be severely restricted. Research from Warwick, Coventry and City universities analysed prescriptions for 31,619 residents in 616 care homes between 2009 and 2012. It was published in the BMJ Open. It found that 18% of residents were taking an antipsychotic in 2009 but this had risen to 19% by 2012, the latest year for which figures are available. It is thought the figure is unlikely to have changed much since then. The drugs can have serious side effects.
(22/09/16) (Rgn) https://www.nursingtimes.net/news/community/care-homes-failing-to-cut-use-of-antipsychotics/7010744.article
Patient safety is being put at risk by doctors being over tired and stressed according to a report, Underfunded, Underdoctored, Overstretched’, from the Royal College of Physicians. The RCP is calling for an increase in funding or an honest debate about what can be provided within the resources provided. 85% of doctors think that the current level of funding is insufficient. The report calls for an increase in funding, training of more doctors and improving the working lives of NHS staff.
The NHS will continue to be affordable through general taxation, the Nuffield Trust says in an analysis of projections by the Office for Budget Responsibility. The Government, in response, has said that the NHS will remain free at the point of use, funded from general taxation (rather than charges having to be introduced because of financial pressures). Because of rising costs faced by the NHS due to factors such as an ageing population and use of technology, annual increases of 3.5% will be needed to keep the health service functioning, leading to a cost of £234bn p.a. by 2030 or 8.8% of GDP, under one scenario. It currently costs 7.4% of GDP.
Funding to general practice increased by 4.4% across the UK last year and by 4.4% in England, according to figures from NHS Digital. In England, spending rose from £9.03bn to £9.45bn. Doctors’ leaders said more was needed to catch up, after funding for GP services had fallen from 10% of the NHS budget in 2004-5 to 8.1% today.
Face down restraint is continuing in NHS mental health wards despite new guidance being issued in April 2014. Of all incidents of restraint, 18.5% were face down in 2015-16, having fallen from 22.4% in 2013-14, according to figures collected by Normal Lamb following responses by 50 of the 58 mental health trusts to freedom of information requests. The total number of recorded restraints rose by 16.6% between 2013-14 and 2015-16.
NICE has published a quality standard for skin cancer which says GPs should refer people with suspected malignant melanoma to a specialist through the two weeks urgent referral system. Currently 29% of cases are only diagnosed following normal GP referral which can take 4-6 weeks. According to the latest available data, from 2013, 56% of malignant melanomas were diagnosed following referral through the two week process. Rates of melanoma in people aged 55 and over have increased by 155% in the last 20 years.
The government’s ‘national living wage’ is not enough to provide a decent standard of income, according to the charity, the Living Wage Commission, following a six month review.
Adult social care could face a crisis if EU workers are not allowed to stay after the UK leaves the European Uniion, two charities, Independent Age and the International Longevity Centre UK, have warned. About 5% of the workforce are from other European Economic Area countries.
Final NICE guidelines on multimorbidity have been published, proposing that tailored care plans should be drawn up for people with two or more long term conditions and that doctors should consider stopping treatment of limited benefit. The final version is reported to be little changed from the draft issued for consultation in March
Press release: https://www.nice.org.uk/news/article/tailored-care-needed-for-people-with-more-than-one-complex-health-condition
The guidance: https://www.nice.org.uk/guidance/ng56
20 September 2016
A declaration on antimicrobial resistance is to be signed by 193 countries at the UN, at an international summit this week. The countries will now have two years to report back with an action plan. The countries have committed to: develop surveillance and regulatory systems on the sale and use of antibiotics; find ways to develop new antibiotics and rapid diagnosis; and educate professionals and the public on how to prevent drug resistant infections. They have agreed to pool funding, already totalling about £600m. The U.K. has been leading calls for such international action.
The family court service is facing an imminent crisis because of a continued increase in the number of child care cases, its most senior judge, Sir James Mumby, has said. The current rate of increase in the number of cases is about 20% p.a., with a rise from about 6,500 a year before 2009 to 15,000 today. He said more should be done to tackle the underlying problems of the cases.
(21/09/16) Feature article: https://www.theguardian.com/social-care-network/social-life-blog/2016/sep/21/parents-need-support-end-cycle-babies-taken-into-care
The proportion of smokers in England has fallen to its lowest level ever at 16.9% down from 19.3% in 2012 according to Public Health England. There has been a fall of about two thirds in the proportion of smokers in the last 50 years, with the number of men smoking dropping from 50% in 1974 to 19.1% in 2015 and for women from 40% to 14.9%. However, smoking still causes over 78,000 deaths a year. E-cigarettes could have helped many people to quit with over a million people saying they used them to help stop smoking, while 700,000 used a licensed nicotine replacement product such as gum or patches. A fifth of the 2.5m people trying to quit were successful.
Waits for cataract surgery vary widely across the country, from 15 days in Luton to 467 days, (15 months), in Enfield, according to a report from the RNIB. NHS England said that most patients were seen within the 18 weeks guaranteed in the NHS Constitution. Jeremy Hunt has asked NICE to bring forward production of new guidelines which are now due to be published for consultatioin in April 2017.
Assigning patients aged over 75 a named GP did not improve their continuity of care, according to research by the Health Foundation looking at 200 practices, which found that the older patients did not see the same GP any more often than younger patients. The research was published in the BMJ. The policy was introduced in April 2014. There was also no change in the number of general practice visits, diagnostic tests or referrals to specialist care.
Cuts to ongoing training for nurses, midwives and allied health professionals are a false economy, a risk to the NHS and indicate a disconnect between funding decisions and national strategic priorities, according to a report from the Council of Deans of Health (the voice of deans and heads of university faculties for those services). Funding for ongoing training has been halved, but the aim is to make more use of this workforce to supplement and support doctors.
People doing exercise in green spaces delivers about £2.2bn of health benefits in relation to adults in England each year, according to research led from the University of Exeter and published in the journal Preventative Medicine.
Senior doctors in England will have to reveal how much they earn from private work, NHS England has said. Every hospital will have to publish a register of consultants’ outside earnings by April 2017. It is likely to report in £50k bands up to ‘over £100k’. The proposals were criticised by the Hospital Consultants and Specialists Association (HCSA) as risking smearing the profession on the basis of a few examples.
A report on integrating public services has been published by the independent social business ‘Collaborate’ and Turning Point. It sets out seven key insights into what is needed to make that happen, including shifting power from producers to communities, moving the narrative from austerity to social challenges and building system infrastrcture to enable collaboration.
Wearing a fitness tracker did not lead to more weight loss than in those not using them in a randomised controlled trial involving 470 overweight volunteers, aged 18-35, followed over two years, who were asked to diet and take more exercise. The research, from the University of Pittsburgh, was published in the Journal of the American Medical Association. It is nevertheless possible that the devices might help some people.
The Liberal Democrats would make social care free in a rebranded National Health and Care Service, its leader Tim Farron, has told its conference. They would raise taxes to pay for this. They are to set up an expert panel – ‘the Beveridge Commission’ – to report back with proposals in six months.
A report on the case for closer working between housing and health services has been published by the King’s Fund. It uses case studies to make the economic case for working together and how housing can benefit health.
People with a gene linked to weight gain are just as likely to benefit from weight loss programmes as those without, according to research based on a systematic review and meta-analysis of data from eight randomised controlled trials involving 9,563 people, led by Newcastle University and published in the British Medical Journal. People with two copies of the FTO gene, about 16% of the population, are on average 3kg heavier than those without.
19 September 2016
There is no evidence of a ‘weekend effect’ in psychiatric hospitals, according to a study based on 45,000 patients admitted to the South London and Maudsley NHS Trust between 2006 and 2015, published in the British Journal of Psychiatry. It found that patients admitted at the weekend were no more likely to die than those admitted during the week. The research was led by Dr Rashmi Patel, a psychiatrist at the trust and academic at King’s College, London.
Men with generalised anxiety disorder were twice as likely to die from cancer, although there was no increase for women with the condition, according to a study of nearly 16,000 British people, followed up over 15 years, of whom 126 men and 215 women had the disorder. The study, from the University of Cambridge, was funded by the Medical Research Council and Cancer Research UK and the results were reported to the European College of Neuropsychopharmacology Congress in Vienna. The association held true even taking account of factors such as age, serious mental illness, smoking, alcohol and physical activity. However, the study can’t prove causation and it is possible there were other risk factors involved that had not been taken into account.
An association between maternal depression and diabetes has been found, with women who are depressed while pregnant being three times more likely to develop diabetes, and those with gestational diabetes being four times more likely to become depressed after giving birth, according to research from the National institute of Child Health and Human Development in the U.S., based on health data and questionnaires on about 2,800 women, published in the journal Diabetologia.
Press release: https://www.nichd.nih.gov/news/releases/Pages/091916_depression.aspx
Future cases of diabetes could be reduced by 80% by warning patients they were at risk (with ‘pre-diabetes’, though there is disagreement about use of the term) and encouraging lifestyle change, according to a literature review by researchers from the University of Huddersfield, published in Practical Diabetes International. Scandinavian research had shown that an 80% reduction in Type 2 diabetes was possible. More education and support to motivate lifestyle change amongst patients at risk are needed, but this needn’t be medically-led: peer and community-based programmes could be cheaper and more sustainable over the long run.
The number of severely obese people rescued by the fire service has increased by a third in three years, from 709 in 2012-13 to 944 in 2015-16, according to figures obtained by BBC 5 Live. The category of bariatric rescues was created as a category for fire and rescue service recording in 2012.
18 September 2016
There are to be no new welfare cuts, but those already announced will still go through, the Work and Pensions Secretary Damian Green has announced.
(19/09/16) Feature, with more detail on the cuts still to come: https://www.theguardian.com/commentisfree/2016/sep/19/austerity-agenda-poverty-damian-green-benefit-social-security
17 September 2016
Food ‘traffic light’ labelling should be made mandatory, the LGA says. A voluntary scheme was instituted in 2013 but about a third of food items are not labelled.
16 September 2016
347 lives a year could be saved if all those eligible went for cervical cancer screening, according to research from Queen Mary University, London, based on the records of more than 11,000 women, published in the British Journal of Cancer. Nearly 2,000 lives are already saved by the screening.
The antimicrobial resistance strategy second annual report has been published, along with the Government’s response to Lord Jim O’Neill’s review of AMR.
Press release: https://www.gov.uk/government/news/governments-progress-in-preventing-drug-resistant-infections
Second annual proogress report on AMR: https://www.gov.uk/government/publications/progress-report-on-the-uk-5-year-amr-strategy-2015
Government’s response to the review: https://www.gov.uk/government/publications/government-response-the-review-on-antimicrobial-resistance
Updated summsary of the evidence: https://www.gov.uk/government/publications/amr-summary-of-the-current-evidence
An ‘Uber-style’ private GP service is to be rolled out to the rest of England after having been piloted in two north London boroughs. The company, Doctaly, doesn’t employ GPs directly but acts as a brokering service allowing people to make appointments with GPs operating in a private capacity. The aim is to roll out the service to the rest of London by the end of the year and the whole of the country by 2018.
Ten year survival rates from different forms of cancer have been calculated by ONS.
The UK is not ready to deal with the issues of an ageing population, according to a report from the Ready for Ageing Alliance. It says that action on tackling the challenges has stalled and in some respects is going into reverse. It says we are a long way from achieving the necessary co-ordination across government departments.
Copenhagen’s success as a healthy city is described in a feature article.
15 September 2016
The number of older people receiving social care support fell by a quarter in the four years to 2014, according to a report, ‘Social Care for Older People: Home Truths’, by the King’s Fund and Nuffield Trust. Councils’ spending on care fell by 25% in the five years to 2015. Over 40% of money paid to care homes came from people paying for themselves. Over a million people with care needs (e.g. who need help with getting out of bed, washing and dressing), now receive neither formal nor informal help, a rise of 10% in a year. The funding gap will reach £2.8bn by 2019-20. The report suggests it is only a matter of time before a care provider collapses. Ray James of ADASS is reported as saying that social care is now ‘at a tipping point’ and ‘in jeopardy’. The number of patients delayed in hospital because of a lack of care has doubled in two years, the BBC says, analysing NHS England figures.
Highlighting the increase in the number of people delayed in hospital: http://www.bbc.co.uk/news/health-37375782
Press release: http://www.kingsfund.org.uk/press/press-releases/older-people-social-care-cuts
The report: http://www.kingsfund.org.uk/publications/social-care-older-people
Jeremy Hunt has been accused of cherry picking research to justify his assertions of a ‘weekend effect’ by a number of senior doctors and scientists in a letter to the Guardian. It says that of eight studies cited by Hunt, only four are independently peer reviewed and three use data from the same population and are not independent. They say that when he started making his claims there were 13 independent, peer reviewed papers refuting his definition of a weekend effect. They call for a pause on any policy or contractual reform driven by the evidence, [which would mean, although they do not say so explicitly, stopping the imposition of the junior doctors’ contract].
The letter: https://www.theguardian.com/society/2016/sep/15/the-evidence-of-an-nhs-weekend-effect-is-shaky
Nearly three quarters of children with child protection plans do not have their details stored on an information sharing scheme, (CP-IS) meaning that they would not be identified as at risk if they presented to NHS A&E departments. The information sharing scheme was set up in December 2014. Just over 34,000 children are registered on the system meaning that 87,000 would not be identified to the health service. This creates a risk of ‘false negatives’, where clinicians would think there was no risk because nothing appears on the system, when in fact there was.
The planned cap on housing benefit will not be applied to people living in supported housing and hostels until 2019-20, the Work and Pensions Secretary Damian Green has said. There was concern that the cap could affect the viability of such institutions.
A loophole which allows extortionate pricing of drugs by dropping the brand name to escape caps is to be closed with a Bill tabled by Jeremy Hunt, the Time reports.
Factsheet on the Bill: https://www.gov.uk/government/publications/health-service-medical-supplies-costs/health-service-medical-supplies-costs-bill-factsheet
Public engagement on STPs (sustainability and transformation plans) is recommended by NHS England in new guidance. The press release says that patients and the public are to be asked to help ‘make decisions about how best to develop services’ and how STP leaders can ‘put the communities they serve at the heart of their work’ [despite the initial draft plans having been submitted at the end of June and not made public.]
Press release: https://www.england.nhs.uk/2016/09/local-health-plans/
The guidance: https://www.england.nhs.uk/ourwork/futurenhs/deliver-forward-view/stp/support/localstp
Cancer patients are not prescribed opioid pain relief until too close to death, meaning they are suffering pain longer than they need to according to research from the University of Leeds based on data on 6,080 patients who died between 2005 and 2012, published in the journal Pain. Typically pain relief was prescribed nine weeks before death.
(16/09/16) (Rgn) https://www.nursingtimes.net/7010615.article
Social workers should receive more support from their employers for the stress they are under, the All Party Parliamentary Group on Social Work has said after an inquiry into adult mental health services in England.
Not reporting FGM should result in harsher penalties for professionals, the Home Affairs Select Committee has said. It said that the failure to successfully prosecute a single case is ‘a national scandal’.
The number of written complaints about the NHS fell by 4% last year to 198,739, according to figures from NHS Digitial.
Sir Howard Bernstein is standing down as chief executive of Manchester City Council.
14 September 2016
Two thirds of doctors say they have had to ration NHS treatment and 94% said further rationing is inevitable, in a survey of 1,039 doctors (including 672 hospital doctors and 367 GPs) carried out by Wilmington Healthcare, a healthcare intelligence provider, for ITV. 23% said they had witnessed rationing of medicines. Nearly three quarters of doctors said restriction of treatments caused anxiety for the patients.
Simon Stevens has warned of hard financial times ahead for the NHS in England, telling the Health Select Committee that there would be ‘a bigger hill to climb’ than first envisaged, with ‘controversies along the way’. He said much of the promised £10bn p.a. would not be available till the end of the period, with less money available in the intervening years. He also noted that £10bn was at the lower end of what had been asked for.
Capita’s provision of back office services for GPs has been described as a ‘shambles’ by the BMA. Problems have included delays in transferring records, shortages of syringes and of stationery. NHS England said the company had been financially penalised for not delivering on contractual standards. The contract is worth £70m a year for seven years, with the possibility of a three year extension. The GP Committee of the BMA has warned that delays by Capita may mean GP registrars cannot practice, if they are not registered on the performers list (although it is unclear how many people are affected).
Jeremy Hunt announces £816m for health research over five years. There will be funding on personalised cancer research, dementia, mental health and antibiotic resistance. The funding, through the National Institute for Health Research, provides for facilities and support services in 20 partnerships, each between a health trust and a university, known as biomedical research centres.
Long term consumption of alcohol increases the risk of atrial fibrillation and so of stroke or blood cots, since it increases the size of the heart’s left, upper chamber or atrium, according to research from the University of California, based on data from 5,220 adults with an average age of 56, and published in the Journal of the American Heart Association. Drinking 10g, or one unit, a day increased the risk of developing atrial fibrillation by 5%.
The junior doctors’ strike is to go ahead next month following a reconsideration by the BMA, after which it said its position had not changed.
Doctors routinely make wrong predictions about when terminally ill people will die, with no correlation in accuracy with seniority of the doctor, according to a review of more than 4,600 medical notes, by researchers from the Marie Curie Palliative Care Research Department at UCL published in PLOS ONE. Further work is now going on to see if it is possible to train doctors to make better predictions to ensure the most appropriate care and treatment can be provided for people with terminal illnesses.
13 September 2016
Oxfam has called on the Prime Minister to tackle growing inequality in the U.K. It says, in a report, that the richest 1% of the population own 23% of the country’s wealth, the top 10% own more than half, while the poorest 20% have 0.8% of the country’s wealth between them.
Around 3.8m over 16 year olds in England have diabetes, 940,000 of them undiagnosed, according to estimates from Public Health England. That is about 9% of the population. About 90% of cases are likely to be Type 2, which is largely preventable. Type 2 diabetes currently costs the NHS £8.8bn a year.
Electronic cigarettes can help smokers quit, if they contain nicotine, according to a Cochrane review which also found no serious side-effects in the short or medium term. Another study by UCL and Cancer Research UK, looking at data on 43,000 smokers over nine years from 2006, published in the BMJ, also says e-cigarettes help people quit, but they do not increase the number of people wanting to quit.
(14/09/16) (Rgn) https://www.nursingtimes.net/7010540.article
The Government’s diabetes prevention programme will only become cost-saving after 14 years, according to a local impact assessment by Sheffield University, reported to PHE’s annual conference.
A third of hospitals do not offer a simple blood test for heart failure, despite it having been recommended by NICE in 2010, according to a report from the All Party Parliamentary Group on Heart Disease. It says that 38% of patients are being misdiagnosed. The report, ‘Focus on Heart Failure’ was compiled and funded by the British Heart Foundation, and makes ten recommendations.
‘Mental Health and Wellbeing of Looked-After Children’, the Government’s response to the Education Committee’s report, has been published by the Department of Health and Department for Education.
Jamie Oliver has criticised the Government’s obesity strategy, saying it has let down parents and children, in an interview with the Radio Times.
12 September 2016
School nurses are being diverted from their roles by excessive bureaucracy and having to take on child protection work, according to a report from the Children’s Commissioner for England based on a survey of 800 primary and secondary school nurses. Four in ten (41%) nurses said they were unhappy with the responses from Children’s Services on at least half of the referrals they had made. High thresholds by councils meant that school nurses were picking up the early stages of child protection work. 42% said they spent four hours a day or more filling in paperwork.
Press release: http://www.childrenscommissioner.gov.uk/news/vital-role-school-nurses-threatened-paperwork-eats-time-children
The report: http://www.childrenscommissioner.gov.uk/publications/lightning-review-childrens-access-school-nurses-improve-wellbeing-and-protect-them-harm
Annual blood pressure checks could save an average of 4,500 heart attacks and strokes a year, according to Blood Pressure UK, announcing a week-long campaign, ‘Know Your Numbers’ encouraging the public to have their blood pressure checked. One in three people in Britain (16m) have high blood pressure. It is estimated that 5m have not had the condition diagnosed.
There are big differences in quality of life for girls in different parts of England and Wales, according to a report from Plan International UK (a charity) with the University of Hull, using data on: childhood poverty; life expectancy; teenage conception rates; GCSE results; and percentage of girls under 18 not in employment, education or training. The report author said it was difficult to get all the data they would have liked at local authority level. The report also included interviews with 103 girls.
A new strain of gonorrhoea is becoming resistant to more treatments, according to a report from Public Health England. There have been 17 instances of it reported so far in 2016, and there were 15 in the previous year. PHE are recommending the use of two classes of antibiotic for treatment in the hope that simultaneous development of resistance to both is unlikely. There is a risk that if the outbreaks can’t be contained it will become untreatable.
More than 2,000 people were taken to hospital in a police care last year, according to foi responses from 4 of 43 police forces in England and Wales. If extrapolated to all forces, the figure would be 9,600. This was reported to be an increasing problem.
The sugar industry sponsored and shaped a literature review in the 1960s, focusing on fat as the main cause of heart disease, so diverting attention from sugar, according to an article in JAMA Internal Medicine. Conflict of interest was not required at the time. The Sugar Research Foundation (now the Sugar Association) is said to have paid for the research and re-drafted it until it was ‘satisfactory’. The literature review appeared in the New England Journal of Medicine in 1967.
A report on early intervention for mental health has been published by NHS Commissioners. The report, ‘Support from the Start’ (8pp), provides four examples of work being done by different CCGs: early intervention in psychosis in Salford; increasing the resilience of school children in Hounslow; helping those bereaved by suicide in Cornwall; and supporting women with perinatal mental health issues in Coventry and Warwickshire.
10 September 2016
The NHS is at a tipping point and needs more funding or else something else will have to give, Chris Hopson, Chief Executive of NHS Providers has warned in an Observer article. Detailing increasingly declining performance he says that this rarely ‘goes off the edge of a cliff’, but that there is a long slow decline only visible in retrospect, which means it is difficult to know when to sound a warning bell, but that NHS trust bosses are ringing that bell now. The solution, he says, is either more funding in the autumn spending review or options such as: rationing access to care; relaxing performance targets; shutting services; extending and increasing charges; cutting priorities delivered; or controlling the size of the NHS workforce. Chris Hopson also said that seven day services couldn’t be delivered with current funding. The Government said it had delivered on what the NHS had asked for with £10bn p.a. extra by 2020.
News item: https://www.theguardian.com/society/2016/sep/10/hospitals-on-brink-of-collapse-say-health-chiefs
The article: https://www.theguardian.com/commentisfree/2016/sep/10/impossible-for-nhs-to-provide-quality-service-something-has-to-give
09 September 2016
The DfE appears to have been trying to silence Natasha Devon as the government’s schools’ mental health champion, despite claiming to be wanting to work with her, according to internal DfE emails that she has obtained. Ms Devon has now compiled a report on children and young people’s mental health which says the government’s response to the problem is inadequate as well as raising concerns about underfunding of services and the impact of austerity.
The national diet and nutrition survey has been published showing that children’s sugar intake is double the recommended level, while for teenagers it is three times as much. The recommended amount is 5% of children’s daily calorie intake, but the actual figures were 13% for 4-10 year olds and 15% for 11-18 year olds. The survey covers a random sample of 1,288 adults and 1,258 children between 2012-14. There had been a reduction in the volume of sugary drinks consumed by 4-10 year olds. Only 8% of 11-18 year olds ate the recommended five portions of fruit and vegetables a day.
Press release: https://www.gov.uk/government/news/young-children-still-exceeding-sugar-recommendation
Drug related deaths reached record levels in 2015, according to figures from the ONS. Of 3,674 drug poisoning deaths, 2,479 involved only illegal drugs. Deaths from heroin and cocaine were at their highest levels since comparable records began in 1993. Drug users also appear to be getting older, with deaths from heroin in the 30-39 and 40-49 age groups both at record levels. The number of people using illegal drugs has dropped to an historic low according to recent crime survey data. An independent, expert group convened by PHE and the LGA recommended improved access to good quality drug treatmet.
Press release on independent expert group report: https://www.gov.uk/government/news/new-recommendations-to-address-deaths-from-drug-misuse-published
Page with a link to the independent report: http://www.nta.nhs.uk/news-drds-inquiry-report.aspx
The Government’s response to the Health Select Committee’s report on childhood obesity has been published.
Prescriptions of antidepressants to 6-18 year olds has increased by 28% in the last decade, according to research involving 360,00 young people in Wales reported to the British Science Festival. 40% of the drugs prescribed are ones that have been shown not to work and can have toxic side effects. The number of diagnoses of depression fell over the period, which the researchers suggest could be because of doctors trying to avoid labelling the young people as mentally ill. Girls were three times more likely than boys, and those from the most deprived areas twice as likely as those from the least deprived, to be given antidepressants.
Three quarters of Britons do not know the types of cancer linked to obesity according to a survey of a representative sample of 3,293 adults by Cancer Research UK. It found that 24% of men and 27% of women were aware of the link between obesity and cancer.
08 September 2016
The monthly performance figures from NHS England show many targets continuing to be missed. The number of days of delayed discharge from hospital were a quarter higher in July than the previous year, at 185,000, according to figures from NHS England. Other targets missed included referral to treatment within 18 weeks (91.3% against a 92% target), A&E, ambulance response times, diagnostic tests and rapid first treatment of psychosis.
Demand in the NHS has reached record levels with 5.8m patients attending A&E in April-June, the largest number in a single quarter, according to the King’s Fund’s quarterly monitoring report. Just over 1m of those attending A&E were then admitted to hospital. The report also found that hospitals had 90% bed occupancy, when the level considered safe is 85%. Delayed discharges were also at their highest levels since records began. Nearly a quarter of CCGs (out of a sample of 44) and 47% of NHS trusts were forecasting end of year deficits.
The number of young people with suicidal thoughts calling Childline has doubled in five years, from 8,800 to 19,500 according to the annual report of the NSPCC. Six times more girls than boys reported feeling suicidal. The report said it was concerned that a lack of support was leading children to crisis point.
Service quality for dementia, diabetes and learning disabilities varies widely across England according to comparisons of performance published on the official ‘My NHS’ website. The proportion of CCGs not performing well enough is 57% for dementia, 71% for diabetes care and 92% for care for people with learning disabilities. The rating for care of people with learning disabilities was based on the proportions receiving annual check-ups and the ability to keep people out of hospital with 193 out of 209 CCGs being deemed to ‘need improvement’ and none receiving the highest rating of ‘top performance.’
The benefits of statins have been underestimated and the harms exaggerated according to a review article on the interpretation of the evidence for them published in the Lancet. Out of 10,000 people taking statins for five years, it says 1,000 ‘major cardiovascular events’ (e.g. heart attacks or strokes) could be prevented in those with existing vascular disease, and 500 prevented in those at risk. That means that they prevent 80,000 heart attacks and strokes each year in the U.K. The average number of side effects of that 10,000 population would include five cases of myopathy, 50-100 new cases of diabetes and 5–10 haemorrhagic strokes. However, the risk of side effects are reduced once statins are no longer taken. About 50-100 patients out of the 10,000 would experience adverse effects such as muscle pain. Placebo-controlled randomised trials show that most reported adverse events are not actually caused by the statins. The article does not say how the literature reviewed was selected. There were some criticisms of this review as being industry-sponsored and involving researchers from the original studies so limiting its independence.
A new coalition of 29 leading organisations to lobby on behalf of NHS staff from the EU has been set up following the EU referendum result. It is to be called the Cavendish Coalition, named after the Royal College of Nursing’s London headquarters, where the group first met. Member organisations include ADASS, the Academy of Medical Royal Colleges, the BMA, Care England, NHS Clinical Commissioners, NHS Confederation, the RCN and Unison.
Preventing avoidable hospital admissions has been explored from the perspective of older people in research from Birmingham University. It involved interviews with 104 older people, interviews or focus groups with 47 health and social care professionals and survey responses from 45 GPs or hospital doctors. Nine older people felt they could have been cared for elsewhere, though their doctors disagreed. A number of older people had delayed getting in touch with emergency services, worried about using scarce NHS resources. Health staff felt admission was most likely to be avoided if there was contact with specialist staff who understood the complexities of the older person’s experience. More access to social care services could help prevent emergency admissions.
The number of calories burned at rest falls sharply during puberty, and is 25% lower at the age of 15 than 10, a reduction of 500 calories a day, according to a study by Exeter Medical School following 279 children over 10 years, published in the Journal of Obesity. Their resting use of calories was estimated on the basis of their use of oxygen while in a sealed canopy. It is thought this could help explain a rise in obesity in adolescents.
07 September 2016
Simon Stevens is urging the BMA to call off the junior doctors’ strikes planned for October, November and December, saying that hospitals will not be able to cope and seriously ill patients will be put at risk. The strikes were also criticised by others in the medical profession, including two unnamed sources in the BMA.
A single NHS website where people can book appointments, order prescriptions and get advice is to be available by the end of next year, the Government has said. The new site, NHS.uk, an update of NHS Choices, will also allow people to register with a GP, download their medical records and compare how well their local health service compares with other areas. It will also offer an online triage system with patients able to input symptoms online and receive tailored advice or a call-back from a healthcare professional. Data from approved apps will feed directly into personal health records. A review of IT in the NHS has also been published, led by Prof Robert Wachter. Jeremy Hunt has said 12 NHS trusts are to be made exemplars with others able to learn from their experience.
Press release: https://www.gov.uk/government/news/new-plans-to-expand-the-use-of-digital-technology-across-the-nhs
The Wachter report: https://www.gov.uk/government/publications/using-information-technology-to-improve-the-nhs
Community pharmacies contributed £3bn to the NHS, public sector, patients and wider society in England in 2015, which was more than they received from the Department of Health, according to a study by PricewaterhouseCoopers commissioned by the Pharmaceutical Services Negotiating Committee.
Doing the recommended 150 minutes of exercise a week can reduce the risk of dying from alcohol related cancer according to a study by researchers from London, Canada, Norway and Australia, based on data from 36,370 people aged over 40 from health surveys undertaken between 1994 and 2006. The research was published in the British Journal of Sports Medicine.
Media coverage of mental health has increased between 2008-14, but there has been little improvement in how it is reported in terms of stigmatisation, according to a review of articles on two days in every month over those years (excluding 2012), published in the journal Acta Psychiatrica Scandinavica.
A guide to ‘Spreading Change’ in person- and community-centred approaches for health and wellbeing has been published by Nesta. It uses a framework of encouraging behaviour by making it easy, attractive, social and timely (EAST). It is supplemented by a guide on supporting self-management, for helping people with long term conditions.
06 September 2016
A strategy to ‘solve poverty’ has been published by the Joseph Rowntree Foundation, based on four years of research and evidence reviews. It sets out a five point plan to ensure that by 2030: no-one is ever destitute; less than a tenth of the population are in poverty at any one time; and nobody is in poverty for more than two years. The five areas for action are: (1) boost incomes and reduce costs; (2) deliver an effective benefits system; (3) improve education standards and raise skills; (4) strengthen families and communities; and (5) promote long-term economic growth benefitting everyone. The programme would cost £14bn – £15bn a year which could be met by taxing some universal benefits, cutting tax allowances and increasing the national insurance upper earnings limit. They say that poverty currently costs the UK £78bn a year, made up of £69bn on public services to deal with the problems it creates and £9bn in lost taxes and increased benefits.
Feature article and comment: https://www.theguardian.com/commentisfree/2016/sep/06/eradicate-poverty-britain-choose-practical-solution
Press release: https://www.jrf.org.uk/press/jrf-sets-out-new-long-term-deal-solve-poverty
The report: https://www.jrf.org.uk/report/we-can-solve-poverty-uk
Prosecutions for violence against women and girls reached record levels last year, with a rise of 10% to 117,568 in 2015-16, according to the annual report from the Crown Prosecution Service. This was thought to be partly fuelled by an increase in online abuse such as revenge porn.
Only 1.6% of primary school lunchboxes met canteen nutritional standards, in a survey by Leeds University of 300 lunchboxes in 12 primary schools in England. This is an improvement on the 1.1% that passed the standard in a similar survey in 2006. Only 17% of the lunchboxes contained vegetables or salad. There had been a fall in the number containing sugary drinks, from 61% to 46% but there was no improvement in the 60% which contained savoury snacks such as crisps. The research was commissioned by Flora.
A seven-day GP access scheme cut A&E attendances by 26%, but this represented a saving of £768,000 compared to the £3.1m cost of the scheme, according to research by the University of Manchester of the Greater Manchester pilot scheme, published in PLOS Medicine. The analysis covered 56 practices and 346,000 patients. There could be other health benefits not covered in this research such as from more timely access to primary care. Because it was not possible to disentangle set-up from running costs, the longer term costs of such schemes might be lower.
Support for people with diabetes is not always good enough, particularly to enable them to self-manage their condition, according to a report from the CQC, ‘My Diabetes, My Care’. People at high risk of developing Type 2 diabetes were not always identified and helped to become healthier. Most of those people the CQC talked to did receive the annual checks recommended by NICE. A number of examples of good practice were highlighted.
(07/09/16) (Rgn) https://www.nursingtimes.net/7010367.article
Economic recessions and austerity are associated with increases in suicide and mental health problems, particularly among women, according to a review of 41 previous studies by City University in London and Stanford in the USA, published in the BMJ. However they said that most of the studies had evidence of bias and the results should therefore be treated with caution.
Doctors should prescibe exercise outdoors to improve people’s health, the LGA has said. It recommends a similar model to one instituted in New Zealand in 1998. [The press release refers to a report on social prescribing, ‘Just What the Doctor Ordered’ which was published in May. It also gives a number of case studies where this approach is already being used.]
A healthy weight is more important for avoiding Type 2 diabetes than exercise, with those who are obese but fit having a five times greater risk of developing the disease than those of normal weight, according to research from the University of Sydney involving data on over 30,000 people.
E-cigarette advertising made young people less likely to believe smoking one or two cigarettes was harmful, though it didn’t make tobacco smoking more appealing, according to a randomised controlled trial of 400 young people aged 11 to 16, by the universities of Cambridge and North Carolina, published in the journal Tobacco Control. There was concern that this could lead to more experimenting with cigarettes, although there was no evidence of this happening so far, and such advertising is now banned on television.
WHO Europe has launched an action plan to manage non-communicable diseases. It says that while a lot has been achieved on cardiovascular disease and reducing smoking and drinking, more needs to be done to meet goals on tobacco use and physical inactivity and to halt the rise in obesity.
The 2016 health profiles for each local authority area have been published by Public Health England.
05 September 2016
The junior doctors’ strike planned for September has been called off, but those for October, November and December are still scheduled to go ahead. The BMA called off the strike because of concern that the service might not be able to cope and ensure patient safety with the short period of notice.
Jeremy Hunt’s statement to Parliament: https://www.gov.uk/government/speeches/update-on-the-junior-doctors-contract
The GMC says the junior doctors should call off their strike and warns that it would ‘take action’ if a doctor’s actions led to patient harm. That could lead to doctors being struck off. It says that if patients are at risk because of inadequate medical cover they would expect doctors to return to work if asked to, in good faith, by employers.
Two thirds (67%) of women’s refuges may be forced to close because of benefit cuts, as housing benefit in the social sector is brought down to the same level as for private landlords, according to a survey by Women’s Aid of its affiliated refuges. The effects would vary depending how much the refuge relies on housing benefit for income, but in one case it would reduce income from about £300 to £60 a week. The changes have been deferred until 2018 to allow for a review of the effect on such institutions, but the uncertainty makes long term planning difficult.
Toxic magnetite nanoparticles have been found in human brains, which is of concern because of a possible link with Alzheimer’s disease, although this is far from being proven. The research involved analysis of brain tissue from 37 people and was published in the Proceedings of the National Academy of Sciences.
A report on developing seven day pharmacy services in hospitals has been published by NHS England. The report identifies barriers that have to be overcome and gives examples of how hospitals are doing this and explains what national and local leaders can do to implement the plans.
03 September 2016
There are fears of increasing rationing of health services as the Vale of York CCG says it will delay elective surgery for smokers and people with a BMI over 30. The Royal College of Surgeons warned that this was a dangerous move and Chris Hopson, head of NHS Providers said he expected more decisions like this as CCGs try to balance their books. The Vale of York CCG subsequently said it was putting the policies on hold after being asked to review them by NHS England which said it was right to help patients stop smoking or lose weight before major operations for clinical reasons but against the NHS Constitution to have blanket bans on any particular group. The CCG is currently under special measures so allowing NHS England to intervene.
01 September 2016
The BMA have announced strike dates for October, November and December. Jeremy Hunt continues to criticise the BMA. Various bodies, including National Voices and the Patients’ Association condemn the proposed strikes. The Academy of Medical Royal Colleges said it was disappointed at the prospect of sustained industrial action. Three of the 22 medical royal colleges are known not to have signed the statement (GPs, paediatrics and radiologists). Labour defends the junior doctors against portrayals of them as militant and overpaid.
Cuts to public health are a ‘false economy’, the Health Select Committee has said in a report on ‘Public Health post-2013’. The cuts add to the future costs of health and social care and risk widening health inequalities. It says more cross-government working is required to tackle health inequalities, with a Cabinet Office minister given responsibility for embedding health across all areas of government policy, including education, employment, housing and the environment. The Committee also says that local authorities should be given more powers, such as making health a ‘material consideration’ in planning and licensing decisions.
Press release: http://www.parliament.uk/business/committees/committees-a-z/commons-select/health-committee/news-parliament-20151/public-health-report-published-16-17/
The report: http://www.publications.parliament.uk/pa/cm201617/cmselect/cmhealth/140/14002.htm
The district nursing service is at breaking point because of a drop in staff numbers causing delays and fewer visits and leaving staff exhausted, according to a review by the King’s Fund. The number of district nurses has fallen by 28% over the last five years and 48% between 2000 and 2014, although part of the explanation for this is services being contracted to the private and voluntary sector and those nurses not being counted in the official figures. The workload has also increased with a growth in the number of patients and increased complexity of cases. The work underlying the report was initially designed to produce a framework for good district nursing, but the extent of other problems extended the focus.
(31/12/14) (Rgn) https://www.nursingtimes.net/7010224.article
A report, ‘Sustainability and Transformation Plans: what we know so far’ has been published by the Nuffield Trust, based on a workshop with STP leaders. [Provides a useful summary of the issues and how different areas are tackling them, including reconfiguration, prevention, technology and finance.]
Proposals to increase vaccination among children against a range of diseases have been made by NICE in a draft quality standard, out for consultation until 29th September. They say some vaccination rates have been falling for the past two years and only a quarter of local authorities meet the WHO target of 95% MMR coverage for children. Proposals include chasing up children who miss appointments, giving injections as soon as it is realised they are needed and checking vaccination status at key educational stages.
Organ donor rates are still too low, particularly among BME groups, NHS England has said. The consent rate at 62% has improved on the 57% of 2012-13, but is still below the target of 80% by 2020. Among black, Asian and minority ethnic donors the rate is 34%. The figures are from a report, ‘Organ Donation and Transplantation Activity Report 2015-16’.
Young children tend to copy their parents’ sugary drinking habits according to a report by an adviser to the Natural Hydration Council based on responses from 1,000 parents and one each of their children. Children aged 4-8 whose parents regularly drank fizzy drinks were almost three times more likely to drink them as other children of their age.
31 August 2016
Junior doctors are to hold 5-day strikes every month until the end of the year, after the BMA Council agreed proposals from the Junior Doctors Committee. The first strike will be from 8:00 until 5:00 each day from 12th to 16th September. This follows rejection by the membership of the deal negotiated on their behalf with the Government, leading to the Health Secretary imposing the new contract.
The proportion of girls feeling unhappy with their lives has grown by 21% over five years from 11% to 14% between 2009-10 and 2013-14 according to the latest Good Childhood report from the Children’s Society produced in partnership with the University of York. 34% of 10-15 year old girls said they do not feel happy with their appearance.
Press release: http://www.childrenssociety.org.uk/news-and-blogs/press-releases/girls-in-distress-%E2%80%93-report-reveals-rise-in-unhappiness
The report: http://www.childrenssociety.org.uk/what-we-do/research/the-good-childhood-report
30 August 2016
The living wage has benefitted care workers, leading to higher wages, including among those not directly affected, despite fears that employers would recoup costs by reducing hours, accoding to research by the Resolution Foundation based on pay data for 80,000 employees from more than 2,000 care providers. They say that 57% of frontline workers have benefitted directly from the new minimum wage.
(31/08/16) Feature, comment and analysis: https://www.theguardian.com/social-care-network/2016/aug/31/care-worker-pay-further-increases
Women are 50% more likely than men to be misdiagnosed after a heart attack according to a study by Leeds University researchers which looked at the records of 600,000 heart attack patients admitted to hospitals in England and Wales between 2004 and 2013, published in the European Heart Journal Acute Cardiovascular Care. About three in ten people had a final diagnosis different from the original one.
Patient satisfaction with Scottish health services continues to rise, according to the results of the latest inpatient experience survey.
29 August 2016
A Mediterranean diet is associated with a reduction in mortality for people already suffeirng from heart problems, to a greater degree than taking statins, according to research following 1,200 people over seven years, reported to a global conference on heart disease in Rome. Those eating a diet rich in vegetables, nuts, fish and oils were 37% less likely to die early after accounting for factors such as age, sex, class and exercise. Statins are said to reduce major heart problems by 24%.
Chronic Fatigue Syndome (ME) can be identified by tell-tale signs in the blood according to researchers from the University of California, San Diego who analysed blood samples from 45 people with CFS and 39 healthy individuals. They said a similar process was happening as when animals hibernate. The blood test is said to be able to identify cases of CFS with 90% accuracy. The research was published in the Proceedings of the National Academy of Sciences. [N.B. another piece of research on biomarkers for CFS / ME was published on 21/7/16]
28 August 2016
The BMA has said that GP appointments should be 15 minutes each rather than 10, to cope with increasingly complex cases as a result of an older and more overweight population leading to people having multiple problems, in a report, ‘Safe Working in General Practice’ (dated 18th August). However, the 10 minute requirement was dropped in April 2014 and NHS England pointed out that it is up to each individual GP practice as to how much time to allocate to each patient. However, the BMA’s GP Committee said that increasing appointment times would require more money. The BMA has called for ‘locality hubs’ to take the overflow of patients, allowing GPs to restrict the number of appointments.
Press release: https://www.bma.org.uk/news/2016/august/doctors-set-out-safe-working-levels-plan-for-general-practice
Asthma costs the UK £1.1bn a year, according to research from the Asthma UK Centre for Applied Research at the University of Edinburgh. That includes £666m on prescription costs, £160m on GP consultations, £143m on disability claims and £127m on hospital care. There are at least 1,000 deaths a year from asthma in the U.K. Asthma UK called for more use of new ways of treating the condition including the use of new technology such as smart inhalers.
27 August 2016
The Prime Minister has announced an “audit of public services to reveal racial disparities” to show how outcomes differ by ethnicity in areas including health, education and employment. The work is to be led by a new team in the Cabinet Office, reporting to Communities Secretary Sajid Javid and Cabinet Office minister Ben Gummer.
Fungal infections are developing resistance to the medicines available to treat them, researchers have said. About 7,000 people a year die of fungal infections in the U.K. It is believed that the use of fungicides on crops is one of the main reasons for increased resistance. The comments were made by researchers at a new Centre for Medical Mycology at Aberdeen University which was set up earlier in the year to address such issues.
A call for dedicated funding for health and social care, perhaps through national insurance, has been made by former Tory minister Dr. Dan Poutler. He said that radical, long-term solutions were needed to ensure sustainability and save the NHS and social care from collapse.
26 August 2016
Details are starting to emerge of proposals for large structural changes to the configuration of hospitals in England, as Council leaders refuse to sign up to plans to make changes to hospitals in north west London, under one of the 44 sustainability and transformation plans (STPs) across England. The plans would see two major hospitals, Ealing and Charing Cross, losing their A&E and other services. Leaders at Ealing and Hammersmith and Fulham councils have refused to sign up to the changes. The Guardian says NHS England is describing the STP’s as internal documents and the paper has seen only two of them. The plan proposes reducing the number of acute hospitals in the area from 9 to 5 alongside a ‘local hospital model’. The Guardian says the plan is one of the most detailed and comprehensive produced so far. In the Leicestershire area there are plans to reduce the number of acute hospitals from three to two and in the Black Country to reduce the number of acute units from five to four and to close one of two district general hospitals. NHS England said it expected local leaders to be talking to the public regularly , although other reports said they had insisted the draft plans were kept private.
Anonymous feature on STPs from someone working in a CSU: https://www.theguardian.com/healthcare-network/views-from-the-nhs-frontline/2016/aug/26/nhs-plans-bring-benefits-barred-telling-public-sustainability-transformation-plans
38 degrees press release: https://home.38degrees.org.uk/2016/08/26/38-degrees-crowdfunded-investigation-secret-nhs-plans/
Incisive Health report on STPs: www.incisivehealth.com/uploads/images/services/38%20Degrees%20-%20STP%20Early%20Action%20Report%20-%20August%202016.pdfhttp://www.incisivehealth.com/uploads/images/services/38%20Degrees%20-%20STP%20Early%20Action%20Report%20-%20August%202016.pdf
NHS England response: https://www.england.nhs.uk/2016/08/stp-statement/
Critical care units in Wales are too full and understaffed according to a report from the Welsh Government. It says that 80% of units do not meet professional standards for junior doctor staffing and 50% do not meet the standards for consultants.
Diets generally fail because of a gradual reversion to previous levels of calorie intake, with little difference between low fat and low carbohydrate diets, according to a review of previous studies published in the Lancet. Self-reported calorie intake did not match actuals. It is suggested that there are a number of factors underlying the change including a slowing metabolism, the difficulty of managing physically with reduced energy input and the link between eating and socialising and celebration. The researchers say that this means there should be more focus on the individual than the diet.
The introduction of private providers for hip and knee replacements increases the number of operations, rather than just taking over cases which would have happened anyway, according to research from the IFS.
Press release: https://www.ifs.org.uk/publications/8451
25 August 2016
The first quarter financial deficit of NHS trusts was half the previous year, but only because of additional funding according to a performance report from NHS Improvement. The deficit was £461m, £5m ahead of plan, compared to £930m at the same point last year. However, it would have been £911 without an injection of funds from the £1.8bn sustainability and transformation fund (STF), available to trusts that can meet their financial control totals and trust-specific waiting-time targets. 185 out of 238 trusts were able to access the first quarter STF, amounting to £450m. The report also says that A&E attendances were 6.3% higher than the first quarter last year and there were continued difficulties with delayed transfers of care. Many targets continue not to be met, including A&E, all key response times for ambulance services, diagnostic and referral to treatment and cancer treatment targets. Future financial sustainability is threatened by lower budget increases to come, with the increase of 3.7% this year followed by ones of 1.3% next year and 0.4% the year after, (2018/19). Polling by NHS Providers found that only a third of trusts were fairly confident of meeting their financial targets with 38% not confident and a third unsure. The Mail reports that Trusts were sent letters in July from NHS Improvement asking them to identify departments which could be reprovided by other institutions.
244,000 children will be affected by the reduction in the benefit cap from £26,000 to £23,000 in London and £20,000 in the rest of the country, reducing the incomes of affected families by £60 a week on average, according to the Government’s latest impact assessment of the policy.
The new alcohol guidelines have been approved by the Government following consultation. The reduction in recommended intake from 21 to 14 units for men remains as does the advice that pregnant women should not consume any alcohol at all. It was decided not to include guidance on the maximum number of units that could be consumed in a single session as it was considered to be lacking in evidence and likely to make the guidelines confusing.
The Chancellor should reinstate a distributional analysis of budget decisions to show the impact of tax and spending according to how rich or poor families are, Andrew Tyrie, the Conservative MP and chair of the House of Commons Treasury Select Committee has said in a letter to Philip Hammond. Such an analysis was introduced by the coalition government but then dropped by George Osborne in the following Conservative administration.
Air pollution in cars is up to 40% higher in queues and at busy junctions and is higher inside cars than for pedestrians, according to research from the University of Surrey which monitored pollution levels at traffic lights and inside a car over 3.7 miles, passing through 10 different junctions, published in the journal Environment Science: Processes and Impacts. The pollution can be reduced for motorists by closing windows, turning the fan down and recirculating air.
The IPPR says the NHS would collapse without its 57,000 EU workers and argues that they should be offered free British citizenship to avoid an exodus following Brexit, in a report.
Press release: http://www.ippr.org/news-and-media/press-releases/being-mean-spirited-on-citizenship-could-hit-the-nhs-and-cost-uk-plc
The report: http://www.ippr.org/publications/becoming-one-of-us
Guidance on which smartphone apps count as ‘medical devices’, so need to comply with regulations, has been published by the Medicines and Healthcare products Regulatory Agency.
Press release: https://www.gov.uk/government/news/is-your-app-a-medical-device-its-healthy-to-know-regulator-issues-updated-guidance
24 August 2016
There is a steady rise in happiness and mental health with age, without the dip in middle age found in other studies, according to research fromt the University of California San Diego School of Medicine, based on a random sample of 1,546 men and women aged 21 to 100 from the San Diego County. The research was published in the Journal of Clinical Psychiatry. As well as psychological wellbeing, the study also measured mental health including satisfaction with life and low levels of perceived stress, anxiety and depression.
Excess body fat is now being linked to 13 different cancers, where previously it was only linked to 5 (according to the Daily Mail, or 8 according to NHS Choices), following a review of evidence published in the New England Journal of Medicine.
A report on the health impacts of non-active commuting has been published by the Royal Society for Public Health. They say that on average commuters who do not walk or cycle, consume an additional 800 calories a week while commuting, often as a result of unhealthy snacking. A survey of 1,500 people by Populus, found that two-fifths of people said they excersised less because of the commute and a third reported increased snacking. The report suggests there should be restrictions on junk food outlets in stations, a health and wellbeing requirement included in train and bus franchises and an increase by employers of flexible and home working.
23 August 2016
Proposals for dealing with ‘crisis’ levels of demand in A&E have been put forward by the Royal College of Emergency medicine and the Royal College of Nursing, based on a recent crisis summit. They include the proposal that A&E’s should be transformed into hubs, with a range of services.
(Rgn) Contains a link to pdf of the report: https://www.nursingtimes.net/7010111.article
RCEM press release (pdf): http://www.rcem.ac.uk/CEM/document?id=10213
The risk of breast cancer amongst women using combined HRT is 2.7 times higher than others according to a study by the Institute of Cancer Research in London, which suggested that previous studies may have underestimated the risk (at 1.7 times). This represents an increase from 14 to 34 women in 1,000 getting breast cancer. It monitored 39,000 women over six years and was published in the British Journal of Cancer. The researchers said women should make a decision on HRT based on their individual circumstances and were not advised to make a change based on this one piece of research.
22 August 2016
The biggest risk to achieving a ‘seven day NHS’ is workforce overload, with a lack of GPs, consultants and other health professionals, according to an internal risk assessment and other documents seen by the Guardian and Channel 4. NHS staff are seen as a barrier to achieving change because they are thought not to believe in the case for change. Other risks include the possibility that the aims of improving quality of care at weekends and reducing the death rate from weekend emergency admissions might not be met. The Brexit decision could also impact on the plans since the NHS employs 55,000 staff from elsewhere in the EU. Labour calls for an enquiry into the revelations and some medical Tory MPs criticise the Government’s approach. An internal DH briefing paper suggests that the focus on the weekend effect has not been helpful in the move towards seven day services.
Extract from the risk register with commentary: https://www.theguardian.com/society/2016/aug/22/nhs-weekend-working-risk-management-document
The view of a junior doctor: https://www.theguardian.com/commentisfree/2016/aug/22/leaks-flaws-jeremy-hunt-deception-seven-day-nhs
The proportion of 14 year old girls suffering depression and anxiety has increased from 33% to 37% since 2005 according to a survey carried out for the Department for Education. On the other hand the figure for boys, at 15% had fallen slightly. There were falls in the proportion of the young people who drank alcohol, took drugs, smoked or missed school. Those who said they had drunk alcohol fell from 30% to 12%. The problems were more marked among children of parents educated to at least degree level.
NHS trusts will be expected to cancel outpatient appointments and operations to deal with winter pressures, as part of specific plans to cope, NHS England has indicated in a submission to the House of Commons Health Select Committee.
The number of smokers quitting through use of NHS services has fallen for the fourth year in a row to 195,170 in 2015-16, a 15% fall on the previous year according to figures from NHS Digital. 47% of those under 18 successfully quit compared to 57% of those aged 60 or over.
Links to the reports: http://www.digital.nhs.uk/catalogue/PUB21162
Deaths from heart disease have fallen in Wales from just over 12,000 in 2005 to just over 8,800 in 2014, according to the Heart Disease Annual Report.
21 August 2016
Women and BME people are under-represented on NHS trust boards, according to information from freedom of information requests covering 1,450 board members in 114 trusts, published in a report, ‘Action not Words – Making NHS Boards More Representative’. People from a BME background hold only 2% of trust boards chairs, despite making up 15% of the population as a whole. People from a BME background make up 4% of executive directors and 7% of non-executive directors on trust boards. While 80% of NHS staff are women, they make up 28% of chairs, 47% of executive directors and 38% of non-executive directors. [While Labour peer Lord Philip Hunt is quoted in the Guardian article, it is not clear who is the author of the report]
The CQC is to be able to inspect and rate more types of provider, including cosmetic surgery, substance misuse centres, termination of pregnancy services, refractive eye surgery providers and independent providers of ambulance services, dialysis units and community health services, the Government has proposed in an eight week consultation.
CQC comment: http://www.cqc.org.uk/content/comment-department-healths-proposal-enable-us-rate-more-types-provider
20 August 2016
Widespread staff shortages in hospitals mean signs of illness are being missed and newly qualified doctors are being left in charge of up to 100 patients, according to a survey of 395 doctors below the level of consultant undertaken by a doctor from the north east, Pete Campbell, with assistance from the BMA. It found that 21% of rota gaps were not covered by any doctor and another 18% were covered by staff in addition to their existing schedule.
19 August 2016
The High Court has said the CQC must review its processes for dealing with comments before publishing its inspection reports, following a judicial review brought by SSP Health. The judge rejected the CQC’s claim that there should be no mechanism for complaining against decisions taken within the ten day window for raising factual inaccuracies. Up until now it has been purely up to the lead inspector whether any changes should be made to a report, but the judge said they should not be the sole arbiter and the CQC should have an internal independent process.
Bids for £5m funding for perinatal mental health are being invited by NHS England, to be increased to £40m by 2018 as part of a £365m package over five years. More than one in ten women develop a mental health illness during pregnancy or in the first year after birth. Only 15% of NHS areas provide specialist care and support to such women.
18 August 2016
The Government’s delayed childhood obesity strategy has been widely criticised for not going far enough. It proposes a voluntary target to reduce the amount of sugar in children’s food and drink by 5% next year and by 20% in four years. Primary schools are to be asked to provide 30 minutes of physical activity a day, with a further 30 minutes at home. Proposals in earlier drafts of the strategy are said to have been dropped including measures to reduce advertising and promotion of junk foods to children. It is also reported that a proposal to ban trans-fats was in earlier drafts but was removed. Those criticising the strategy for not going far enough included charities, medical bodies, the LGA and the Chief Executive of Sainsbury’s. The British Retail Consortium said it was disappointed at voluntary reductions as some manufacturers might use it to try and take advantage. [The whole strategy is only 13 pages.]
(19/08/16) (Rgn) https://www.nursingtimes.net/7010049.article
(20/08/16) The Royal Society for Public Health says it won’t help parents resist ‘pester power’: https://www.theguardian.com/society/2016/aug/20/failure-to-curb-junk-food-ads-parents-public-health-chief
(22/08/16) More criticism, from Action on Sugar and Cancer Research UK: https://www.theguardian.com/society/2016/aug/21/theresa-mays-first-test-was-obesity-strategy-and-she-has-failed-health-experts-say
A consultation on the soft drinks industry levy (sugar tax) has been launched by HMRC and the Treasury. The consultation closes on 13th October.
An EHRC review of racial equalty calls for urgent action to tackle systemic unfairness. The review, by the Equality and Human Rights Commission, reviews inequality in a number of areas including education, employment, crime and health. Although there have been improvements in some areas, the life chances for young minority ethnic people have got worse over the last five years. Black African women have a mortality rate four times higher than white women in the UK and are seven times more likely to be detained under mental health legislation.
Press release: https://www.equalityhumanrights.com/en/our-work/news/widespread-inequality-risks-increasing-race-tensions-warns-ehrc
Links to the report and other information: https://www.equalityhumanrights.com/en/race-report-healing-divided-britain
GPs receiving feedback on their prescribing cut potentially hazardous prescriptions by 12% in a trial involving over 250 GP practices in three Scottish health boards, published in the BMJ.
There are examples of drug companies cutting prices of cancer drugs following the ending of the cancer drugs fund.
17 August 2016
A report on progress in children’s mental health since March 2015’s Future in Mind, has been published by an Education Policy Institute Commission chaired by Norman Lamb. This is the second report from the commission and includes information from foi responses from CAMHS providers. It finds that 83% of trusts had experienced recruitment difficulties. Recruitment challenges had led to an 82% increase in staff spending in the last two years. Of 122 Local Transformation Plans, they assessed only 15% of them as ‘good’ with 85% ‘requiring improvement’. Although £119m has been allocated to local areas, because this is not ring fenced and it is only part of the support provided, it is possible that overall spending on children and young people’s mental health may not have increased.
(19/08/16) (Rgn) https://www.nursingtimes.net/7010054.article
GPs’ confidence in CCGs has fallen according to the results of the latest 360 degree stakeholder survey conducted by MORI. There were falls from the 2015 results in a number of areas, including confidence amongst GPs of CCGs’ ability to deliver results for patients from 64% to 59% and those thinking arrangements for participation in decision making were effective from 68% to 59%. Only 33% of GP practices felt they could influence CCG decision-making a great deal or a fair amount and 49% said their views were not listened to.
A care home room costs over £30,000 p.a. on average, according to a report by Prestige Nursing and Care based on a survey of 165 care homes and official statistics. They say that the cost of a care home has risen by 5.2% in the last year which is more than ten times the rise in average pensioner income.
A feature article explores the use of business intelligence in hospitals in East Kent and Bournemouth and Christchurch areas. This helps in meeting the four hour A&E target as well as for such things as discharge.
16 August 2016
A warning on cuts to health visitor numbers has been raised by a number of prominent health and children’s organisations and unions in a letter to the Times. There was a drop of 433 posts, from 10,114 to 9,711 just between March and April. It is thought the reductions are because of local authorities having to find cuts. They say that health visitors have a vital role promoting good public health and reducing demand on other parts of the health system.
Variations between CCGs in tackling health inequalities have been mapped in research by the University of York, Centre for Health Economics. Looking at preventable hospital admissions, it shows that inequality is not always related to how rich or poor the area is. People living in the fifth most deprived districts have 72% more emergency hospital admissions and 20% more planned admissions than those in the most affluent fifth of neighbourhoods. Excess hospital admissions from poorer areas are said to be costing the NHS £4.8bn a year.
Press release: http://www.york.ac.uk/che/news/2016/nhs-adopts-che-ccg-indicators/
A dementia atlas for England has been published by the Department of Health showing considerable variation across the country. The interactive map shows indicators grouped under five headings: prevention, diagnosis, support, living with dementia and end of life care. The proportion of those receiving the annual check up they should receive varies from 50% to 86%. Some areas have as many as 8,000 ‘dementia friends’, while others have none.
Direct link to the interactive atlas: https://shapeatlas.net/dementia/6/52.945/-2.147/l-dup65/b-10M
Actress Carey Mulligan has been appointed the first UK global Dementia Friends Ambassador by the Alzheimer’s Society and Jeremy Hunt.
End of life care in care homes is beset with uncertainties according to research from the universities of Hertfordshire and Lancashire based on three studies over a year involving 29 care homes, 528 residents and 205 home care staff, published in BioMed Central (an open access publisher). They found that uncertainty related to three things: what is the ‘right’ treatment; who should do what, and when; and in what setting end-of-life care should be delivered, and by whom.
A report on waiting times for elective surgery has been published by the Patients’ Association, saying that there has been an 80% increase in the number of patients waiting over 18 weeks for elective surgery between the calendar years 2014 and 2015. This document, ‘Feeling the Wait’, is the sixth in a series of annual reports on the topic. It is based on foi requests, to which there was a 78% response rate. NHS England said they had ‘significant concerns’ about the report which they said was misleading and statistically flawed. They said waits for an NHS operation were close to an all time low.
The report (pdf): http://www.patients-association.org.uk/wp-content/uploads/2016/08/Waiting-Times-Report-2016-Feeling-the-wait-The-Patients-Association.pdf
A campaign against the proposed sugar tax has been launched by soft drink manufacturers, pubs, convenience stores and off licences. It is being funded by the British Soft Drinks Association.
15 August 2016
The agency cap is likely to save the NHS £800m in its first year of operation, with no evidence of an impact on patient safety, NHS Improvement has said. Since the cap was introduced in November. two incidents of potential harm have been reported, 23 incidents with no harm and 11 incidents of service closure. It appears that trusts have breached the cap rather than risk patient safety, with 90% of trusts (214) exceeding the cap in each week of the first quarter of 2016-17. [Further figures are available on cap breaches.]
Owen Smith has said a 100% publicly funded NHS would be a ‘red line’ for him if elected Labour leader. He said that the recently published DH annual report showed that NHS spending on private providers had doubled from 4% to 8% since 2010. He also reiterated a promise to increase spending on the NHS by 4% a year. Meanwhile, Jeremy Corbyn set out plans for a ‘National Education Service’ modelled on the principles of the NHS. Both candidates said they would restore the bursary for nurse and midwife training.
There is not a ‘weekend effect’ of greater mortality for emergency surgery undertaken at the weekend, although there was previously and it has fallen over the last decade, according to research from Queen Elizabeth Hospital in Gateshead based on 30 day mortality for emergency general surgical admissions in the North of England between 2000 and 2014, published in the British Journal of Surgery. The overall 30 day mortality rate fell from 5.4% in 2000-2004, to 2.9% in 2010-14.
Some breast and prostate cancer drugs are available in other countries of similar wealth, but not the UK, according to a report by Breast Cancer Now and Prostate Cancer UK. They note that other countries split the role of technological assessment and the negotiation of price, which in the UK is combined in a single body such as NICE or the Scottish Medicines Consortium.
12 August 2016
The Junior Doctors’ Committee of the BMA has asked its full council to authorise more industrial action from early September, saying that ministers have failed to address concerns about the contract which the Government is imposing from October after its rejection by 58% of relevant BMA members.
A third of trusts warned by NHS Improvement of their ‘excess pay growth’ had been told by the CQC within the previous year to increase staffing, according to an analysis by the HSJ of CQC reports. The highlighting of high pay growth was made in the context of the ‘reset’ aimed at reducing costs, although NHSI have since acknowledged that there may be good reasons for the increases. Of the 63 providers identified as having a high pay bill, 32 had had CQC inspection reports within the previous year and in 22 of these they were told to improve staffing levels either across the organisation or within specific departments.
McDonalds and KFC are being pressured to stop using antibiotics on animals (except to treat illness) because of the growing threat of antimicrobial resistance.
11 August 2016
The NHS monthly performance figures show targets still being missed in England, with delayed discharges 23% higher than the same month last year. 59% of the delays were due to the NHS, 32% social care and 7.9% joint. The proportion of those seen in A&E within four hours rose slightly from 90.2% in May to 90.5%, although for just hospital A&Es the figure was 85.8%. It was the busiest June on record, with A&E attendances up by 2.1% on the same month last year and emergency admissions 4.7% higher. The ambulance target for responding to the most serious cases within eight minutes was missed for the 13th month in a row, at 69% compared to the target of 75%. NHS Providers Chief Executive Chris Hopson said that the NHS cannot cope on its existing funding levels.
Almost 9 in 10 GPs and other practice staff find their work life stressful, with a third feeling that admitting to being overly stressed would make them seem less capable to their colleagues, according to a survey of 1,004 practice staff, including 111 GPs as well as practice nurses and practice managers, by Dods Research for Mind. Over half (54%) of GPs and other staff said that workplace stress had affected their physically health and 21% said it had led them to develop a mental health problem. While 88% of primary care workers found their work life stressful, the equivalent figure for for the wider UK workforce is only 56%.
More than a third (34%) of female students have mental health problems, compared to a fifth (19%) of male undergraduates, according to a survey by YouGov of 1,061 students. Overall, 27% of students had a mental health problem. For LGBT students the figure was 45%. Of those with mental health difficulties, 47% say they have difficulty completing some daily tasks. The most common mental health problems are depression (77%) and anxiety (74%). The next most common is eating disorders, at 14%.
The number of care applications to Cafcass reached its highest ever level in July, at 1,305, which was 16% higher than the same month last year. Demand has been rising since 2013. (Cafcass is an independent NDPB which represents children in family court cases)
Jeremy Corbyn has promised that Labour under his leadership would remove all private providers from the NHS, so returning it “fully to public ownership”, speaking in the second of a series of debates with leadership challenger Owen Smith.
10 August 2016
The two week referral target for psychosis is not being fully implemented by a quarter of CCGs, according to responses from 170 of the 209 CCGs to a Liberal Democrat freedom of information request. Of those responding, 23% said they had only applied the target to 14-35 year olds. The target, which applies to 14-65 year olds experiencing their first experience of psychosis, was introduced in April 2016.
(11/08/16) Official statistics on ‘early intervention in psychosis waiting times’: https://www.england.nhs.uk/statistics/statistical-work-areas/eip-waiting-times/
The supply of A&E doctors is not keeping up with demand, according to the Royal College of Emergency Medicine. The United Lincolnshire hospitals NHS trust has said it may need to close A&E wards at night because of the shortage of emergency doctors. There have also been problems at the North Middlesex hospital. NHS Providers said there is not enough money for the NHS to provide what it is being asked for.
Sustainability and transformation plans are not being made public and are even being kept from GPs’ representatives, Pulse Magazine reports. The magazine asked all of the 44 areas to share their plans and all refused.
The BMA has said GPs should not feel pressured into signing up to the new voluntary contracts and giving up their current (GMS or PMS) contracts. The GP Committee advised them to avoid any hasty decisions and to consider participating in the new ‘multispeciality community providers’ while retaining their current contracts.
Cot deaths are at their lowest recorded level in England and Wales according to the ONS. The number of deaths from sudden infant death syndrome (cot deaths) and those from other unknown causes was 128 in 2014 and 165 the previous year. Figures were first collected in 2004 when there were 207 such deaths.
Results of the hospital PLACE assessments have been published by NHS Digital. PLACE is the Patient Led Assessments of the Care Environment.
09 August 2016
Possibly only a third of deaths of people detained under the Mental Health Act were reported to coroners according to an analysis by the Health Service Journal. MoJ figures show that between 2011-14, there were 373 deaths of people detained under the Act that were reported to coroners, but data supplied to the Independent Advisory Panel on Deaths in Custody show there were 1,115 deaths in that period.
Disabled people in poorer areas are more likely to have benefits removed in fit-to-work tests than those in wealthier areas, according to research due to be published next week in the journal Radical Statistics, based on an analysis of data from over 300 local authorities between 2007 and 2015. It found that in poorer areas, with more disability, the employment and support allowance was being removed at a higher rate than better off areas, whereas in healthier areas people were found fit for work less often. All those being assessed were previously on a benefit so had already been identified as having a health problem.
Doing much more than the WHO recommended 150 minutes exercise a week was associated with a reduced risk of five conditions: stroke, breast cancer, bowel cancer, diabetes and heart disease, according to a systematic review and meta-analysis of 174 studies published in the BMJ. The WHO guidance is for 600 ‘metabolic equivalent minutes’ (MET minutes) a week, equivalent to 150 minutes brisk walking or 75 minutes of running, but further substantial health gains were associated with activity levels up to 3,000 or 4,000 MET minutes a week, with gains tailing off after that. The pattern identified was most prominent for ischemic heart disease and diabetes. Those with an activity level of 600 MET minutes per week had a 2% lower risk of diabetes, while the increase from 600 to 3,600 reduced the risk by an additional 19%.
The UK performs fewer cataract operations than most other western countries, according to OECD figures which put it at 22nd out of 30 countries. It carried out 731 operations per 100,000 people compared to Portugal at the top of the list with 1,273. The lowest number was Ireland at 206, followed by Norway at 239. Norman Lamb says the NHS is heading towards financial meltdown.
The gap in life expectancy between men and women is the second lowest in Europe, at 3.7 years, compared to the European average of 5.5 years, according to figures from Eurostat. It is suggested it could be due to fewer men in industrial jobs and more women having the stress of both a career and child minding.
39% of retailers have sold e-cigarettes and vaping liquids to under 18’s in contravention of the law, according to 634 spot checks between January and March 2016 by local council trading standards officers, supported by the Department of Health and co-ordinated by the Chartered Trading Standards Institute. 68% of the illegal sales were made in markets and car boot sales with the fewest made at national newsagents, petrol station kiosks and convenience stores which tend to be more experienced in selling age-related products.
A new software system enables GPs to confer with consultants on whether to refer patients to them or not. The software is Kinesis from Cloud2 and is being used by practices covered by Wandsworth CCG in London. In 2015-16, GPs sent 3,993 requests via Kinesis of which 48% did not lead to a referal meaning a saving of about £275,000 if it is assumed each of those would otherwise have been referred.
08 August 2016
The ‘troubled families’ programme has had no discernible effect on unemployment, truancy or criminality, according to an unpublished evaluation report, a senior civil servant has told BBC’s Newsnight programme. The report is by an independent consultancy, Ecorys, which examined data from 56 local authorities. The £1.3bn scheme has had two phases, the first to help 120,000 families at a cost of £400m and the second a further 400,000 families at a cost of £900m. A previous assessment said that 117,000 families had been ‘turned around’, saving £1.2bn.
Food and diet surveys under-report calorie consumption, with the actual number being 3,000 a day, compared to the 2,000 reported, according to analysis by the Behavioural Insights Team (BIT). Reported calorie consumption is too low to sustain current weight, even if the minimum possible exercise was being undertaken. Estimates of the real total figure are drawn from such sources as national spending figures on how much food is bought and chemical analysis of how much energy people burn. They say a drop in physical activity is unlikely to explain the large increases in obesity and suggest that a focus on diet rather than activity is needed to combat it. In fact calorie consumption has probably been increasing rather than decreasing.
Link to the document: http://www.behaviouralinsights.co.uk/publications/counting-calories-how-under-reporting-can-explain-the-apparent-fall-in-calorie-intake/
29% of hospitals in the UK are not following guidance on screening bowel cancer patients for Lynch syndrome, an inherited disorder related to the cancer, according to Bowel Cancer UK, based on foi responses. The rates of testing varied from 29% in Wales to 100% in Northern Ireland. The overall rate of testing increased from 49% in 2015 to 71% in 2016.
A social prescribing scheme did not cut GP consultations or improve patients’ health, including depression and anxiety, according to an evaluation of a scheme in the City and Hackney CCG area in which patients could be referred to activities such as cooking and gardening. The research looked at 381 patients referred to the scheme, compared to a control group with similar backgrounds and comorbidities. Full outcome data was only available on 14% of patients. The researchers said there could be other benefits not captured by their research. Evaluation of other similar schemes have produced more promising results.
07 August 2016
Sponsorship of the olympics by Strongbow has been criticised by the Alcohol Health Alliance, in a letter to the Guardian, with a warning that it could encourage underage drinking.
The letter: https://www.theguardian.com/sport/2016/aug/07/olympic-sponsorship-and-alcohol-dont-mix
06 August 2016
People with mental health problems earn considerably less than others, with men who suffer from phobias or panic attacks earning 58% the amount of their peers, while men suffering from anxiety or depression earn 74% of the amount as men without such problems, according to evidence collected by the Equality and Human Rights Commission, due to be published next month. The differences are less for women, with those suffering anxiety or depression earning 90% as much as their peers.
About 360,000 households are having deductions made from benefits to pay for council tax arrears, in a downward spiral of debt, according to data revealed under the Freedom of Information Act. Information received from 133 local authorities found over 190,000 families having such deductions made, which is then extrapolated to produce the 360,000 figure. Those on the lowest incomes were forced to pay something towards their council tax for the first time from 2013.
05 August 2016
Free condoms and advice should be provided to young people and gay men, to reduce the spread of sexually transmitted infections, including HIV, new draft guidance from NICE proposes.
Press release: https://www.nice.org.uk/news/article/we-can-reduce-stis-by-increasing-condom-availability-says-nice
CCGs have increased their funding to GPs, with 75% more being spent on ‘enhanced services’ since 2013-14, according to Pulse Magazine. A freedom of information request answered by 48 CCGs found that spending on enhanced services had risen from £59m in 2013-14 to £103.5m this year, which would be an inrease of £195m if extrapolated across the country.
A report exploring how the £22bn efficiency savings needed by the NHS by 2020 can be met, has been published by the Nuffield Trust. It considers one, or a combination of three possible sources: (1) NHS providers becoming more efficient; (2) NHS commissioners reducing the rate of increase in activity, either by reducing demand or limiting access to care; or (3) more funding for the NHS. It suggests that the efficiencies are unlikely to be realised with the NHS being left with a £6bn funding gap.
04 August 2016
Most Britons would not be comfortable letting someone with a mental health condition look after their children or marry into their family, according to research by NatCen commissioned by Public Health England. When given a description of symptoms of depression, 82% said they wouldn’t be happy having such a person look after their children, 64% wouldn’t be comfortable having them marry into their family and 35% wouldn’t feel happy having them as a colleague. The research also found that 91% of people are confident they know what it means to have good wellbeing and 72% feel they know what to do to increase their wellbeing.
An obesity quality standard has been published by NICE. It relates to local clinical diagnosis and treatment for children and adults (so does not cover prevention or national policy) and draws on previously issued guidelines. The Daily Mail reports this with the rather lurid headline, “Give fat patients £100-an-hour therapy on the NHS doctors are told”, which refers to the recommendation to offer counselling to those who have tried and failed to lose weight. The Mail report also says doctors are advised to send patients to Weight Watchers or for gastric band operations “all free on the NHS” (although that was already in existing guidance).
53% of supermarket promotions were for less healthy products according to research by Which, which said they should do more to promote healthy foods. Over 77,000 promotions between April and June, in six supermarket chains were analysed, with items which had a red traffic light label for fat, saturates, sugar or salt counted as unhealthy.
Ten to 16 NHS trusts are to become centres of global digital excellence, leading the application of information technology, NHS England has announced. Twenty six of the most digitally advanced trusts have been invited to bid for up to £10m each from a £100m funding pot.
A bottom-up, localised approach should be used to tackle longstanding problems in areas such as health, welfare, criminal justice and education, the Policy Exchange argues in a report, ‘Delivering Differently.’ It suggests that more should be done to devolve powers to local authorities and the civil service should be redestributed ‘to all corners of the country.’
03 August 2016
Spending on diabetes prescriptions has increased by 86% in the last decade, from £514m to £957m between 2005-6 and 2015-16, according to figures from NHS Digital (the new name for HSCIC). This was made up of £423m on antidiabetic drugs, £344m on insulin and £187m on diagnostic and monitoring devices. Diabetes prescriptions now make up 10% of the primary care prescribing bill, representing the largest single group of prescribed medicines (it was 6% ten years ago).
CCGs are encouraging GP practices to form into federations, with £15m having been spent supporting them to do that, in 92 CCGs that responded to Pulse Magazine. The General Practice Forward View said that NHS England would ask CCGs to provide £171m to ‘stimulate development of at-scale providers.’ However some CCGs were concerned at conflicts of interest, and said they wouldn’t fund the establishment of other local providers in that way so shouldn’t do so for GPs.
02 August 2016
NHS England can legally fund the HIV preventive drug ‘Prep’, the High Court has ruled. NHS England had said it was the responsibility of Public Health within local authorities to provide the drug as it was preventive and that they did not have the authority. The case was taken by the National Aids Trust (NAT). NHS England (NHSE) has now said it will appeal. It is also to review the evidence on the cost-effectiveness of Prep. NAT subsequently criticised NHSE for saying that other treatments would not be treated if Prep was, saying that prioritisation meant balancing all treatments against each other and it was invidious to pick out just one as the cause.
(04/08/16) Approval for other treatments delayed by NHSE: http://www.dailymail.co.uk/news/article-3722686/How-blameless-sick-paying-price-HIV-drug-NHS-chiefs-spell-nine-vital-treatments-gone.html
Anyone who needs a cataract operation should get it without delay, Jeremy Hunt has said, in the light of an investigation by the Daily Mail which found that in some areas only people with severe problems were deemed eligible, and that often only one eye would be operated on. Jeremy Hunt said that decisions on who gets treatment should be clinically led. [I’m not sure that the quoted comments of Jeremy Hunt quite live up to the headline that he has ‘ordered’ trusts to provide the surgery.]
A summary of evidence on alcohol consumption by under 18 year olds has been published (15pp) by Public Health England.
A briefing on integrating health and social care has been produced by the Parliamentary Office of Science and Technology (POST).
01 August 2016
Poverty costs the public purse £78bn a year, or a fifth of spending on public services, according to research by Heriot-Watt and Loughborough universities, commissioned by the Joseph Rowntree Foundation. The largest proportion of this cost is £29bn for treating health conditions associated with poverty, which is about 25% of healthcare spending. A further £9bn is linked to the cost of benefits and loss of tax revenue. £10bn of the cost is related to education and that is 20% of the schools budget. Police and criminal justice costs account for £9bn, children’s services £7.5bn, adult social care 4.6bn and housing £4bn. About 58% of children’s services budgets are poverty related.
People diagnosed with cancer are twice as likely to live at least 10 years than at the start of the 1970s, but that means many people are having to live with the side effects of treatment and there is greater pressure on the NHS, according to a report from Macmillan Cancer Support, ‘Cancer: Then and Now’. More than 170,000 people diagnosed in the 1970s and 1980s are still alive. About 625,000 people face poor health or disability after treatment for cancer. It is estimated that about a quarter of survivors will have long-term issues that need support.
NHS Improvement has said that NHS trusts are not being targeted for cuts to their workforce, and its list of trusts with high pay bill growth was merely intended to ‘start a discussion’. This response, by NHSI Chief Executive Jim Mackey was in relation to concern following the financial ‘reset’ announcement that finance might take precedence over patient safety with possible staff cuts. Mackey acknowledged that there might be good reasons for pay bill growth, such as taking on new services.
The Accessible Information Standard came into force on 1st August 2016. It puts requirements on bodies providing health care or adult social care to make sure that people with a disability, impairment or sensory loss are provided with information they can easily read and understand. There are five requirements: (1) to ask people if they have any needs and find out how to meet them; (2) to record them; (3) to flag on a person’s notes that they have needs; (4) share information about needs with other providers, if there is consent; and (5) ensure people receive information they can access and understand and receive communication support if they need it.
The new voluntary GP contract will tie payment into achieving a number of targets, which could include patient satisfaction, cutting waiting referral times, reducing rates of smoking and obesity and improving life expectancy. Those are some of the targets described in a document from NHS Dudley CCG, one of six pilot areas, which is consulting on its multispeciality community provider (MCP) contract, to be led by GPs but providing primary and secondary care services.
New indicators to spot atrial fibrillation (AF) have been produced by NICE and are to be piloted in 30 GP surgeries next year. There will be incentives for GPs to screen for AF amongst elderly people. NHS Improvement estimate that 8,000 strokes related to atrial fibrillation (AF) could be prevented each year with better management of the condition. It is estimated that 470,000 people have AF but have not been diagnosed, and so are not receiving advice to reduce their risk of stroke. AF is estimated to cause a fifth of the 110,000 cases of stroke each year. The Royal College of GPs said NICE should not be proposing screening which has been rejected by the National Screening Committee.
More of a plant-based diet increased life expectancy, with every 3% increase in calories from plant protein reducing the risk of death by 10%, according to US and Italian researchers looking at dietary records of 130,000 people over 30 years, published in JAMA Internal Medicine. The subjects were nurses and other health professionals, two thirds of whom were women. The associations were only seen in people with at least one other risk factor such as smoking, obesity and not exercising. Lifestyle and medical information was collected every two years and subjects completed questionnaires about what they had eaten in the previous year every four years.
29 July 2016
The Scottish Government is starting a 13 week consultation on a new social security system. Scotland will be responsible for about £2.7bn of benefits spending or 15% of the Scottish benefits bill, with the rest still under the control of the UK government, under the terms of the Scotland Act. The Scottish Government has already made a number of commitments to increasing particular benefits. They are also considering whether to change the language from one of ‘welfare’ and ‘benefits’ to ‘social security’ and ‘payments’ to reflect the fact that it is ‘an investment we make collectively in ourselves’ rather than a payment from some people to others.
The revised Cancer Drugs Fund has come into operation (29th July) with four new cancer drugs immediately available. The fund now fast tracks drugs which show potential but have not yet been licensed, while further information on their effectiveness is collected. NHS England says the new process should speed up access to drugs by four months. The change was criticised by charity Breast Cancer Now, as having a flawed methodology and not allowing the government to negotiate on price. [It is not clear from the press reports what it is about the methodology that is flawed.]
28 July 2016
More details of the new voluntary GP contracts have been revealed in NHS England board papers. The contracts were announced by David Cameron last year (4th October 2015) in connection with seven day working, but that is not mentioned in these papers. The contracts will be for 10-15 years and will allow GPs to keep existing GMS contracts alongside the new ones or to become fully integrated in new ‘multispeciality community providers’, which will also provide secondary services. The contracts will include a gain/risk share agreement meaning that some funding could depend on reducing acute admissions.
Deaths from the misuse of drugs were at their highest level in 2014 since records began in 1993, at 2,250, an increase of 15% since 2013 and 44% since 2004, according to a report from HSCIC, ‘Statistics on Drug Misuse, England 2016’. The number of hospital admissions where ‘poisoning by illicit drugs’ was the main diagnosis rose by 57% between 2004-05 and 2014-15, to 14,279. However, the number of people aged 16-59 who reported taking an illicit drug has been falling slightly, from 10.5% in 2005-06, to 8.6% in 2014-15 and 8.4% the following year.
People with even mild sight problems were 12% more likely to say their health was poor, and 14% more likely to be under the care of a psychiatrist for mental health problems, according to a study of 112,300 men and women aged 40-74 by researchers from University College London, published in JAMA Opthalmology. The researchers said that even mild vision impairment could affect people’s social life, activity and eating habits and could lead to people feeling less in control of their lives. They said that the NHS is not doing enough to help such people.
The Local Government Ombudsman upheld a higher proportion of complaints last year than the previous year, up from 46% to 51%, it has said, reporting its annual complaint statistics. Overall, the number of complaints was similar to the previous year but complaints and enquiries about education and children’s services rose by 13%, of which 53% were upheld. Complaints about councils’ provision of home care rose by 29% with 67% upheld. Of complaints related to child protection, 68% were upheld, while 70% of complaints on adult care planning were upheld.
The NHS is to target European medical schools to recruit applicants for GP training, NHS England has said. NHS England said it had been working with Health Education England and that recruitment would focus on medical schools that taught in English.
NHS England is changing hospital contracts to limit them increasing GPs’ workloads, for instance with a ban on blanket policies for discharging patients back to GPs if they do not attend an outpatient appointment and allowing secondary care doctors to onward refer within the same organisation rather than having to go via the GP.
Increasing use of private health providers has increased inequality and harmed the NHS according to a study, by researachers from Queen Mary University of London, looking at changes in hip surgery in Scotland following legislation allowing treatment in private hospitals at NHS expense. It was published in the Journal of Public Health. It found that NHS provision declined as pivate provision increased and that the poorest and oldest sections of society were least likely to get an artificial hip than the rest. It is thought that this was because of private providers cherry picking the easiest patients.
Eligibility criteria for cataract operations are imposed by 73% of NHS trusts, that is 66 of 91 responding to an foi request from the Daily Mail, out of 150 in total. Typically this meant scoring 6 out of 12 or less in sight tests but they might also be assessed according to how far their lives were impaired (e.g. whether they had fallen, whether they lived alone etc.). Half of the trusts would only operate on the worst-affected eye.
The number of suicides in prison was at an all time high last year, with 105 ‘self-inflicted deaths’ (which also incude accidental deaths as a result of a person’s own actions), in the 12 months to June 2016, in England and Wales, according to the latest ‘Safety in Custody’ quarterly update. There was a similar percentage increase in the number of incidents of self-harm, up by 27% in the year to 34,586.
Screening for lung cancer did not increase anxiety, meaning that psychological distress is not a valid reason for not undertaking such screening, according to a randomised controlled trial of 4,000 men and women aged 50-75, at high risk of lung cancer, with follow ups at two weeks and two years, published in the journal Thorax.
A transgender identity should not be characterised as a mental disorder, according to a study involving interviews with 250 transgender people published in the Lancet Psychiatry. This was the first of a number of field studies evaluating a proposed change to the WHO International Classification of Diseases. ‘Distress and impairment’ are considered essential characteristics of mental disorders, but the researchers suggest they can be explained by experiences of social rejection and violence rather than resulting from transgender identity itself. Association with mental illness can be used to affect people’s rights such as in relation to decision making on child custody and reproduction.
Scottish legislation giving each child a ‘named person’ to help access services, breaches rights to privacy and a family life under the European convention on human rights, the supreme court has ruled. It has given the Scottish Government 42 days to amend the legislation. The aims of the scheme, which the court said were legitimate and benign, were to provide someone such as a teacher or health worker to act as a single point of contact to help parents access services and to identify children in need of protection. However, the information sharing provisions would allow disclosure of confidential information to a wide range of public authorities, without the child’s or parent’s permission and would risk breaching rights to privacy and confidentiality.
27 July 2016
Spending on premium rate overtime for hospital consultants increased from £125m in 2013-14 to £168m last year according to information obtained by the BBC from 140 foi responses out of 186 trusts and health boards approached. Rates are determined locally, and while many consultants work extra for nothing or at standard pay rates, others receive double or triple pay. The highest amount received was £375k in the year on top of the consultant’s salary. The research suggests that up to half of consultants may have received higher overtime payments. It was suggested that rising demand and a shortage of consultants was causing the increased use of overtime payments.
An hour’s brisk exercise a day could offset the effect of being sedentary on premature mortality, according to research re-analysing the data from 16 previous studies covering more than a million people, published in the Lancet. People who sat for eight hours a day but were physically active had a lower risk of early death than those sitting for fewer hours but being inactive. Watching t.v. was found to be more harmful than sitting at a desk, possibly because of other habits associated with it such as snacking. Inactivity is said to be responsible for 90,000 deaths a year, one in six, and to cost the UK economy £1.7bn a year.
(28/07/16) (Rgn) http://www.nursingtimes.net/7009607.article
The number of GP training places taken up has increased by 7% compared to the same point last year, in England, with 83% of training posts filled so far. According to Health Education England, 2,691 out of 3,250 training places have been filled after two rounds of recruitment. Some areas were struggling more than others with 40% of places unfilled in the North East Region. HEE has a target to train 3,250 a year by August of this year.
Aerobic capacity was the second biggest predictor of premature mortality in middle aged men after smoking, according to research on a representative sample of 656 Swedish men, recruited at the age of 50 in 1963, who did a test to measure VO2 max in 1967 and were then followed until 2012. When aerobic capacity was split into three equal groups, the increase between each group was associated with a 21% lower risk of death over 45 years.
Recovery rates for psychological therapies have reached their highest level ever, at 49% for April and 48.2% in the fourth quarter, against a target of 50%, according to figures from NHS England. In April, 85% of people started treatment within six weeks of referral, against a target of 75%. The target of 15% of people with anxiety and depression having access to services was met with a figure of 16.8% in the fourth quarter.
People in more affluent countries are more likely to suffer post-traumatic stress disorder than those in poorer countries, according to researchers from the Netherlands, Australia and London. The research was based on representative samples of the population in 24 countries, with interviews with a total of 86,687 people, to establish the levels of PTSD. It was published in the Journal of Psychiatry. Contrary to expectations, countries with greater cultural and socioeconomic vulnerability to adversity were found to have a decreased rather than increased risk of PTSD.
26 July 2016
Unaccompanied migrant children are being failed by the UK and other European countries, in their responsibility to look after them, according to a report from a House of Lords committee. This has led to thousands of them living in squalid conditions and being preyed on by traffickers and people smugglers, it says. In 2015, 3,045 unaccompanied children applied for asylum in the U.K. At least 137 children have drowned in the Mediterranean since the start of the year. The Home Office said that 20 children had been accepted for transfer to the U.K. since an Act committing to this received Royal Assent (the Immigration Act received Royal Assent on 12th May).
(27/07/16) Alf Dubs’ dismay at the delay: https://www.theguardian.com/world/2016/jul/27/peer-condemns-shocking-delays-over-help-for-unaccompanied-child-refugees
Patients monitoring their diabetes at home fared better than those seen only by their GP, in research which followed 391 people with type 2 diabetes for nine months. Half the group visited the doctor as necessary, and at least once a year. The other half sent in measures of blood glucose, blood pressure and weight to their GP practice electronically, with doctors and nurses then deciding which patients needed further help, treatment and advice. The telemonitoring group was found to have better control of their diabetes and blood pressure. The research was published in PLoS Medicine.
Alzheimer’s is more likely to be undiagnosed in men than women because it tends to display different symptoms, problems with speech and movement rather than memory, according to research based on post-mortems on the brains of 1,600 people with Alzheimer’s, reported to the Alzheimer’s Association International Conference. Men also seemed to be affected at an earlier age, in their 60’s, rather than in their 70’s for women.
A report on public service failure and turnaround has been published by the Institute for Government, looking at an example from each of four sectors: hospitals, local authorities, children’s services and schools. Lessons include avoiding the immediate temptation to blame and restructure.
A report on preventing mental ill health through local action has been published by the Mental Health Foundation, produced with and commissioned by Public Health England. It helped shape PHE’s input into the Five Year Forward View for Mental Health. The report advocates a whole population approach, to involve schools, employers, public services and others. It considers approaches for improving mental health literacy, reducing stigma and discrimination and developing mentally healthy communities. It then goes on to consider what can be done at different stages of the life course.
25 July 2016
Only 20% of patients with suspected inflammatory arthritis are seen within the target three days, according to an audit of 5,000 patients in England and Wales by the British Society for Rheumatology. About one million people suffer from inflammatory arthritis in the U.K. Fewer than half of patients saw a specialist within NICE’s target of three weeks.
Behavioural Activation Therapy was found to be as effective but cheaper and quicker than cognitive behavioural therapy for treatment of depression, in a randomised controlled trial of 440 people, split into two groups, one each receiving either treatment. A year after treatment started, two thirds of participants in both groups had a 50% reduction in depressive symptoms and had a similar number of depression-free days. The research was funded by the National Institute for Health Research and published in the Lancet.
24 July 2016
Dr Kate Granger has died. Dr Granger, a consultant geriatrician, was diagnosed with incurable cancer in 2011 at the age of 29. On the basis of her experience as a patient, and the importance of the doctor’s personal approach, she started the hellomynameis campaign, to encourage doctors to introduce themselves, which has spread widely. With her husband, she has raised £250,000 for cancer. The Kate Granger Compassionate Care Awards were started in her name and will be presented for the third time this September.
(25/07/16) (Rgn) http://www.nursingtimes.net/7009502.article
22 July 2016
Jeremy Hunt has been criticised for only submitting his department’s accounts on the day Parliament rose for the summer recess, in a letter from the chair of the Public Accounts Committee, Meg Hillier. The letter expressed dismay at the delay in publishing the departmental expenses and said it “smacks of an underhand attempt to cover up the poor state of finances in your department.” The department only stayed within its £118.3bn budget by some last minute changes including using £950m of capital as revenue and receiving 417m more than planned from national insurance receipts because of an ‘administrative error’.
NAO report on health financial accounts: https://www.nao.org.uk/press-release/reports-on-department-of-health-nhs-england-and-nhs-foundation-trusts-consolidated-accounts-2015-16/
NHS England should do more to reduce delayed discharges from hospitals, according to the public accounts committee which says it shows ‘a striking poverty of ambition’ in saying that it would not be possible to make progress in reducing delays because of adult social care being unable to meet demand. It says more needs to be done to understand the differences between areas and share good practice.
Jeremy Hunt has confirmed the Government’s commitment to ‘seven day’ NHS services, despite suggestions that there might have been a rowing back from the policy following the resignation of David Cameron, who had championed the policy.
Annual reports and accounts have been published for the Department of Health and other non-departmental public bodies such as NHS England, Public Health England and NICE.
Alcohol directly causes seven different types of cancer according to a review of recent epidemiological and biological research, from Otago University, New Zealand, published in the journal Addiction. The conclusion was based on epidemiological evidence. It is estimated that the seven sorts of alcohol attributable cancers make up 5.8% of all cancer deaths world-wide.
21 July 2016
A ‘reset’ of NHS finances will see trusts and CCGs in special measures and the ending of some fines for waiting times, NHS England, NHS Improvement and the CQC have announced. Five NHS trusts and nine CCGs are being put into special measures. Nationally set fines for missing waiting time and other targets are being replaced by measures related to the improvement of individual organisations. Trusts are to receive £1.8bn from a sustainability and transformation fund, to help bring their deficit down from £2.45bn last year to £250m this. However, there are concerns that attempts to save money could affect patient care and safety, with trusts facing financial penalties for ‘over-recruiting’ staff. It was also suggested that the problems are systemic rather than caused by poor management in individual organisations.
Attempts to cut staff will be met with stiff resistance: http://www.nursingtimes.net/7009482.article
The government does not have a coherent planning and management framework, which leads to poor value for money and a lack of long-term, joined-up thinking, the NAO has said on a report on progress with single departmental plans and another on the comprehensive spending review process. This is despite there having been some improvements.
Bursaries for student nurses and midwives are to end in 2017, the Government has confirmed, following a consultation. The Government argues that replacing the bursaries with loans means the cap on the number of training places can be lifted. Two thirds of those applying for a university nursing course are currently not offered a place. The changes were criticised by representatives of nurses and midwives who were concerned that the prospect of large debts could people off applying for training.
Twenty six CCGs have been rated ‘inadequate’, with nine placed into special measures by NHS England. Of the others, 91 scored ‘requires improvement’, 82 were ‘good’ and 10 were ‘outstanding’.
Everyone should consider taking vitamin D supplements in autumn and winter in order to obtain the recommended 10 micrograms a day, Public Health England is recommending after a review of the latest evidence. It is hard to obtain enough of the vitamin through diet alone and the sun is not strong enough in the UK in autumn and winter to help the body produce it. Vitamin D helps regulate the amount of calcium and phosphate in the body which are important for healthy bones, teeth and muscles. About 450 children are admitted to hospital each year with rickets.
Press release: https://www.gov.uk/government/news/phe-publishes-new-advice-on-vitamin-d
Report from the Scientific Advisory Committee on Nutrition: https://www.gov.uk/government/publications/sacn-vitamin-d-and-health-report
A new legal duty to report suspected child abuse could apply to support staff as well as professionals a government consultation proposes. It was expected it would apply to professionals such as doctors, teachers and police officers, but it could also apply to managers, administrative staff, caretakers, dinner ladies and others.
Chronic Fatigue Syndrome, or ME, has physical markers, rather than being ‘all in the mind’, according to research from Cornell University which was able to accurately identify 83% of sufferers purely through stool and blood samples. Those with the disease had a lower diversity of bacteria in the gut and fewer species which are anti-inflammatory. There were indications of inflammation in the blood suggesting that bacteria had entered the blood stream causing an immune response making the symptoms worse. The study was published in the journal Microbiome.
Harold Bodmer, the President of ADASS has died suddenly. He was 61. He took on the year-long position of President of the Association of Directors of Adult Social Services in April.
5,700 cases of female genital mutilation were recorded for the first time in 2015-16 according to the first such annual statistics, published by the HSCIC. In only 18 of the cases, the FGM was performed in the UK. In 43 cases the women or girls were born in the UK, while in 37% of cases where the country of origin was known, they were from Somalia. (These are all cases where the FGM was recorded for the first time, rather than that the FGM occurred in this year or even that this was the first attendance relating to it).
(27/07/16) Letter on the risks of misinterpreting the statistics: https://www.theguardian.com/society/2016/jul/27/caution-needed-with-fgm-statistics
(31/07/16) Further letter on problems with the data: https://www.theguardian.com/society/2016/jul/31/we-need-better-data-on-fgm-not-propaganda
A team of NHS consultants involved in outsourcing and other major projects is to be closed down, NHS England has said. The Strategic Projects Team is part of the Arden and Greater East Midlands Commissioning Support Unit. It has been involved with the Hinchingbrook Hospital franchise, the UnitingCare contract for older people’s services in Cambridgeshire, both of which subsequently collapsed, and a number of other projects that were then dropped.
Energy drinks should be banned for sale to under 16s because of their high sugar and caffeine content and links to health problems such as headaches, stomach aches and sleep difficulty according to a research from the Food Research Collaboration, an initiative of City University. The report was writen by researchers from Durham University and Action on Sugar.
The BMA has passed a vote of no confidence in Capita in relation to its provision of support services to GPs after a series of problems. Capita are creating a more standardised system from the existing local systems.
A report on inequality among LGBT groups has been published by the Government Equalities Office. The report (164pp) was produced by the National Institute for Economic and Social Research. It systematically reviews published and unpublished literature from 2008 onwards.
20 July 2016
Patients who do not have contact with a GP for five years could be deregistered if they do not respond to two letters asking them to confirm their details, in an extension of ‘list cleansing’ begun by NHS England in some areas from 2013. Pulse magazine has seen a contract with Capita under which it will request a list from GPs in the eleventh month of every contract year of all patients not seen for five years, and write the letters. GPs will then have six months to confirm the existence of those who have not responded. The aim is to save money as GPs are paid a capitation fee of on average £136 for each registered patient. Doctors’ leaders criticised the proposal because of the extra work for GPs, inconvenience to patients and the risk that some patients would unfairly be deregistered.
A Scottish child poverty bill is to be introduced allowing the Scottish Government to reintroduce statutory child poverty targets that were abolished by the Westminster Government earlier this year, Nicola Sturgeon has announced. A consultation setting out proposals for a bill is to be published in the summer. The UK government’s Welfare Reform and Work Act 2016 repealed elements of the Child Poverty Act 2010, including the target of ending child poverty by 2020 and the requirement to produce child poverty strategies and report on them annually.
The rollout of universal credit is to be delayed by another year until 2022, five years behind the original target date for completion, officials have said. Speaking to the Public Accounts Committee they said this was not a delay but simply recognised the increased scope of the programme as the government desired to do more with welfare reform. The delay will benefit several million families currently receiving working tax credits who will be worse off when they move to universal credit as a result of cuts made last year by George Osborne.
Mini strokes could have more longer lasting effects than previously realised, with 45% of those who had suffered one having lasting cognitive impairment, 43% complaining of fatigue and 26% having a psychological problem such as anxiety or depression, according to research from the University of Birmingham involving 9,500 people who had had a mini-stroke, or transient ischemic attack, and a control group of 46,500 people. The research was published in the European Journal of Neurology.
Jamie Oliver’s eight week food courses improved people’s eating habits, with the number of fruit and vegetable portions eaten increasing from 2.7 daily before the programme to 4.1 six months later, and snacks consumed from 1.7 to 1.1. The research, undertaken by Leeds University, surveyed 800 participants of Ministry of Food courses in Leeds between 2010 and 2014, with 500 surveyed after six months, and was published in the journal Public Health Nutrition.
19 July 2016
A mental health strategy implementation plan has been published by NHS England. ‘Implementing the Five Year Forward View for Mental Health’ sets out how new funding, which has already been promised, will be made available to CCGs. Funding will go on: integrating IAPT (Improving Access to Psychological Therapies) with physical health; six pilot sites to develop new approaches to secure and children’s mental health; improvement of perinatal mental health services; and a roll-out of Liaison and Diversion services for people involved in the criminal justice system.
The Government has not fulfilled its claim to be funding the Five Year Forward View, the House of Commons health select committee has said. Rather than giving health an extra £8.4bn a year by 2020, that figure only applies to NHS England, whereas the complete health budget, including such things as education, public health and other DH funding, will only rise by £4.5bn. That bigger budget has been the normally accepted definition of NHS spending up until now. Taking money out of those other areas will make it harder to achieve the ambitions of the Five Year Forward View. A proportion of the extra money will also have to go towards paying off existing deficits. The committee also says that measures such as holding down pay and capping agency staff are not sustainable ways of finding the £22bn savings required. Seven day services could only be funded by cuts elsewhere. [N.B. this discrepancy was noted in a briefing from 17/12/15 by the King’s Fund, Nuffield Trust and Health Foundation]
Larger scale general practice reduces patient satisfaction, makes no difference to quality of services but does help struggling GP practices to cope better through increased operational efficiency, according to a study by the Nuffield Trust in collaboration with the Royal College of GPs, ‘Is Bigger Better? Lessons for Large Scale General Practice’. The report looked at two national surveys and three in-depth case studies and was informed by a literature review. While larger practices and federations improved patient access, patients valued having a relationship with their own doctor and smaller practice team. It concludes that policy makers should be realistic about the pace at which large-scale organisations can contribute to service transformation. Three quarters of practices are now working collaboratively.
Press release: http://www.nuffieldtrust.org.uk/media-centre/press-releases/new-large-scale-gp-organisations-are-helping-practices-cope-little-sign-
Benefit related issues were responsible for 41% of foodbank referrals in a two year period, according to an analysis by Oxford and Chester universities of records from the West Cheshire Foodbank, part of the Trussell Trust Foodbank Network. Delays in benefit payments accounted for 20% of referrals, benefit changes (e.g. moving from ESA to JSA) for 14% and sanctions for 8%. One in five people affected by benefit sanctions were children.
Amanda Spielman has been confirmed as the next Chief Inspector of Ofsted, the Department for Education has announced.
An NHS programme to train vulnerable people in digital skills helped with their health, with over half feeling more confident to manage their health, 21% making fewer visits to their GP and 6% making fewer visits to A&E. The Widening Digital Participation programme was run by NHS England and the Tinder Foundation.
A briefing on lessons from the government’s ‘responsibility deal’ has been published by Sustain (‘the alliance for better food and farming’). It says that key lessons for the government are: not to delay implementing measures on marketing and promotions; not to let industry set the terms of its commitments; to use mandatory measures and penalties for inaction; not to rely on voluntary self-regulation; and not to offer any last chances for industry to self-regulate.
Prepackaged baby food was found to be more healthy in some respects than recipe books for home cooking according to research from Aberdeen and Warwick universities published in BMJ Archives of Disease in Childhood. They compared the nutrient content, price and food group variety of 278 baby meals from supermarkets with 408 recipes for home cooked meals from 55 cookbooks designed for babies and toddlers. The home-cook recipes had almost treble the level of saturated fats, double the protein, higher levels of salt and 26% more calories than the ready meals. However the home-cook recipes were much cheaper and had a greater variety of nutrients. There does not appear to be any evidence of how closely the recipes correlate with what is being cooked at home in practice.
More than half of assualts on NHS staff are by over 75 year olds according to figures from NHS Protect. People over 75 make up about 24% of patients being treated but are responsible for 57% of assaults. It is thought the likely reason is dementia and the stress and confusion of a hospital stay.
Advice on ‘Getting Every Adult Active Every Day’ has been published by Public Health England. It includes the suggestion that GPs should be physical activity role models.
The guidance (web page): https://www.gov.uk/government/publications/health-matters-getting-every-adult-active-every-day/health-matters-getting-every-adult-active-every-day
A mapping of STP areas against LEPs and combined authorities has been produced by the NHS Confederation. The 44 Sustainability and Transformation Plan areas do not directly map against the Local Enterprise Partnership areas or combined authority areas. [Or, I think, NHS England local area team areas and other sub-regional groupings. Maybe it could be the basis for a new jigsaw puzzle – in shops in time for Christmas.]
18 July 2016
Three junior health ministers have been appointed, Philip Dunne, the most senior of the three as Minister of State for Health, Nicola Blackwood as Parliamentary Under Secretary of State for public health and innovation and David Mowatt as Parliamentary Under Secretary of State for community health and care.
Simon Stevens has set out a ‘radical blueprint’ for the NHS to survive ‘life after Brexit’ in an article in the Daily Telegraph. He said change was needed in four areas: (1) prevention and particularly obesity; (2) more funding for GPs and mental health; (3) improving the NHS’s infrastructure through more capital spending funded by borrowing while interest rates are low; (4) training and looking after staff, including providing reassurance to international NHS employees of their continued welcome; and (5) dealing with financial problems through efficiency and creative solutions, including for social care.
Investing more in GP services would pay for itself, with a 10% increase in core funding likely to be virtually offset by reduced A&E attendances, with further savings from outpatient referrals and a 2% increase in patient satisfaction, according to a study from King’s College, London.
A seven day NHS is unlikely to be achievable for another 20 years because of a lack of funding and staffing, according to Prof Julian Bion who is leading an NHS-funded research project into introducing weekend services. He said that the additional £10bn p.a. for the health service promised by the Government would not be enough to fulfil the Conservative manifesto promise of seven day working.
Cuts to Public Health could hamper efforts to tackle obesity, the LGA has said. Funding for public health is due to fall from £3.38bn in 2016-17 to £3.13bn in 2020-21. Spending on obesity, which had risen in previous years, is to fall from £140m in 2015-16 to £127m in 2016-17.
Today’s young people may earn less than the previous generation according to a report by the Resolution Foundation. Those aged 15-35 earned £8,000 less in their 20s than the previous generation. The 2008-9 recession was only partly to blame, with wages having been squeezed even before that.
A Dutch nurse-led model of community nursing is to be piloted in the UK, according to Nursing Times. The Buurtzorg, or ‘neighbourhood care’, model has a maximum of 12 district nurses who share management functions but still have at least 60% of time spent with patients. The model was designed in 2006 and the Netherlands now has 850 teams with 10,000 nurses. Research suggests the model leads to improved outcomes and patient satisfaction and that it costs 30% less than conventional, hierarchical care systems. The model is due to be piloted at Guys and St Thomas’ and in West Suffolk later this year.
(12/07/16) Video of talk given at the King’s Fund about the model: http://www.kingsfund.org.uk/audio-video/jos-de-blok-buurtzorg-could-it-work-in-england
Vulnerable children risk being retraumatised because services focus on their challenging behaviour rather than its underlying causes, according to a report from YoungMinds, ‘Beyond Adversity’.
17 July 2016
NHS Trusts had to borrow £3.36bn from the Treasury last year to meet budget shortfalls, made up of £2,825m for revenue and £530m for capital according to figures collected by the House of Commons library for Liberal Democrat health spokesman Norman Lamb. The money went to 109 of the 156 acute trusts and one mental health trust.
16 July 2016
Sugar was a smaller proportion of the diets of overweight and obese people than those with a BMI in the ‘normal’ range according to analysis led from Glasgow University analysing the diets of 132,479 people involved in the Biobank research project and published in the International Journal of Epidemiology. Sugar accounted for 22% of the energy intake of those who were overweight or obese, but 23.4% of those of normal weight. However, those weighing more consumed 14% more fat.
15 July 2016
The disproportionate growth in spending on specialised services threatens the financial sustainability of the NHS according to a report from the Public Accounts Committee. Between 2013-4 and 2015-16 the budget for specialised services rose from £13bn to £14.6bn, an average annual increase of 6.3% while the overall NHS budget rose by 3.5% a year. It says that NHS England should take action to ensure drugs and medical equipment are affordable, that services are cost-effective and that demand for the services is better managed. There are 146 specialist services, usually for people with rare conditions.
The Government’s child obesity strategy could be delayed until the autumn it is reported. It is also said that the latest drafts of the strategy circulating in Whitehall have watered down previous commitments. Firms were initially to be given six months to produce plans saying how they would reduce sugar content by 20% in five years but in the latest draft were being merely challenged to reduce sugar levels. The delay was later confirmed by the Government. The BMA called the delay ‘completely unacceptable’.
31% of women with secondary breast cancer felt their concerns were not adequately listened to, either before or after diagnosis, according to a report from Breast Cancer Care based on a survey of 841 women. 49% said they were not told to bring a friend or loved one to the appointment when they were told they had incurable cancer although 80% were advised to do so with other forms of cancer. A fifth of those surveyed did not see a hospital doctor for at least eight weeks after they first approached their GP with a problem. Secondary stage breast cancer (when it has spread to other parts of the body) kills about 11,600 people a year.
A report on the impact of health and social care structural changes on public health has been published by PRUComm. This is the fifth report of the PHOENIX project which started in 2013.
Stress and trauma are not causes of breast cancer according to research from the Institute of Cancer Research looking at over 100,000 women in research that started in 2003.
The new chief executive of the GMC is to be Charley Massey, a director general at the Department of Health. He replaces Niall Dickson who is to step down at the end of 2016.
14 July 2016
Jeremy Hunt remains as health secretary, one of only four Cabinet ministers to retain their role, in the new prime minister, Theresa May’s government. Justine Greening replaced Nicky Morgan as Secretary of State for Education. Savid Javid moved from Business to Communities and Local Government. Damian Green becomes the Work and Pensions secretary. The Department for Energy and Climate Change has been scrapped.
The latest NHS England monthly performance figures have been published showing that responses to the most serious, Red 1, ambulance calls have not met the 75% target for the 12th month in a row. The figure for May for Red 1 calls was 70.5%. Six out of eight cancer targets were met but the target of 85% of cancer sufferers treated within 62 days was missed, at 81.4%: the target has only been met once since January 2015. The number of delayed discharges reached a record number for the third month running. The target of 95% of A&E patients treated within four hours was also missed.
Being overweight or obese puts men at a greater risk of dying early than women according to a study by a global consortium of researchers, pooling data from 189 studies involving almost 4m people published in the Lancet. It excluded people who smoked or had a serious illness who might therefore have reduced weight because of that. It found that for men the risk of death before the age of 70 was 29% for an obese man but 19% for a man of normal weight. For women the respective figures were 15% and 11%. On average, overweight people lose one year of life expectancy and moderately obese people lose three years. They said that obesity is second only to smoking as a cause of premature deaths.
The collapse of the Cambridgeshire £726m contract with UnitingCare should have been foreseen according to an evaluation by the National Audit Office. The contract collapsed after only eight months. The two NHS trusts behind UnitingCare said the report was balanced. The NAO says that the new contract was rushed through without properly testing the cost assumptions. One problem was that, set up as a limited liability partnership, the new entitty was subject to VAT, which the trusts had not been, and this cost was not taken into account. The contract was supposed to have saved the local health economy £178m by 2020. The wasted costs of contract set-up and bidder costs was estimated to be £8.9m.
Poor health and poverty is costing Wales billions of pounds a year, according to a report from Public Health Wales, “Making a Difference: Investing in Sustainable Health and Well-being for the People of Wales.” It sets out ten key areas for action to improve health and wellbeing and save money.
Press release: http://www.wales.nhs.uk/news/42095
The report: http://www.wales.nhs.uk/sitesplus/888/page/87106
A campaign encouraging people suffering breathlessness to seek help has been launched by Public Health England. Aimed mainly at those aged 50 and over, it says that those with a persistent cough or who get out of breath doing things they used to be able to do, should see a doctor to check for the risk of lung conditions, including cancer, or heart disease. It is estimated that 1.7m people have one of a number of undiagnosed illnesses.
13 July 2016
Adult social care services are facing cuts this year as the £382m raised from the new 2% council tax precept is outweighed by additional costs such as the new national living wage and increasing numbers of older people, leading to a shortfall of £940m, according to a survey of directors of adult social services. The overall social care budget rose by 1.2% last year from £13.65bn to £13.82bn but there was variation between councils with 70 of 151 reporting a fall. However since 2011 it has fallen by £4.6bn, or 31%. It is estimated that 39% of the £940m shortfall will be met by cuts to services, with the rest met by rationing, increased charges and other means. Only 31% of directors were confident they could make the required savings and still meet their statutory duties.
Press release: https://www.adass.org.uk/council-tax-precept-fails-to-close-adult-social-care-funding-gap/
The Government’s plans for reform of children’s social care have been criticised by the Education Select Committee which says it should scrap its plans for setting up a new social work regulator set out in the Children and Social Work Bill. It says that social work is being pulled in different directions by the DfE and DH. It attacked structural reforms and said improvements were more likely to come from such things as reducing social worker caseloads and stopping experienced professionals leaving the service. Ministers have argued that improvements will come from taking services out of local authority control. The committee said that the negative rhetoric about social workers from government was contributing to high stress and low morale.
Suspected sepsis should be treated as an emergency in the same way as heart attacks, NICE has said. There are about 150,000 cases of sepsis each year and 44,000 deaths of which it is estimated between 5,000 and 13,000 could be avoided. The symptoms can be vague, making it hard to diagnose.
Some NHS trusts may need to reduce staffing to meet financial targets the Chief Executive of NHS Improvement, Jim Mackey has suggested in an interview with the Health Service Journal. That could include telling those trusts that exceed one nurse per eight patients that it cannot be afforded. He is also reported to have said that if demand rises by 2% it doesn’t mean that costs need to go up. The comments were subsequently criticised from a number of quarters.
The rate paid by CCGs to nursing homes for nursing care is to be increased by 40% from £112 to £156.25 per patient per week, the Department of Health has announced. The new rate will be backdated to 1st April. This is an interim rate, pending review, with a new rate from January 2017 and a possible regional variation from April 2017.
The treatment of ovarian cancer in specialist regional centres could improve survival rates from two to three years, compared to care in general hospitals, according to research led from Manchester University comparing data from patients treated in three international cancer studies and at three UK centres compared with UK averages, published in the journal Clinical Oncology. It is not clear which of any of a range of possible factors explains the better performance. If Britain matched the best in Europe, almost 2,400 deaths within five years could be avoided. Ovarian cancer currently causes over 4,000 deaths a year in the UK.
The Meningitis B vaccine is not to be offered to older children up to the age of 11, on the grounds that it would not be cost effective, the Joint Committee on Vaccination and Immunisation has said. It also said there will not be a ‘catch up’ programme for one to two year olds who missed the jab because of lack of available stocks.
Deaths from asthma reached their highest level since 2003 last year at 1,302 people in England and Wales according to figures from ONS. The figures were 17% higher than 2014. Women accounted for 938 of the deaths, with the 811 of those over 65 making up 62% of the total.
Early intervention schemes working with parents and young children have had mixed success according to a review of 75 schemes by the Early Intervention Foundation. The Family Nurse Partnership was one of 17 programmes judged likely to be effective if commissioned carefully. The Parents and First Teachers scheme was one of 18 found to have promising early findings. Five schemes were found to have had no effect, although such schemes could be adapted and improved to have an effect in future.
Just under 6% of people newly diagnosed with diabetes attended an education course in 2014-15 although they can provide the skills to manage the condition, according to Diabetes UK’s annual State of the Nation report. The report says that 41% of people with Type 2 diabetes and 19% of those with Type 1, are meeting their targets for blood pressure, blood glucose and cholesterol. About a third of CCGs do not commission diabetes courses, although they are meant to do so. There are about 3.5 million people in Britain with diabetes, of which about 90% are Type 2.
A greater proportion of women over 40 had babies than those under 20, last year according to figures from the ONS, the first time that has been the case since 1947. The number of live births per 1,000 women over 40 was 15.2, compared to 14.5 per 1,000 women in their 20s. The average age of having a child is now 30.3. The highest fertility rate is for women aged 30-24, where it is 111 per 1,000 women. The Royal College of Midwives said that with nearly 3,000 more births, workforce numbers are not keeping up with the rising birth rate. The increase in the number of live births was 0.4% above 2014, but the fertility rate fell slightly from 1.83 to 1.82 children per woman.
An NHS trust has partnered with libraries in Staffordshire, helping to keep them open. Volunteers are now being used to staff libraries. The trust has a five year contract with the council under which it receives no payment for running the eight libraries but keeps income from charges and provides two people to work on the project. It sees it as a way to support people’s mental wellbeing.
Feature article: https://www.theguardian.com/healthcare-network/2016/jul/13/nhs-libraries-wellbeing-health-promotion-community
12 July 2016
The UK is poorly prepared for the impacts of global warming in the coming decades according to a report by the Committee on Climate Change (CCC). The Government is required by law to use the CCC report to develop its adaptation plan. The 2,000 page report was prepared over three years by 80 experts. The main analysis is based on what will happen even if the 2015 Paris agreement is fully delivered. It says that what we now think of as extremely hot summers will be typical by mid-century with hospitals and care homes struggling to cope. Amongst other risks are water shortages, difficulties producing food, flooding, new diseases and international unrest.
The Government’s vision for adult social work has been published by the Department of Health (7pp).
Integration of health and social care services for older people is generally poor despite some good examples, according to a report from the Care Quality Commission, ‘Building Bridges, Breaking Barriers’. It says that despite widespread commitment substantial progress is needed. Problems included: a lack of culture supporitng collaboration; difficulties in identifying older people at risk; short term initiatives; poor monitoring and evaluation of integrated care; a lack of connection resulting in older people and their carers having to navigate complex local services themselves and falling through the gaps. It says that the GP enhanced service for avoiding unplanned admissions has not been effective.
Press release: http://www.cqc.org.uk/content/older-people-denied-personalised-effective-and-responsive-care-due-poor-integration-across
Sex education is inadequate or missing in many schools according to an online survey of 914 young people aged 16-24, by the Terrence Higgins Trust. It found that half rated the sex and relationship education (SRE) as ‘poor’ or ‘terrible’, 95% were not taught about LGBT relationships, 75% were not taught about consent, 97% had no discussion about gender identity, and nearly 60% didn’t receive, or didn’t remember receiving any information about HIV. It was suggested that this was causing a safeguarding crisis for young people. The Government, in February, refused to make SRE compulsory.
Doctors and nurses should listen to parents if they think their child is deteriorating rapidly, even if tests show no cause for concern, according to a Patient Safety Alert issued by NHS Improvement. It says that in 2015, about 7% of patient safety incidents reported to the National Reporting and Learning System as death or severe harm were relating to not recognising or acting on deterioration. Resources are provided both for the care of adults and children. NHS Improvement said that parents are sometimes worried about wasting doctors’ time or that they won’t be listened to, but children can deteriorate rapidly and it is important parents feel listened to.
Regulation of social work should not be under direct government control, as proposed in the Children and Social Work Bill, the Association of Directors of Children’s Social Services has said.
A 1% increase in alcohol duty could reduce A&E visits due to violent injury by 6,000 a year according to research from Cardiff University based on data for adult visits to 100 A&E departments between 2005 and 2012. They suggest this would be more effective than minimum pricing. Lower alcohol prices were associated with more A&E attendances even allowing for poverty, differences in household income, spending power and time of year. There was a stronger link with poverty and inequality: a 1% reduction in poverty and a slight fall in income inequality would reduce the number of visits for violence-induced visits by 18,000 a year.
DH officials are not exploring options for new health charges, they have told the House of Lords Committee on the Long-term Sustainability of the NHS.
A report, “Clinical Commissioning: GPs in Charge?” has been published by the King’s Fund and the Nufield Trust. It is based on the experience of six CCGs that have been following since they were first set up. It says that relationships between CCGs and GP member practices are fragile with the latter feeling unable to influence CCG decision making. Only 20% of GPs without a formal commissioning role felt they could influence their CCG, a fall from 35% in 2014. It finds that CCGs have achieved better GP engagement than previous forms of commissioning. It says that clinicians should continue to be at the heart of planning decisions and they need developmental support to enable them to do the job properly.
Press release: http://www.kingsfund.org.uk/press/press-releases/cornerstone-nhs-reforms-faces-uncertain-future
The report: http://www.kingsfund.org.uk/publications/clinical-commissioning
11 July 2016
There will have to be staff cuts if the NHS is to balance its books, along with lengthier waiting times, the King’s Fund has warned. They said that it is not credible to say that the NHS can meet the increased demand for services, deliver the current standards of care and stay within its budget.
Press release: http://www.kingsfund.org.uk/press/press-releases/politicians-must-be-honest-about-nhs
The report: http://www.kingsfund.org.uk/publications/deficits-nhs-2016
The Royal College of GPs has appointed 29 ‘ambassadors’ to help ensure the GP Forward View proposals are implemented, it has announced. They will represent GPs on the newly established Sustainability and Transformation Boards.
Progress on tackling FGM could be threatened by lack of funding for local initiatives, according to a report by the Tackling FGM initiative, which was set up by five charitable trusts. The initiative has given £2.8m over six years to community-based prevention schemes. It said that local authorities, CCGs and Health and Wellbeing Boards all had a part to play in funding.
Taking multivitamin and mineral supplements in pregnancy is not necessary for most women, as they do not improve the mother or baby’s health, according to a review of the evidence published in the Drugs and Therapeutics Bulletin (apparently not a ‘systematic review’). However it does confirm the existing advice to take folic acid and vitamin D supplements. The research was rejected by the Health Supplements Information Service.
Happiness increased for each extra portion of fruit and veg eaten per day according to research from the University of Warwick and the University of Queensland, analysing the diaries of 12,385 adult Australians in 2007, 2009 and 2013. The wellbeing effects were found to occur within two years. The research is due to be published in the American Journal of Public Health.
10 July 2016
The number of people wanting to change gender has risen largely in recent years, leading to long waiting lists, with concerns about the mental health of those affected, according to figures obtained through the freedom of information Act by the Guardian. Figures obtained from the UK’s 14 gender identity clinics show a number experienced increases in referrals of several hundred per cent. There are just over 15,000 gender identity patients but it is estimated that there could be 130,000 or more experiencing gender incongruence.
Palliative care for children varies a good deal across the country according to charity Together for Short Lives, based on responses to foi requests. They have produced an interactive map, including ratings, for all those CCGs and local authorities in England that responded. They say that 81% of local authorities are failing to plan and fund care for children with life threatening conditions. However 93% of CCGs commission children’s palliative care.
(11/07/16) (Rgn) http://www.nursingtimes.net/7006326.article
Press release: http://www.togetherforshortlives.org.uk/news/9592_seriously_ill_children_face_a_postcode_lottery
Interactive maps: http://www.togetherforshortlives.org.uk/about/our_policy_work/9591_map_data
The introduction of the levy on sugary drinks should be delayed, the Food and Drink Federation has said, in the face of the vote to leave the EU, with weak consumer confidence, increased costs and staff shortages. The comments were made by its Director General, Ian Wright, speaking at the FDF conference.
08 July 2016
Specialist surgery for congenital heart disease is to be focussed in a fewer number of centres with services ceasing in 3 out of 13 areas, Central Manchester, Leicester and the Royal Brompton, NHS England has proposed, subject to consultation. Both Leicester and the Royal Brompton have resisted moves for their closure before and there are indications they may do so again. It is also planned to move non-surgical cardiology services elsewhere from five hospitals: Blackpool, South Manchester, Papworth, Nottingham and Imperial. Overall 8 out of 22 units are to be closed. The closures are expected to be complete by 2021.
Health services should do more for children at risk of harm, the CQC has said in a report, ‘Not Seen, Not Heard’, based on 50 inspections over the last two years, as well as focus groups with inspectors and children themselves. It says that there have been improvements in assessing risks but that health services are not consistently protecting and promoting the health and welfare of children. It calls for more to be done by, amongst others, hospitals, health visitors, GPs and commissioners. Of responses from young people, 43 of 69 (62%) said their voice was not heard or they did not feel involved in their care.
An association between taking statins and a reduced risk of death from cancer has been found by researchers from Aston University who analysed data on 22,677 cancer sufferers between 2000-13. It found an association between taking statins and a 47% reduced risk of death from prostate cancer, 43% from breast cancer, 30% from bowel cancer and 22% from lung cancer. The research was reported to the European Society of Cardiology Conference.
Manmade climate change increased the risk of death by 20% in London in 2003, and was responsible for 64 of 315 deaths according to modelling using climate model simulations and a health impact assessment, published in the journal Environmental Research Letters.
A report, ‘Staffing matters; funding counts’ has been published by the Health Foundation, arguing that there has been a ‘boom and bust’ approach to staffing and that short term measures such as recruitment from abroad just put a sticking plaster on deep-seated, systemic problems. It says there should not be an over-emphasis on new roles, such as physician associates and nursing associates to fill workforce gaps.
A citizens’ jury on antibiotic resistance has been held in Cardiff looking at what can be done in Wales to combat the problem. A panel of 14 members of the public have been hearing evidence on the issue and have made recommendations.
07 July 2016
A strategy on young people leaving care has been published by a cross-government group of departments, including DfE, the Cabinet Office, DCLG, DWP and the Department of Health. It sets out how young people will be supported to achieve five outcomes: being supported to live independently; having improved access to education, training and emplooyment; experiencing stability and feeling safe and secure; improved access to health support; and financial stability.
There has been virtually no improvement in happiness, anxiety and feeling that things are worthwhile in the last year, although there was a slight increase in life satisfaction, according to the latest wellbeing statistics from ONS. It is the first time since the surveys started in 2011 that wellbeing has plateaued. Men have now almost caught up with women in levels of happiness but women on average suffer more anxiety.
The shortage of nurses is likely to last for some years and could get worse, according to a report prepared for the Migration Advisory Committee by the Institute for Employment Studies, whose publication was put off during the EU referendum. The report contributed to the decision to allow visas to nurses from outside the EU for the next three years. The report found that a tenth of posts were vacant, a third of nurses are over the age of 50 and replacement nurses will not be available to fill the gaps given the 17% cut in nurse training places between 2009-13. That has meant that in the past year a quarter of new recruits have come from overseas.
A new national staffing framework for all NHS providers has been launched by the National Quality Board which is made up of a number of organisations, including NHS Improvement. It suggests that a new metric of staffing, the care hours per patient day (CHPPD), should be extended beyond hospital to other settings such as mental health and community provision. The measure has been criticised as being a ‘blunt instrument’. The new framework replaces guidance from 2013. It should allow more use of professional judgement in setting staffing levels.
Although employment is picking up, wage growth remains low, affecting living standards according to the OECD in its latest employment outlook across its 34 member countries, with UK workers amongst the worst affected. As well as low wage growth, a high level of labour market inequality and low quality jobs were affecting workers. They also found that 9% of jobs were at risk of being automated.
Press release: http://www.oecd.org/employment/job-market-recovering-but-wage-growth-remains-weak.htm
The report: http://www.oecd.org/employment/oecd-employment-outlook-19991266.htm
There is significant risk to hundreds of newborn babies because of a lack of clear guidance and inconsistent practice according to an investigation by the Care Quality Commission, prompted by brain damage caused to baby Elizabeth Dixon at Frimley Park Hospital in 2000 and her death a year later. Among its recommendations are for unborn babies to be given an identification number so that clinical information can be transferred from the mother’s to the baby’s records after birth. The investigation examined practice at 19 acute trusts and took evidence from commissioners and families. It found that where there were problems, multidisciplinary meetings did not always take place.
The Government is not going to privatise child protection or politicise social work, Edward Timpson, Minister for Children and Families has told the Association of Directors of Children’s Services’ conference. This was in response to concerns raised by a number of senior figures about the Children and Social Work Bill. He also used the speech to launch the new government strategy for care leavers.
Results of the GP Patient Survey 2016 have been published by NHS England, showing continuing levels of satisfaction, with 85% describing their overall experience of their GP surgery as good. Awareness of online booking being available increased by 4 percentage points to 31%. The proportion of patients who get to see their preferred GP has continued to decline, falling from 36.7% in July 2015 to 35.3%. Responses were obtained from over 800,000 people.
Recruitment for GP training is progressing much better than in previous years with almost nine out of ten places across the UK filled, according to Pulse Magazine. This time last year, one in five places was still unfilled. However some areas, such as the North East, still have problems.
A new national whistleblowing champion has been appointed by the CQC. The appointee, Henrietta Hughes, whose official title is National Guardian for Speaking up Freely and Safely, is a practising GP and medical director for NHS England’s North Central and East London area team. The first person appointed to the post, Dame Eileen Sills, resigned after less than two months. The role includes leading a network of local ‘freedom to speak up guardians’.
Children’s mental health needs more done by councils and the NHS by providing support to pregnant women, new mothers and children, the LGA says in a report, ‘Best Start in Life’. It said that councils should work closely with health partners to provide integrated services. The report highlights a number of initiatives different councils have taken.
Press release: http://www.local.gov.uk/web/guest/media-releases/-/journal_content/56/10180/7885952/NEWS
(20/05/16) The report: http://www.local.gov.uk/web/guest/publications/-/journal_content/56/10180/7833324/PUBLICATION
A report on how the number of delayed discharges varies between different hospitals has been published by the Centre for Health Economics at the University of York. It looks at how the number of delayed discharges varies by hospital type and the extent to which variations can be explained by demography, case mix, the availability of long term care and hospital governance. It finds that a greater availability of care home beds is associated with fewer delays but also that foundation trusts have fewer delayed discharges.
The implications of an ageing population for the UK are set out in a report from the Government Office for Science, which brings together information about today’s older population with trends and projections to investigate the challenges and opportunities and implications for policy.
A report on how social care providers can use technology to improve services has been published by the Voluntary Organisations Disability Group.
Three new technology and innovation appointments have been announced by NHS England. The role of chief information and technology officer has been split in two. The new Chief Clinical Information Officer is to be Professor Keith McNeil a transplant specialist who has held various senior healthcare management roles. The new Chief Information Officer is to be Will Smart, currently chief information officer at a London trust. A third appointment is Juliet Bauer as Director of Digital Experience at NHS England.
06 July 2016
The Government is to impose the revised junior doctors’ contract, despite it having been rejected in a ballot of BMA members. Imposition will start in October and is likely to be completed by autumn the following year.
Jeremy Hunt statement to Parliament: https://www.gov.uk/government/speeches/jeremy-hunt-updates-parliament-on-junior-doctors-contract
The care.data information sharing programme is to be scrapped the Government and NHS England have announced. The scheme, which was to enable the collection and sharing of GP and hospital patient information, was suspended in February 2014, just before it was due to go live, because of concerns about whether patients had been given sufficient information about the programme and worries about safeguards on use of the data. Two reviews were then commissioned by the Government, one from the CQC and the other from the national data guardian, Dame Fiona Caldicott, and as a result of that a consultation has now been launched on new data security standards for health and social care. They say that while the public should be told the benefits of data sharing, they should also know how the data may be used and must be able to opt out if they don’t want it shared. They also propose stronger sanctions for breaches of the rules. Work on sharing data will now be taken forward by the National Information Board.
Press release: https://www.gov.uk/government/news/new-safeguards-and-public-conversation-about-health-and-care-data-proposed
Written statement to Parliament: https://www.gov.uk/government/speeches/review-of-health-and-care-data-security-and-consent
Fiona Caldicott speech to the King’s Fund: https://www.gov.uk/government/speeches/rebuilding-public-trust-for-the-use-of-data
The consultation: https://www.gov.uk/government/consultations/new-data-security-standards-for-health-and-social-care
GPs have been pressured by nursery schools to prescribe antibiotics unnecessarily, according to research from the University of Birmingham, looking at nursery school policies on conjunctivitis, published in the British Journal of General Practice. It looked at the sickness policies of 164 nursery schools across the UK (identified via a Google search) and found that 142 (87%) had policies requiring children with conjunctivitis to be excluded (although that is not required by PHE guidelines). Of those, 81 (49%) said a child must be treated with antibiotics before being readmitted to nursery. A survey of 200 GPs and nurses found that 25% said the policies were the main reason they had prescribed antibiotics. There are about 25,000 registered nurseries in the UK.
(08/07/16) (Rgn) http://www.nursingtimes.net/7006225.article
Guidance on vaping in public places for employers and organisations has been published by Public Health England. It proposes five principles to help create a policy on use of e-cigarettes: 1. make clear the distinction between smoking and vaping; 2. Ensure policies are informed by evidence; 3. identify and manage the risks of uptake by children and young people; 4. support smokers to stop smoking; 5. support compliance with smokefree law policies.
Joint statement on developing a consensus on e-cigarettes from PHE and other organisations: https://www.gov.uk/government/publications/e-cigarettes-a-developing-public-health-consensus
There has been policy overload in relation to end of life care, with 76 different publications on the subject in England since 2004, according to a report, from Sheffield Hallam University, ‘State of the Nations’. They say that the amount of information makes it hard for commissioners and providers to understand and implement good practice.
A report on information sharing to protect vulnerable children and families has been produced by the Centre for Excellence for Information Sharing and published by the Department for Education. The report “shares findings and presents recommendations on how to overcome barriers to effective multi-agency working and information sharing.”
A series of essays on tackling the causes of pooor health and making health improvement an objective of all policy areas has been published by the Health Foundation and the All Party Parliamentary Health Group. The report, ‘A Healthier Life for All: the case for cross-government action’, identifies that most factors contributing to health lie outside the health care system, poor health has serious economic consequences and improving public health will reduce pressure on public services.
Press release: http://www.health.org.uk/news/cross-government-action-needed-improve-health-uk-according-all-party-parliamentary-health-group
The report: http://www.health.org.uk/publication/healthier-life-all
05 July 2016
Junior doctors have rejected the deal over a new contract negotiated between the Government and BMA by 58% to 42%, with a 68% turnout, prompting the junior doctors’ leader, Johann Malawana, to resign. The Government is now minded to impose the contract. The BMA said it had no plans for further strikes.
Government proposals for 100% retention of business rates by local authorities have been issued for consultation. There is likely to continue to be a system of redistribution to recognise the varying needs of different areas, and protection from significant shocks to the system.
Press release: https://www.gov.uk/government/news/historic-opportunity-for-councils-to-shape-their-financial-future
Dying patients and their relatives are to have 24/7 telephone access to specialist support as part of plans for palliative care up to 2020. Callers will be able to speak to specialist doctors or nurses about such things as pain relief. By 2020, all patients should have care plans relating to such things as where they want to die and ‘do not resuscitate’ orders. However campaigners said more funding was necessary for standards to improve. Pilots are to test out new approaches to palliative care in different areas.
Press release: https://www.gov.uk/government/news/government-commits-to-high-quality-end-of-life-care
NHS finance chiefs fear a worsening financial situation and poorer care ahead, according to a survey of 200 CCG and NHS Trust finance directors by the Healthcare Financial Management Association. 49% of CCG financial directors expect their organisation to end the year in a worse financial position and 67% of CCG finance officers and 48% of trust finance directors report a high degree of risk in achieving this year’s financial plan. Of all of those surveyed, 22% thought that the quality of care will worsen during this financial year (compared to 9% who thought that last November). A third think care will deteriorate in 2017-18. Of the 63% of respondent trusts that had agreed control totals with NHS Improvement, 60% did not expect to meet the conditions attached. Only 16% were very or quite confident that the NHS organisations in their area would be able to make the changes required by their Sustainability and Transformation Plan.
Cases of syphilis and gonorrhoea have increased markedly over the last two years in England, according to figures from Public Health England. Although sexually transmitted infections as a whole have fallen slightly, this was said to be due to less testing for chlamydia, and therefore fewer diagnoses. Between 2012 and 2015, cases of syphilis rose by 76%, from 3,001 to 5,288, while those of gonorrhoea grew by 53%, from 26,880 to 41,193.
Moorfields Eye Hospital is to make a million eye scans available to Google so its DeepMind artificial intelligence system can be trained to spot problems such as macular degeneration and diabetes related sight loss. Although the data will be anonymised, there has been criticism of previous such arrangements because of concerns about data protection.
Web pages on the research partnership: http://www.moorfields.nhs.uk/landing-page/deepmind-health-research-partnership
Antidepressants were the medicines that had the most increased number of prescriptions between 2014 and 2015, having risen by 6.8% to 61m, according to a report from the HSCIC, ‘Prescriptions dispensed in the community – 2005-2015’. The number of antidepressants prescribed had more than doubled (108%) in the ten years to 2015. The number of prescriptions overall rose by 1.8% in the last year and 50.4% over ten years. The number of antibacterial drugs dispensed fell by 5.6% in the year.
Serious risks to NHS finances are posed by the economic consequences of leaving the EU according to an analysis by the Health Foundation. It says that any extra funding from money no longer being paid to the EU would be cancelled out by slower economic growth.
The NHS complaints system should be changed significantly according to researchers from Imperial College, London, writing in the BMJ Open. They analysed 100 representative responses from over 3,000 doctors who had received a complaint or were going through complaint proceedings. The major themes reported were negativity towards the complainant and those managing the process (48%), impotence and powerlessness (45%) and emotional distress (42%). Only 6% of the doctors saw the complaint as a ‘learning process’.
Results from the National Cancer Patient Experience Survey 2015 have been published by NHS England. There was a response rate of 65%, with 71,000 patients taking part. It shows patients generally positive about being treated with dignity and respect and being involved in decisions on their care and treatment but with many people saying they would like more support from their GP practice during cancer treatment and more care and support from local health or social services. The data will be added to the new cancer dashboard, launched earlier this year.
The public health services that have been cut hardest have been those for children, such as health visiting, school nursing and childhood obesity programmes, making up 14% of £50.5m in 2016-17 from the 77 councils that provided information to the Health Services Journal. More than 50 services were being or had been decommissiioned by the 77 councils in 2015-16 and 2016-17.
The Minister for Community and Social Care, Alistair Burt, has said he will resign in September when the new Conservative leader is announced.
A report promoting walking and cycling has been published by the Faculty of Public Health. The report, ‘Local Action to Mitigate the Health Impact of Cars’, “provides practical advice, based on best practice, to help local authorities design towns and cities that encourage active travel.
Examples of improved patient safety have been published by NHS Improvement. The report highlights the work of 15 Patient Safety Collaboratives, local teams of experts looking for ways to reduce avoidable harm.
04 July 2016
A reform programme for children’s social care in England for the next five years has been published by the Department for Education. It is looking for a third of authorities to be delivering children’s services through ‘new models’, such as not-for-profit trusts, by 2020. It says that the delivery of social care services by in-house local authority teams ‘is not delivering consistently excellent practice’. It suggests that authorities “are diverse in size and demography, but the structure for delivering services is much less diverse and governed by very many of the same rules” and structural change may be the key to unlocking improvement.
Written statement: http://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2016-07-04/HCWS57/
60% of GP referrals to CAMHS lead to no treatment according to foi responses from 15 mental health trusts received by Pulse magazine. The proportion of cases which progress to treatment has fallen from 44% in 2013 to 39% in 2015.
A scheme to support young people leaving children’s homes until they are 21 is to be piloted by local authorities with government backing, the Secretary of State for Education, Nicky Morgan has said. The scheme, ‘Staying Close’ is proposed in a review of residential care by Sir Martin Narey. As well as providing support, the scheme will allow the young people to retain links with their former children’s home. The scheme mirror’s the ‘Staying Put’ policy supporting children in foster care until they are 21. [N.B. the full strategy for care leavers was published on 7th July.]
Patients’ ability to access GP records online has grown dramatically, NHS England claims. It says that “over 95% of GP practices are now set up to offer online access to detailed GP records including test results and diagnoses as well as referrals, immunisations, procedures and medications history”, up from 3% in January. ‘No show’ rates for appointments booked online are 35% lower than those booked conventionally. Figures from March show 8.6m people have signed up to book appointments online.
Dame Julie Mellor, the Parliamentary and Health Service Ombudsman, has resigned, in the light of revelations about her former deputy, Mick Martin, who was involved in the cover up of the harrassment of a director of a trust at which he was acting chair. An investigation is due to report on what Dame Julie knew about the case and her failure to act on it.
Annual health checks for people with learning disabilities reduced avoidable emergency hospital admissions according to research from St George’s University, London, published in the Journal of Epidemiology and Community Health, looking at an enhanced service (DES) offered by some GP practices. Avoidable emergency admissions fell from 69 per 1,000 in 2009-10 to 56 per 1,000 in 2011-12 in participating practices, but rose from 70 to 77 per 1,000 in non-participating practices.
Revised statutory guidance on conflicts of interest for CCGs has been published by NHS England. It proposes strengthening a number of procedures and recommends that CCGs should have a minimum of three lay members on their governing bodies.
Guidance on oral health in care homes has been published by NICE. There are concerns that oral health can often be neglected but it can have a signifiant impact on quality of life. NICE said that staff need to be properly trained to be able to provide good quality oral health care. They encouraged Health and Wellbeing Boards to ensure dental care was provided for care home residents.
Sir Martin Narey’s independent review of children’s residential care in England has been published.
(11/07/16) Feature article by the chief executive of the Independent Children’s Homes Association: https://www.theguardian.com/social-care-network/2016/jul/11/narey-report-gives-childrens-homes-the-status-they-deserve
Reducing the number of prescriptions for antibiotics does not put patients at risk according to research from King’s College, London looking at data on 4m patients from 610 GP surgeries covering ten years from 2004 to 2015, published in the BMJ. The research looked at the safety of not prescribing antibiotics for upper respiratory tract infections – coughs, colds and ear infections. There was a very small increased risk of pneumonia and peritonsillar abscess, but both are easily treatable.
A report on the healthcare needs of autistic people has been published by the ‘Westminster Commission on Autism’ which includes MPs, charities, autistic self-advocates and academics. Recommendations include for better training of healthcare staff, autism-specific questions to be included in inspection and annual health checks for autistic people.
Three quarters of people living in cities support clean air zones to bring their cities into line with European standards, according to a survey by YouGov of 800 people in Birmingham, Leeds, Nottingham and Southampton.
Welsh mental health outcomes have not improved since the implementation of the Mental Health (Wales) Measure in 2012 according to charity Gofal, based on annual surveys of 800 people (with a total of 3,600 survey responses). There had been an increase in the proportion of people offered alternative forms of treatment and a steady improvement in waiting times. However there had been no improvement in whether respondents felt they had managed to access the advice, treatment or support needed, or whether the service had led to improved mental health and wellbeing.
A measure of individual wellbeing which can be used to evaluate public policies has been proposed in a paper from the Centre for Health Economics at the University of York. The measure would be years of good life, making use of data on income, health-related quality of life and longevity.
03 July 2016
Tax and benefit changes will favour the older at the expense of the younger in the next four years, according to an analysis by the Resolution Foundation. The analysis of the impact of tax and social security changes shows that the biggest losers, by £220 a year by 2020, will be those in their 30’s while the biggest beneficiaries will be those in their sixties who will gain £170 a year. Millenials are due to lose a total of £1.7bn while baby boomers are to gain £1.2bn by 2020. The Resolution Foundation is setting up an ‘intergenerational commission.’
A call by the BMA for more funding for the NHS has been rejected by the Government. The BMA appealed for a further increase in funding, citing the popularity of suggestions made during the referendum campaign that more could be made available. Jeremy Hunt said it would be a matter for David Cameron’s successor.
01 July 2016
Diagnoses of malignant melanoma in people aged 55 and over in the UK reached their highest level ever at 10,583 in 2014, over three times as many as the 3,100 twenty years ago, according to figures from Cancer Research UK. Rates of all forms of melanoma increased by 155% for over 55’s and by 63% for under 55’s in those twenty years. Around 2,000 people aged 55 and over died from melanoma in 2014. It is thought the increases amongst over 55 year olds is the result of more people going on package holidays to the mediterranean in the 1970s.
Press release. http://www.cancerresearchuk.org/about-us/cancer-news/press-release/2016-07-01-melanoma-diagnoses-hit-10000-a-year-for-over-55s
A draft EU directive to cut air pollution should be honoured by a post-Brexit UK, MEPs have said. The directive would set national limits for five pollutants by 2030. The European Parliament is to vote on the directive in the autumn. The UK was involved in drafting the law, pushing for it to be watered down.
Draft NICE guidance on end-of-life care for children and young people has been published, emphasising the importance of involving young people and their parents. It says that parents or carers should be consulted about what they think their child should be told about their condition. They should discuss such things as the child’s preferred place of death, whether continuing with food and water is in their best interests and organ donation. Medical staff should not assume a ‘do not resuscitate’ order is in place. Health professionals should not be afraid to cuddle and comfort dying children, if appropriate.
Personal maternity budgets could be £3,000-£6,000 each for women who wish to take control of their care, according to the chair of the national maternity review, Baroness Julia Cumberledge, speaking to the Commons health committee. Personal maternity budgets are currently being trialled in seven areas. It is hoped that giving women control of their budgets may drive change such as more provision for births at home or in midwife-led units.
The new chair of the Royal College of GPs Council is to be Dr Helen Stokes-Lampard, to succeed Prof Maureen Baker in November 2016.
A quality standard to improve the recognition and referral of cancer has been published by NICE. Amongst other things, the standard says that GPs should be given direct access to key diagnostic tests, and there should be quicker access to tests for symptoms of stomach and colorectal cancer.
Giant arrows on the floors of supermarkets pointing to fruit and veg increased their sales by 15% in research from the University of New Mexico published in the Journal of Nutrition Education and Behavior. The ten arrows were 6ft by 3ft and had messages such as ‘follow for a healthy heart’. Although they bought more fruit and vegetables, the shoppers did not spend more overall.