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2016 Q4 October-December

Health and Wellbeing Policy Update: October-December 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, please contact me at ‘webmaster at equwell dot org dot uk’ (replacing ‘dot’ and ‘at’ with the respective signs).

31 December 2016

The number of serious incidents affecting patient safety have increased in the last few years, with the number of deteriorating patients receiving sub-optimal care rising from 260 in 2013-14 to 588 in 2015-16 and the number of diagnostic incidents (delays or not acting on results) rising from 654 to 923 over the same period.  The figures were obtained by Norman Lamb from NHS England using freedom of information requests.  Despite the increases being proportionately large, they are on relatively small numbers, and the Department of Health suggested the increases were because of better recording of such incidents.


30 December 2016

Women suffer more work related stress than men, with the situation worse for those aged 35-44 when many women are juggling responsibilities for looking after children and elderly parents according to the HSE.  In the past three years, 272,000 women reported work related stress compared to 200,000 men.


29 December 2016

Medicines are to have bar codes to promote safety, the Department of Health has said.  The barcodes, on drugs and other products such as surgical tools and breast implants, will help stocktaking, tracking products through the supply chain and identifying patients if there is a need for a product recall.  Early results from six pilot projects suggest that the use of the technology should save the NHS £1bn over seven years. [Is the significance of this that the NHS is instituting an innovation?  Or that it is new that it is starting to use bar codes as we enter 2017?]

A report forecasting changes to Britain in the 2020’s has been published by the IPPR.  Amongst other things, it says that on current trends, the 65+ age group will grow by 33% by 2030 with those over 85 doubling,  the adult social care budget funding gap could hit £13bn by 2030-31, the incomes of high income households will grow 11 times faster than low income households and climate change and resource depletion will mean we will increasingly hit limits of the world’s natural systems.  There are also likely to be significant job losses from automation, with the economy hitting “peak human” before robots and artificial intelligence take over.
Press release:


28 December 2016

A third of councils will lose out from social care funding announced in the local government settlement, according to Andy Burnham.  £240m was transferred from the new homes bonus, but the way it is being redistributed means that 57 councils will be worse off.
(15/12/16) (£)

83% of 40-60 year old Britons are either overweight, physically inactive or exceed alcohol guidelines, according to Public Health England which has launched a health campaign, One You, aimed at this age bracket.  More men, (87%), than women, (79%), fit into this category.  The campaign includes an online quiz which then links to further information and support.
Press release:
(27/12/16) Data on changes in behaviour and health of 40-60 year olds over the last 20 years:

Vaping shops, selling e-cigarettes and associated apparatus, are opening at the rate of two a day, with 1,700 across the country, according to industry body ECigIntelligence.  It said the highest concentrations of shops were in the North of England, Scotland and London.


27 December 2016

Four out of five young carers are not receiving any support from their local council according to a survey by the Children’s Commissioner for England.  Replies from 130 of the 152 relevant councils produced an estimate of 33,500 young carers being supported, which was compared to the 166,000 young carers aged 5-17 identified in the 2011 census.  The survey also found there were 160 carers aged under five.

‘Bed blocking’ cost the NHS £445m in 2015-16 according to an analysis by Labour.

An independent body to assess NHS finances could be set up by Labour, alongisde a commitment for a specified proportion of GDP to be spent on it, the shadow secretary for health John Ashworth has said in an interview.

NHS money should be spent on caring for people at home rather than in hospital, the Chief Nursing Officer, Prof Jane Cummings has said in a letter to the Daily Telegraph.


26 December 2016

Crisis child and adolescent mental health services are inadequate according to a majority (72%) of psychiatrists, in a survey for the Guardian by the Royal College of Psychiatrists’ faculty of child and adolescent psychiatry.  The survey of 253 out of about 2,000 consultant psychiatrists working in CAMHS found that 58% thought that care for under 18’s experiencing a crisis was ‘inadequate’ and a further 14% thought it was ‘very inadequate’.  Three quarters of respondents said they thought the inadequacy of services meant the young person’s mental health could deteriorate further, while 71% said it increased the chance of risky behaviour, including aggression.

Twelve hour waits in A&E have trebled in the last three years, from 61,401 in 2012-13 to 185,009 in 2015-16, according to data from NHS Digital obtained by the Mail.  Official figures record 12 hour waits from assessment by a doctor to admission, but these figures are from arriving at the A&E.  The information is collected but not published in England, although it is in the rest of the UK.

Calls about online sexual abuse to Childline have increased by 250% in the last three years and rose by 24% in the year to 2015-16, from 2,994 to 3,716.

A hidden pool of mothers with autism is starting to come to light often as they research the topic in relation to their children with the same condition, according to a number of experts.  However, there may be a risk of their children being taken into care as the undiagnosed mothers appear to be confrontational, unstable, unreliable and of potential harm to their children.


24 December 2016

The number of urgent operations cancelled in November reached record levels, at 446, compared to 243 in the same month last year, and the highest since such records started to be collected six years ago.

Ambulance services face a shortage of paramedics according to data obtained by shadow health secretary Jonathan Ashworth.  The ten regional ambulance services in England are short of 873 paramedics [it is not clear what proportion this is of the total number of such staff].


22 December 2016

Joint investigations of both health and social care complaints by both relevant Ombudsmen has been beneficial according to a joint report by the Local Government Ombudsman and the Parliamentary and Health Service Ombudsman.  A Joint Working Team was set up in 2015 to investigate complaints crossing their boundaries and it carried out 180 investigations in its first year.  The Ombudsmen said that the fragmented health and care system meant vulnerable people were falling through the cracks.


21 December 2016

Funding for children’s mental health was only fully allocated in half of CCGs, with the other half only using some or none of their share of the total £1.4bn for that purpose, according to freedom of information responses to charity YoungMinds from 199 of the 209 CCGs in England.  The proportion fully allocating the allotted amounts appears to be higher than the 33% of the previous year, but incomplete data makes comparisons difficult.  A separate survey by NHS Providers found that 63% of mental health trusts thought their CCG was not complying with the obligation to increase mental health spending in line with their overall budgets, to ensure ‘parity of esteem’.

A&E figures suggest the NHS is on the brink of a crisis, with the number of people in September leaving A&E without being treated having risen by 24% compared to the same month in the previous year and an increase in the proportion of patients having to return, unplanned, within seven days of their attendance up from 7.6% in September 2015 to 8.1% the following year, according to figures from NHS Digital.

A ratio of one nurse to eight patients can still be considered an important point in terms of patient safety, but a range of evidence should be used to determine safe staffing levels rather than having a single ratio across all wards, NHS Improvement has said in new draft workforce guidance.

Lord O’Shaughnessy has been appointed Parliamentary Under-Secretary of State at the Department of Health, replacing Lord Prior.  As James O’Shaughnessy, he was Director of Policy to the Prime Minister between 2010 and 2011.

Changes in the regulation of health and adult social care have been published for consultation by the CQC along with a consultation jointly with NHS Improvement on the assessment of leadership and use of resources.  The consultations run until February.  The CQC is planning fewer comprehensive inspections and a greater reliance on providers’ own assessments of their quality.  The more targeted approach would see comprehensive inspections only for new providers or those about which it has significant concerns.

A framework to promote improved quality criteria across all national health organisations has been published by the National Quality Board.  It provides a nationally agreed definition of quality and a guide for managerial and clinical leaders wanting to improve quality.


20 December 2016

Government claims of the Troubled Families’ initiative’s success misled the public, according to a report from the Public Accounts Committee, which said it overstated the financial benefits, with a claim in March 2015 that it had saved taxpayers £1.2bn not taking account the cost of the programme.  They also said it was misleading to describe short term outcomes such as better school attendance as ‘turning around’ a family rather than using the term to refer to long term, sustainable change.  The committee also attacked the DCLG for obfuscation in delaying the publication of research which found that the programme had ‘no significant impact’.  The payment by results approach was also criticised for incentivising local authorities to push too many families through the scheme too quckly.

Brexit could cause a severe shortage of nurses in the NHS, according to a report from the Institute of Employment Studies.  The uncertainty could deter nurses from elsewhere in the EU coming to the UK and lead to some already here returning.  Nurses from elsewhere in the EU make up 5% of the nursing workforce in England.  This comes at a time of increasing demand with the ageing population.  Applications to study nursing next year are down by 20% following the Government’s decision to end nursing bursaries.

The child poverty unit has been abolished by the Government, according to answers to parliamentary questions by Labour MP Dan Jarvis.  It has prompted fears that the priority of reducing child poverty has been reduced.  The unit was originally set up by the Labour Government in 1999. The size of the unit fell from 23 full-time equivalent staff members in 2013 to 10.5 in 2015-16.   It was run joinltly by the DWP, DfE and the Treasury.  The work has now been absorbed in to the DWP.  The Government said the change didn’t imply a reduction in its commitment to tackling poverty.
(21/12/16) Feature and comment by Yvette Cooper:

NHS health checks may have prevented up to 8,400 heart attacks and strokes according to a study led by Queen Mary University based on the experience of three areas of London in the first five years of the programme.  It was funded by DH and published in the British Journal of General Practice.  It found that the health checks increased diagnoses of diabetes by 30%, hypertension by 50% and chronic kidney disease by 80%.  They led to 40% more statins being prescribed which could cut deaths from heart attack or stroke by 4,600-8,400 over five years.

Overseas patients have not paid NHS bills totalling £30m in 2015-16 according to responses from 104 trusts to freedom of information requests by the Press Association.

The NHS is struggling from a mismatch between funding and demand according to a report from the King’s Fund.  Hospital admissions have increased by 3.6% a year since 2003-4.  Between 2010-11 and 2014-15, funding increases fell to 1.2% a year from the previous 4.8%.  The funding squeeze is set to tighten even more, to 1.1%, zero and 0.4% in the  three years 2017-18 to 2019-20.  The report says there is a need for more investment in community services and on prevention.  Reasons for the increases in demand are not fully known, but are likely to include population growth, an ageing population, rising expectations, earlier referrals from GPs for suspected cancer and technological advances making it possible to treat more people.
Press release:
The report:


19 December 2016

NHS trusts that meet their financial ‘control totals’ will receive an additional bonus from the sustainability and tranformation fund, according to a letter to trusts from NHS Improvement seen by the Health Service Journal.  The money will come partly from unallocated STF, but also from funds which would have gone to trusts who have missed their targets, thereby potentially exacerbating their problems.  Trusts would receive matched funding for any savings above the control total, pound for pound, with a further bonus from any residual STF funding at the end of the year.

The Scottish Health and Social Services delivery plan has been published by the Scottish Government.  It aims to move away from a ‘fix and treat’ approach to preventing people becoming ill and early intervention when they do.  It says mental health should be given equal importance to physical health.  It wants to move care out of hospitals and closer to home.  Some acute services could be transferred to regional or national centres of excellence.  Palliative care should be available to everyone who needs it by 2021.  There is to be increased spending on GPs and primary care to bring it up to 11% of the frontline budget by the end of the parliament.

Suicide rates should be tackled by greater government action, including restricting access to online resources that give information about suicide methods, the Health Select Committee has said in a report on the subject.  It says that the government should increase support for public mental health and early intervention services, with better training for GPs.  Rates have been on a downward trend since 1981 but started to rise again in recent years, with the rate in 2013 the highest since 2001.  4,820 people in England are recorded as having died from suicide in 2015 and the figure was 6,188 in the UK as a whole, but Dr Sarah Wollaston, the chair of the committee, said the true figure was likely to be much higher.  The government is due to publish a revised suicide prevention strategy in January.

People suffering child abuse have worse health at the age of 50 according to research from UCL published in the journal Pediatrics.  The research involved data on 8,076 people born in 1958, tracked to the age of 50.  Those who had been abused as children were 70% more likely to have a long term illness and not own their own home at the age of 50 than those who had not suffered abuse.

Very heavy drinkers should have their livers scanned to check for cirrhosis, or scarring, according to a draft NICE quality standard.  The threshold for heavy drinking is 50 units a week for men (equivalent to five bottles of wine) and 35 units for women (or three and a half bottles of wine).  Nearly 2m people in England drink above such levels.  If tackled early enough, the liver can recover, through treatment and lifestyle changes.  The recommended scan is ‘transient elastography’ which uses ultrasound and low-frequency ‘elastic waves’.  The quality standard is open for consultation until February.  About 10,000 people die in the UK each year from cirrhosis.


18 December 2016

Devolution shouldn’t excuse government responsibility for sustainable health and social care funding, the Public Accounts Committee says.  In a report on the deals being discussed that give powers to groups of local authorities and elected mayers in twelve parts of England (three of which have broken down), it says central government has failed to identify its objectives for devolution and says taxpayers need to understand who is spending their money and where responsibility lies.  It says that the government should not devolve problems to local areas without the resources to manage them.  It notes the tension between local government having to maintain services within resources determined by central government.

NHS trusts’ income from private patients has risen by 23% in the last four years, to 2015-16, from £454m to £558m, according to information given by ministers in parliament.  Over the same period, the number of patients waiting more than 18 weeks for treatment increased by 54%, from 234k to 360k.

Spending on agency staff in the NHS has come down, but not as much for medical locums as other staff according to NHS Improvement chief executive Jim Mackey, who said it was unfair on the permanent doctors for others to demand high rates for stand-in shifts.  Some locums were earning up to £155 an hour.  In the seven months from April to October, NHS trusts spent £616m on locum doctors.


17 December 2016

Jeremy Corbyn has asked to meet Theresa May about the social care crisis and possible emergency top-up funding.  After cuts to social care budgets of £4.5bn since 2010, he called for an urgent meeting ‘at the highest level’ to discuss emergency support to tide services over until April, but also to consider longer term solutions.

Over half of obese and seriously ill patients referred for free council gym membership quit after three months, with 38% leaving after six weeks, according to research from the University of Northumbria.


16 December 2016

Over £3bn of NHS capital could be transferred to revenue by 2020 according to conference presentation slides seen by the Health Service Journal.  In addition to the planned £1.2bn transfer this year, there could be a further £1bn in 2017-18 with £500m and £250m in each of the subsequent years.

Hospitals in England have been advised by NHS Improvement to postpone planned operations over Christmas, from 19 December to 16 January, to ensure there are enough beds free for emergencies.  The advice was revealed in a letter obtained by the Health Service Journal.  Hospitals in England are being advised to reduce their bed occupancy to 85% from the current 95%.  NHS Improvement said that a reduction in elective activity in the run-up to Christmas is standard practice.

There is a relationship between nurse staffing levels and clinical outcomes, according to research led from the South Bank University, based on an analysis of data based on 120m patient entries over six years from one NHS acute trust, published in BMJ Open.  Part of the aim of the study was to investigate the mining and use of routinely collected clinical data.  With 40 sorts of correlation identified, this was described as the first step towards building a mathematical model of the relationship.

The soft drinks levy should have an impact but will not be enough to solve the obesity crisis according to research led from Oxford University, published in the journal Lancet Public Health.  Based on modelling, it suggests that on the best case scenario, the levy could reduce the number of cases of adult and child obesity by 144,000 each year, prevent 19,000 cases of diabetes and avoid 270,000 decayed teeth.  Children should gain most.  The amount of gains depend whether the companies reformulate their products to avoid the levy or pass it on, so discouraging consumption and whether they change their marketing to focus on low sugar products.

The Government’s response to the Health Select Committee report on the impact of the spending review on health and social care has been published by DH.

The Government’s response to the Health Select Committee report on public health post-2013 has been published by DH.


15 December 2016

Local authorities are to be allowed to raise the social care precept to a maximum of 3% in each of the next two years, rather than 2% over three years in order to bring forward funding to address the social care crisis, the Communities Secretary Sajid Javid has announced as part of the local government finance settlement.  The change is expected to raise £625k more over the course of the parliament than the existing 2%.  [Councils can increase the precept by more than this if they hold a referendum that approves the change.]  There is also to be a £240m adult social care support grant, taken from the new homes bonus which is a scheme to incentivise house building, bringing the total to nearly £900m.  The additional funding was largely welcomed but criticised as being insufficient and only putting off the time when more sustainable funding needed to be agreed.  Local government leaders contested the Government’s contention that this was new money, noting that the £240m was diverted from housing and was already top sliced from local government grant, and the 3% precept was only 1% more than most authorities were planning anyway.|SCSC|SCDDB-2016-1215
(16/12/16) Feature article:
Press release:
The detailed documents of the settlement:

Bed occupancy averaged 95% in English hospitals last winter, between December 2015 and the end of February 2016, against the maximum recommended 85%, according to an analysis by the Nuffield Trust.  This causes a range of problems such as disruption to patients as they are moved round, lack of beds to move patients to from A&E and a risk of increased infection.  On one day in January, 4,390 extra beds (known as ‘escalation beds’) were opened, the highest for the winter, and equivalent to seven extra hospitals.

The 10% highest paid earners in Europe are paid as much as the bottom 50%, according to the Global Wage Report 2016-17 from the International Labour Organisation.  There was also a big gender gap amongst senior executives, which was 50% amongst chief executives.–en/index.htm

£101m of funding to support and spread the work of the new care vanguards has been announced by NHS England.  This matches the funding from the previous year.

Councils should provide oral health programmes in schools, NICE says, as part of a new quality standard.  It suggests councils could introduce toothbrushing, fluoride varnishing schemes or healthy eating advice.

A campaign on sepsis to help parents and carers spot warning signs in children has been launched by Jeremy Hunt, the Health Secretary.  The campaign is being run by PHE and the Sepsis Trust.  About 37,000 people die from sepsis each year.  Signs of sepsis in children include the child looking mottled, bluish or pale, appearing lethargic or difficult to wake, being abnormally cold to the touch, breathing rapidly, having a rash that does not fade when pressed, or having a fit or convulsion.  Sepsis happens when the body’s response to an infection injures its own tissues and organs such as when an infection spreads throughout the whole body causing the immune system to go into overdrive with the resulting inflammation causing more problems than the original infection.
Background information about sepsis:
Information about sepsis and what to do about it:

The public health allocations to local authorities have been published by DH, showing a total of £3.3bn to be allocated for 2017-18.


14 December 2016

Most parents of overweight and obese children think their weight is about right, leading to the fear that obesity is becoming normalised, according to the latest Health Survey for England 2015, published by NHS Digital.  Nine in ten mothers and eight in ten fathers of an overweight child said they were about the right weight, while for obese children, 48% of mothers and 43% of fathers said they were about the right weight.  The survey, undertaken by the National Centre for Social Research involved interviews with 8,034 adults and 5,714 children.  Amongst other figures from the survey: 5% are regularly using e-cigarettes (but only 1% of those who had never smoked had used one); 31% of men and 16% of women drank over 14 units in a usual week; 18% of adults had provided unpaid care to someone in the last month because of long term ill health, a disability or old age; and the proportion of children smoking and drinking is the lowest on record.
Press release:

A reduction in the number of hospital beds is contributing to an increase in patient deaths, according to a leading health statistician, Professor Sir Brian Jarman, whose work helped identify the Mid Staffs scandal.  The number of hospital beds in England has halved in the last three decades, from 297,364 in 1987-8 to 130,404 now and bed occupancy has not fallen below the government’s recommended 85% since 2002.  Admissions, however, have nearly doubled since the 1980’s, to 16 million.

The number of discharges from hospitals at night has increased by 15% between 2012-13 and 2015-16 from 219,072 to 252,261, according to responses to freedom of information requests received from 89 of 154 hospital trusts.

The new UK Dementia Research Institute is to be led from University College London with Professor Bart De Strooper as its director, the Government has announced.  The new research network, involving centres from around the UK, with UCL as the hub, is to receive funding over the next 10 years of £150m from the Medical Research Council and £50m each from Alzheimer’s Research UK and the Alzheimer’s Society.

A report on commissioning to tackle the social determinants of health in the eight ‘core’ cities has been published by NHS Clinical Commissioners.  The report, “Shaping healthy cities and economies: The role of clinical commissioning”, looks at how CCGs can impact on health by commissioning services related to such things as employment, innovation, physical activity and economic and environmental wellbeing.

A report arguing for more private healthcare has been published by the Institute of Economic Affairs.  It proposes cherry picking the best of the Swiss, Dutch, Belgian, German and Israeli healthcare systems with a bigger market for non-profit and for-profit insurers and tax rebates for patients wishing to opt out of NHS care, while retaining universal access.


13 December 2016

Hospitals are failing to investigate too many deaths and frequently ignore relatives, a review by the CQC has found.  The review was ordered by Jeremy Hunt following problems with the Southern Healthcare NHS Foundation Trust failing to investigate deaths sufficiently.  The review was based on how 12 NHS trusts investigated unusual or unexpected deaths or those where there had been errors, discussions with more than 100 families and a survey of all NHS trusts.  A review of 27 investigations found that the families’ views had been taken on board in just three cases.  The CQC has said the system for investigating such deaths is to be overhauled.
Jeremy Hunt’s statement to Parliament:
Press release:

Happier people tend to live longer, according to research by the English Longitudinal Study of Ageing at UCL published in the BMJ.  The study asked participants four questions on three separate occasions between 2002 and 2006.  It involved 9,365 participants, 1,310 of whom died in the follow up period.  There was a 24% reduction in mortality for those who experienced three high levels of enjoyment over the four year period compared to those who said they experienced no levels of high enjoyment.

Only 18.5% of GP practices offer ‘full extended access’, meaning appointments on Saturday and Sundays and for an extra hour and a half on weekdays, according to an NHS survey of 7,139 of the 7,459 practices in England.  The figures were uncovered by the Health Service Journal.


12 December 2016

Spending on residential care for older people is less than the recommended minimum of £554 a week in most local authorities, according to 90 responses to freedom of information requests by Labour MP Jess Phillips.  The £554 a week is a ‘floor price’ recommended by the LGA.

Increasing the social care precept will increase the postcode lottery of provision, experts have warned.  The warnings came from, amongst others, Martin Green, chief executive of Care England which represents care home providers, Andrea Sutcliffe of the CQC, and Lord Lipsey of Labour and Norman Lamb, the Lib Dem shadow health secretary.
Background briefing:
Background information on funding social care.
Birmingham chief executive Mark Rogers says years of cuts could have catastrophic consequences:

Cognitive and behavioural tests at the age of three were predictive of future success, with those having low scores for language, behavioural, movement and cognitive skills going on to account for 80% of crimes, 78% of prescriptions and 66% of social welfare payments as adults, in research based on a representative group of 1,037 people born in 1972-3, part of the Dunedin longitudinal study.  It was published in Nature Human Behaviour.  While many of those with poorer scores were from disadvantaged backgrounds, a similar proportion of middle class children scoring poorly went on to develop problems later.  The group with poorer scores accounted for about 20% of the population but use 80% of public services [so all those things they used to tell us about Pareto on training courses is true after all!]

Contraceptive services for women have, or may be, cut in a quarter of councils in England, according to freedom of information responses received from 140 councils by the Advisory Group on Contraception, which is made up of charities, such as the Family Planning Asociation, doctors and specialists and the Local Government Association.  Of the councils responding, 20 (14%) said at least one site had or would close this year and another 18 (13%) said that clinics could be closed this year.  This was described as a false economy, with every £1 spent on contraception leading to £11 averted health costs.

Happiness depends more on relationships and health than money and poverty, according to a study,from the LSE led by Lord Richard Layard.  It was based on a range of data sources including an analysis of survey data from four countries, Britain, the USA, West Germany and Australia.  It says that spending more to reduce mental ill health would be self-financing because of the return through increased employment and tax receipts and reduced health costs.  A much later (26th December) response from other psychologists expressed concern that the results could be interpreted to downplay the importance of poverty despite much other research over many years making the link.
(13/12/16) Speech by Gus O’Donnell to the conference where the research was presented:


11 December 2016

People with eating disorders in England are being sent to Scotland for treatment, many miles from home, because of a lack of service places in England according to doctors, patients and charities.  NHS England would not say how many patients were being treated in Scotland.  However anecdotal evidence suggests that in some places there are more English than Scottish patients.


10 December 2016

Services for seriously ill children are stretched to capacity raising the risk that further increases in demand could threaten patient safety, with some paediatric intensive care units working at 115% of capacity according to the Paediatric Intensive Care Society.  Nationally, such ICUs have been designated as at ‘Critcon 2’, meaning that the system is runninng at full stretch.

The Better Care Fund is not achieving many of its objectives, according to an investigation by the Observer.  Responses from 98 councils to freedom of information requests to 151 councils in England found that 58% of 505 targets for improving care in people’s homes and communities were missed.  Analysis by the King’s Fund for the Observer, shows that the 2% social care precept will raise only £382m a year, which is less than 3% of the total cost of social care, and far less than the £612m cost of implementing the ‘national living wage’.  The use of the precept may also increase inequalities as better off areas can raise more than those needing most help.
Feature article:

400 people killed themselves shortly after being released from police custody over the last seven years in England and Wales, according to figures from the Equality and Human Rights Commission, with most of the deaths occuring within 48 hours.  It is calling for the NHS to take over the health care of people detained in police stations.

All diesel cars should be banned from London according to a campaign being led by doctors, nurses and other health professionals.  The campaign group, ‘Doctors Against Diesel’ says 9,400 Londoners die prematurely every year from breathing diesel fumes.


09 December 2016

Hospital admissions for self-harm by children  and young people have risen by 14% in three years in England and Wales, an increase of 2,372 cases to 18,788, according to figures obtained from freedom of information requests by the NSPCC.  Responses were received from all but six health trusts in England and health boards in Wales.

A report on learning disabled people’s health and care has been published by NHS Digital and PHE.  People with a learning disability have a lower life expectancy than the general population; 18 years lower for females and 14 years lower for males.  People with a learning disability were 8 times more likely to have a severe mental illness as the general population.

The role of public health in breaking the cycle of violence in families and communities is explored in a publication from the UK’s Faculty of Public Health.  Amongst the approaches proposed are promoting policies to reduce inequality and deprivation, parenting classes, early years interventions and action on alcohol misuse.


08 December 2016

The monthly performance indicators for NHS England show the number of people waiting for non-urgent surgery is the highest since December 2017. The figures show that 3.9m people, or 7% of the population of England, are on a waiting list for an operation.  Targets missed included: treatment within 18 weeks (90.4% against a target of 92%); A&E four hour treatment target (83.7% for hospital based A&Es compared to the target of 95%); and cancer treatment within 62 days of GP referral (81.1% vs a target of 85%).  The number of bed days lost to delayed transfers of care out of hospital was up 25% on the same period last year, to just over 200,000 days, the highest number since records began in August 2010.  57% of delays were wholly or partly down to the hospital with 35% due to a lack of social care support.

NHS quality continues to decline according to analysis of a range of figures by the Nuffield Trust and the Health Foundation in their annual Quality Watch survey.  Patients are waiting on average a week longer for treatment than four years ago (6.6 weeks compared to 5.5 in 2012).  The report says the pressures of austerity took some time to feed through so further decline could be expected and that a system under such pressure would at some point be unable to provide care to the standards expected by patients and staff.
Press release:

Online advertising of junk food to children is to be banned from 1st July 2017, the Committee on Advertising Practice has said.  It will cover food and drinks high in fat, salt or sugar in non-broadcast media including  print, online, games and the cinema, where children make up a quarter or more of the audience.  It brings non-broadcast media into line with the rules for television that were introduced in 2007.  The Advertising Standards Authority, which regulates all media in the UK has said it will administer the new rules.  The changes were welcomed by campaigners but they said they did not go far enough, as children will still be exposed to such adverts where they do not make up at least a quarter of the audience.

Baby boomers should stay physically and mentally active for a healthier future, the Chief Medical Officer, Prof Dame Sally Davies says in her annual report, ‘Baby Boomers: Fit for the Future’, which focuses on the health of people aged 50-70, and considers the impact of lifestyle choices on health.  It suggests they stay in work for as long as possible or engage in community and voluntary activities.  It says that 45% of the disease burden of this age group is attributable to lifestyle choices such as diet, smoking and weight.  An increasing number of older people are contracting sexually transmitted infections, with an increase in the 50-70 age group of 38% between 2010 and 2014.
Press release:
The report:

Mental health accounts for less than 1% of local authorities’ public health budgets, having fallen from 1.4% in 2013-14 to 0.9%, according to Mind, based on information from freedom of information requests.

A tenth of crimes recorded by the police are domestic abuse cases according to figures from the ONS.  In 2015-16, 1.2m women and 651k men were victims of domestic abuse, according to the Crime Survey for England and Wales.  The majority of cases, 76%, involved violent attacks.  The prevalence rate of domestic abuse was 6 in 100 adults.  Prevalence is at its lowest level since March 2005, but has remained fairly stable since March 2009.

Nine million Britons are lonley all or most of the time, often as a result of life events such as becoming a young mother, retirement, long term health issues, bereavment and family breakdown, according to a report from the British Red Cross and the Co-Op, based on a survey of 2,500 people and in-depth interviews with 100 people.  A third of people who are lonely have been through a divorce or separation.  Over half of the population said they sometimes feel lonely and only a fifth said they never felt isolated.

Transgender people face much higher risks of poverty, suicide, unemployment and mental health problems than the rest of the population according to a survey of over 28,000 trans people by the Washington DC-based National Centre for Transgender Equality.  It found that 39% had experienced ‘serious psychological distress’ in the last year, compared to 5% of Americans overall.  40% said they had attempted suicide at some point in their life, nine times the overall rate in the US.

Closure of Sure Start children’s centres nearly doubled last year, according to a parliamentary question from Labour MP Dan Jarvis answered by Education minister Caroline Dinenage.  As of 31st October 2016 there were 3,259 chidlren’s centres.  In each of the five years from 2011 to 2015 the closures were respectively: 12, 27, 33, 85 and 156.  Concern was also expressed that cuts meant remaing centres couldn’t offer a full service.

A survey of people’s views on obesity has been published by Public Health England.  It finds that people tend to underestimate their weight and struggle to identify the point when someone becomes obese, suggesting that it is becoming normalised.  The research was commissioned from NatCen Social Research, as part of the British Social Attitudes Survey.


07 December 2016

Cuts to health visitor numbers mean only 70% of families now receive all the mandated baby and infant reviews, at 6-8 weeks, 1 year and 2-2.5 years, according to a survey of 1,224 health visitors (HVs) by the Institute of Health Visiting.  It also found that 85% of HVs said their workload had increased over the last two years, with 40% of the increase due to a reduction in the number of HVs.  80% of respondents said they are seeing an increase in domestic violence and abuse and perinatal depression in the families they visit.  The number of HVs rose from about 8,000 to 12,000 between 2012 and 2015.  However, according to figures from NHS Digitial, the numbers fell by 9.7%, from 10,309 in October 2015 to 9,311 in August 2016.  According to evidence to the Health Select Committee, 56% of local authorities are planning further cuts next year.

The numbers waiting for more than four hours for a hospital bed after an emergency admission have grown nearly five fold in five years between 2010-11 and 2015-16, from 97,559 to 473,453, according to an analysis by the BBC of official figures.  The current figures represent 11% of the 4.2m patients admitted in the year to September 2016.

More than 7m people in the UK are living in poverty despite being in working families, out of 13.5m in total, according to a report by the New Policy Institute, commissioned by the Joseph Rowntree Foundation.  It finds that deprivation is increasingly linked to the high costs of private rented housing.  Disability is also an important factor.  The 13.5m living in households under 60% of the median household income after taking account of housing costs is 21% of the UK population which has not changed much in more than a decade.  However there has been a steady rise in the proportion of them who are in working families which now stands at a record 55%.  However, there are 400,000 fewer pensioners in poverty despite 1.7m more in that age bracket.

Children’s services are becoming increasingly reliant on unstable sources of funding, such as short term grants, according to a report from the Association of Directors of Children’s Services (ADCS).  Cuts in funding come alongside rising demand for care.  The report also said there was a churn in the social care workforce.

936 women were killed by men in the six years between 2009 and 2015, in England and Wales, according to the ‘Femicide Census’ developed by charity nia and Women’s Aid.  Of that total, 598 (64%) were killed by current or former partners and 75 (8%) by their sons.

Maternal death rates linked to heart problems have doubled since the 1980s, with a quarter of such deaths linked to cardiac disease, but doctors too often miss the symptoms because they do not expect young women to be affected, a report, ‘The Confidential Enquiry into Maternal Deaths’, led by Oxford University, finds.  They said pregnant women should expect to have their blood pressure and urine tested at every antenatal visit.  The numbers involved are small, with 2.18 women out of 100,000 maternities dying as a result of heart problems during or soon after pregnancy between 2012 and 2014, which is 17 of the 67 dying each year.

NICE guidance on end of life care for children and young people has been published, saying that they should be encouraged to write their bucket lists as part of jointly drawing up care plans with clinicians.  It also says account should be taken of the emotional and practical needs of the family as well as the young person.
Press release:

Small charities are facing complex procurement processes from central and local government that mean they miss out on contracts, according to a review of 120 contract tenders by grant-giving body Lloyds Bank Foundation.  Public services are therefore missing out on what such bodies can offer, such as local knowledge, in tackling social issues.  In one case, a contract worth less than £350,000 a year required answers totalling 27,000 words.  In another, a charity bidding for a mental health contract was marked down for not having a hard-hat policy: the same process was used as for procuring building work.

Optimistic women are less likely to suffer from a number of fatal diseases such as cancer, heart disease, lung conditions and stroke, according to research led from the Harvard TH Chan School of Public Health, using data on a large number of employed and retired female nurses in the U.S. aged 58-83 who were monitored for the next eight years.  Higher optimism was associated with a lower risk of death, even after controlling for such things as marital status, the wealth of family background, blood pressure, cholesterol and depression.  The results were published in the American Journal of Epidemiology.


06 December 2016

Funding for cancer care has been announced by Simon Stevens.  It includes an investment in radiotherapy machines alongside £200m over two years to improve local cancer services.

Guidance on what works to improve the mental health of children and young people has been published by Public Health England.

Barriers for BME people accessing mental health services are identified in research from the Brighton and Sussex Medical School published in BMJ Open.  They include relationship issues between patients and providers, such as, long waiting times, language barriers,and  poor communications and personal and cultural factors such as a negative perception of mental health issues, a reluctance to discuss psychological stress or seek help.

A report on ‘The Challenge and Potential of Whole System Flow’ has been published by the Health Foundation.  It looks at how to increase the integration and flow of patients, information and resources within and between health and social care systems.


05 December 2016

Proposals allowing councils to be exempted from children’s social care law are to be reintroduced by the Government into the Children and Social Work Bill, children’s minister Edward Timpson has said.  The proposals, which would allow councils to apply to opt out of some legal requirements in order to develop innovations,  were defeated in the House of Lords last month, but they are to be reinstituted in what the minister called a ‘much altered and improved form’.  There is to be a list of core duties, such as child protection and child in need duties, which councils will not be able to opt out of.  Other changes to the original proposals include: the education secretary will not be able to impose exemptions; references to exemptions being used for ‘efficiencies’ will be removed; and a wider group will have to be consulted by councils when applying for exemptions.
Piece by Edward Timpson:

A draft ‘sugar tax’ bill has been published by the Government, providing for a levy on some soft drinks.  There are to be two bands, one for drinks of more than 5g per 100ml and another for those over 8g.  It will not apply to fruit juices or milk drinks.  The Office for Budgetary Responsibility estimates that it could add 18p to 24p per litre (or 6p to 8p per can) to the price of fizzy drinks, if the costs are passed on to the consumer.
Responses to the consultation:

A review by Dame Carol Black on the impacts of drug or alcohol addiction and obesity on employment outcomes has been published by DWP.  Part of the terms of reference for the review, which was set up under David Cameron’s administration, was to consider whether obese people or those with addictions should be deprived of benefits if they refused to have treatment.  The review says that such an approach could be unethical and was likely to be ineffective, as people might hide their addictions and with treatments and other help too sporadically available.  The report recommends bringing together health, social and employment agencies to work together collaboratively.

The cost of social care rose significantly last year, with the average cost of a care home rising by nearly a quarter, from £558 a week to £686, and the cost of a nursing home place rising by more than a third, from £692 to £925 a week, according to an analysis by the social care services directory,  The figures are based on data from providers registered with the company and calls to services.

A bill to combine the parliamentary and health service ombudsman and the local government ombudsman has been published. The role of the new body is to be extended to include a role in championing improvements in complaint handling and promoting good practice.

Loneliness in older people should be tackled by the public and third sector working together and signposting them to such things as dance groups, swimming clubs, choirs, volunteering and befriending programmes, to promote physical and mental wellbeing, NICE recommends in a new quality standard.

Women are tending to receive worse dementia care than men, with women seen by GPs 10% less frequently than men, according to research from University College London, based on the dementia records of 68,000 patients with dementia and 259,000 without, over the decade from 2002 to 2013.  The research was published in the journal Age and Ageing.  Women were 18% more likely to be given antipsychotic or sedative medications.

Doctors caring for dying patients should get more support, the BMA says, with only 15% of doctors saying they had accessed formal or informal networks, according to an online poll, with 457 respondents.

A third of employees have missed or postponed a GP appointment because of work pressures, according to a survey by YouGov of 1,000 people at middle management level or below, for digital healthcare company Doctor Care Anywhere.  As a result of the pressure, 34% made a health problem worse and 37% stayed at work despite being unwell.


03 December 2016

Millions of pounds have been paid to some social care companies despite some poor standards, according to an investigation by Corporate Watch, based on an analysis of CQC published reports.  While most companies in the domiciliary care market are small operations, just scraping by, they focus on the five biggest home care companies by revenue, thought to be responsible for 15% of home care provision across the UK.  They found that of 192 domiciliary care services run by five major companies, inspected in the last two years, 80 were classed as ‘requires improvement’ and 8 as ‘inadequate’.  While the average of the 184 branches run by the top five private providers classed as ‘good’ was 54%, this figure was 76% for all the domiciliary agencies in England.  In the last five years, £36m was paid to owners with a further £34m of liabilities in company accounts.

85% of paediatric intensive care beds in England were full on Friday night, with no spare capacity in cities including London and Leicester, the Observer reports.  It suggests this is an indication of the increasing demands on the health service.

A tenth of jobs (30,000) in the learning disabilities sector could be lost in the next four years, as a result of insufficient funding for social care, particularly to cover the increased national living wage, according to research commissioned by LD charity HFT from the economics and business consultancy CEBR.  The research involved survey analysis from social care providers and financial modelling.  The report says that increased funding of 5% a year is necessary to meet increasing demand, based on the current level of service.


02 December 2016

Over half of heart attack patients are not receiving the recommended rehabilitation within 33 days, according to the National Audit of Cardiac Rehabilitation.  The rehabilitation includes reintroduction to exercise and guidance on diet.  Only 44% of women receive the support, compared to 52% of men.

A review into care homes for older people has been launched by the Competition and Markets Authority, looking at how well the market works and whether people are being treated fairly.  It will look at possible unfair practices and contract terms such as sudden rises in bills and hidden charges.
Press release:

The NHS should be run as a mutual organisation, funded entirely from national insurance contributions, which should be made more progressive, Frank Field has proposed, in a submission to a House of Lords committee looking into the long term sustainability of the NHS.


01 December 2016

Patient safety is at risk from junior doctors’ workloads and sleep deprivation, with 43% describing their workloads as ‘heavy’ or ‘very heavy’ and a quarter (24.4%) describing themselves as sleep deprived, in a GMC survey completed by just under 99% of the 54,563 junior doctors eligible to take part.  There are concerns that the pressures mean the doctors are not getting all the training they need.

80% of junior doctors say their job sometimes or often causes them excessive stress, with 54% saying it affected their physical health and a quarter saying it affected their mental health, in a survey of junior doctors by the Royal College of Physicians.  Seven in ten say they work on a rota that has a permanent gap and 41% say that the burden of excessive administrative work poses a serious risk to patient safety in their hospital.

Minimum unit pricing (MUP) for alcohol would be cost effective, Public Health England has said, in a comprehensive review of the evidence on the impact of alcohol on public health and the effectiveness of alcohol control policies.  The review was commissioned by the Government and PHE feels its remit prevents it from explicitly backing MUP, but the review says that MUP, together with relevant taxation, is a highly targeted measure which improves the health of the heaviest drinkers, has negligible impact on moderate drinkers and the on-trade and is “estimated to lead to substantial reductions in harm and increases in government revenue.”  The review found that alcohol is the biggest killer of people between the ages of 15 and 49 in England, it accounts for 167,000 years of lost productivity every year, it costs between 1.3% and 2.7% of GDP, £27bn to £52bn, each year and is the cause of more years of life lost to the workforce than the ten most common cancers combined.  Although the Government promised in March 2012 to introduce a MUP policy, it changed its mind in July 2013.   Forty three dotors, medical groups, campaigners and other organisations have written to the Chancellor asking him to increase the duty on alcohol.
(02/12/16) Press release:
(02/12/16) The report:

HMRC and its American contractor have been condemned for wrongly removing tax credits from thousands of people, in an excoriating report from the Work and Pensions Select Committee.  The company, Concentrix, was contracted in May 2014 to check 1.5m tax credit claims for fraud, the first time the government had delegated benefit decisions to a private company.  The committee criticised the company for a ‘cut first, think later’, ‘guilty until proven innocent’ approach which led to 90% of initial appeals being upheld, but which “left vulnerable people in humiliating hardship” in the meantime, with many having to borrow from payday lenders and rely on foodbanks.  People were sent letters saying their benefits would be stopped in 30 days unless they could prove they were entitled to them, but without being told why, and in many cases not receiving the letters at all.  HMRC were criticised for failing to respond quickly to the crisis and continuing to praise the contractor even at the hight of the crisis.  They say HMRC was not only complicit in the decision making process but “they pressured their failing contractor to subject yet more claimants to it.”  The committee said it had grave concerns about outsourcing benefit decisions to private firms.

Over a quarter (28%) of care homes are at risk of insolvency, according to an analysis of the published financial results of 6,158 operators across the UK by financial analysts Company Watch and Opus Business Services.  The companies were compared with others that subsequently failed and 28% were considered in the ‘warning area’ for financial viability.

85% of trust and CCG finance directors do not believe this summer’s ‘reset’ will restore financial balance in the short term according to a survey by the Healthcare Financial Management Association.  It found that they were generally positive about the STP process but warned about over-ambitious savings expectations and the financial risks involved.  About half of respondents from trusts thought care quality will worsen in 2017-18.—briefing-december-2017

Measures to reduce air pollution are proposed in draft guidance from NICE. Among the measures suggested for consideration by local authorities are reducing speed limits, instituting clean air zones, redesigning speed bumps to avoid speeding up and slowing down between them, more charging points for electric vehicles in residential areas and redesigning buildings for less access to pollution.
Press release:

Treatment for depression round the world reaches only a small minority of people, with 1 in 27 people in poorer countries receiving adequate treatment, according to research from King’s College, London, Harvard Medical School and the World Health Organisation, looking at data on 4,331 people in 21 countries, published in the British Journal of Psychiatry.  Almost half of people didn’t think they had a problem that needed treatment.  Only a third of people in low income countries thought they needed treatment, compared to two thirds in high income countries.

HIV testing should be routinely offered in A&E’s and GPs’s surgeries, depending on local HIV prevalence, NICE has said in new guidance.  In areas of ‘high’ and ‘extremely high’ HIV prevalance, as defined by PHE, testing should be offered and recommended to all patients when they register with a GP or have a blood test.  PHE estimates that 101,200 people are living with HIV in the UK, of whom 13,500 are living with an undiagnosed infection.

Over 250,000 people in England are homeless or lack a permanent place to live, according to Shelter, based on official data and responses to freedom of information requests.  It is the 50th anniversary of the founding of the charity.  The Department of Communities and Local Government said it did not recognise the figures.

A report looking at “the potential for increasing the capacity and diversity of children’s social care services in England” has been published by the Department for Education.  The report was produced by LaingBuisson.  It says private providers would like to run the full range of children’s services and suggests the government could follow international examples and force outsourcing, but the DfE has rejected that option.
(12/12/16) Feature article:

Magic mushrooms’ active ingredient, psilocybin,  produced an immediate reduction in depression that lasted for eight months in people with advanced cancer in two US trials published in the Journal of Psychopharmacology.  There were just 29 patients in one of the studies and 51 in the other.

The proportion of outpatient appointments in England that were cancelled has increased from 4.6% in 2005-6 to 6.8% in 2015-16, according to figures from NHS Digital.  There had been a big increase in the number of outpatient appointments in that period, from 60.6m to 113.3m, which meant the actual number of cancellations increased nearly threefold from 2.76m to 7.68m.

The number of organ donations in Wales has risen following the introduction of an opt-out system, with 160 organs transplanted last year of which 39 were through deemed consent, according to official figures.

The new Healthwatch National Director is to be Imelda Redmond, the body has announced.  She has previously had a number of senior roles in the not-for-profit sector.

A new framework for NHS leadership has been published by NHS England and NHS Improvement, working with other arms length bodies.


30 November 2016

The Government has failed to measure whether benefit sanctions provide value for money, according to a report from the National Audit Office.  It says the DWP is not monitoring what happens to those who have benefits cut or witheld, many of whom leave the benefits system.  It also noted that application of the regime varies between areas, with some Work Programme providers referring twice as many for sanctions as other providers in the same area.  The report also found that 24% of Job Seeker Allowance claimants received at least one sanction between 2010 and 2015.  It notes that while the DWP has commissioned some reviews it has rejected calls for a wider review and recommends that it use its own data to evaluate the impact of sanctions.
Analysis and comment:

More NHS managers should have a clinical background, Jeremy Hunt has said, speaking to the NHS Providers’ conference.   He said he plans to send 30 doctors and nurses a year to a fast-track health management course at Yale University and launch an NHS-approved MBA course at a British University next year.  He said that only 34% of NHS chief executives have a clinical background and 54% of all managers are clinicians compared to 74% in Canada and the U.S. and 94% in Sweden.
(02/12/16) Feature and comment:

Student nurses are to be allowed to train on the job rather than having to first complete a university degree, Jeremy Hunt has announced.  Up to 1,000 apprentice nurses could join the NHS each year, starting in September 2017.  They are to be paid a salary, to be set locally.  It will generally take five years to qualify as a registered nurse.
Press release:

A second appeal against plain cigarette packaging has been lost by four tobacco companies, British American Tobacco, Imperial, Japan Tobacco International and Philip Morris.  The companies are now deciding whether to take their challenge further.

Tobacco company Philip Morris has said it would like to phase out conventional cigarettes working in association with governments.  The comments were made by the company’s chief executive, speaking to the BBC about a new product that heats rather than burns tobacco and is thought to be much less harmful.  The company has spent £2.4bn creating the substitute cigarette.  It is claimed that it is more effective than e-cigarettes at converting smokers.

Detentions under the Mental Health Act were the highest last year for at least a decade, according to figures from NHS Digital.  There has been an increase of 47%, from 43k to 64k detentions since 2006, when comparable records began.  There has been a 31% increase in the last five years and there was a 9% rise last year.  The CQC said it was launching an investigation into why the numbers had risen.  NHS Digital also published the Mental Health Bulletin on use of secondary mental health services.

Jeremy Hunt said the call for more money for the NHS was a misjudgement. Speaking at the NHS Providers’ conference he criticised its chief executive’s statement that trusts could not do everything asked of them within current budgets.  Hunt said that to say there isn’t enough money less than a year after the biggest settlement of any government department risks losing credibility with the Treasury, who would just say, ‘whatever we do, it’s not enough’.  Simon Stevens said the NHS would have to undertake considerable ‘service redesign’ to meet its goals of saving money and improving services.  He also hinted that there might still be more money for social care.

The time ambulances have to wait in A&E to hand over their patients has increased by 52% in two years, and so is a key reason for 12 out of 13 ambulance trusts failing to meet the 8 minute response target, according to information gathered by the BBC from freedom of information requests.  The 500,000 hours spent waiting at A&E is equivalent to 286 crews being taken out of the system for a year, or is enough to increase the number of ambulance journeys by 10%.  The Welsh ambulance service has reduced the number of cases it classes as an emergency and is now meeting its targets. Scotland has just adopted a similar approach and England and Northern Ireland are considering following suit.
(29/11/16) Feature looking at how the problems are being tackled in different parts of the country:

70% of parents of a child with a learning disability have felt unwelcome in public, 63% said they had missed a social engagement in the last year because of concerns about public reaction and a fifth have been asked to leave a public space because of their child’s behaviour according to an online poll of 1,000 parents of a child with learning disabilities by Mencap.

A course of antibiotics leaves children 12 times more likely to develop a drug resistant infection in the following months, indicating a risk to individuals as well as to society of antimicrobial resistance, the PHE medical director told the Science and Technology Committee.  The committee heard that progress had been made in reducing the use of antibiotics in the last two years.  However Jim O’Neill, author of a government commissioned report on antimicrobial resistance, said the current government seemed less passionate about the issue than the previous administration.

Hospital managers and senior doctors are working together better than in the past, but there is concern that relations will get worse because of reorganisations and financial pressures, according to research by the Nuffield Trust which included a survey of 472 leaders and clinicians in management roles.  The proportion thinking doctor-manager relationships are positive has risen from 47% in 2002 to 60% now but 37% think relations are likely to deteriorate in the coming year.

Women with premenstrual syndrome should be offered cognitive behavioural therapy, to help manage the symptoms,the Royal College of Obstetricians and Gynaecologists has said in new guidelines.

The Chair of Healthwatch England has been confirmed as Jane Mordue. She has held the position on an interim basis since December 2015.


29 November 2016

NHS trusts say the Government should stop expecting them to do the impossible within their current stretched resources, in a report from NHS Providers.  Its chief executive Chris Hopson says the service cannot hit its tough financial and waiting time targets, transform the quality of care, deliver seven day services and improve patient safety with the current parlous state of its finances.  In a survey of 172 senior executives from 136 of the 238 trusts, 73% said they did not have enough staff to function properly.  Only 10% are confident or very confident that they can maintain the level and quality of services over the next six months because money is tight and 49% expect their financial position to worsen over that time.  There is concern that the pressure means the service will not be able to withstand ‘shocks’ such as a flu outbreak.  Chris Hopson told the HSJ that it would be ‘extraordinary’ if the trusts’ deficit could be kept under £1bn this year and there should be more recognition of what had been done to stop things running out of control.
Feature article by Directror of Policy and Strategy at NHS Providers, focussing on innovtions:
The report:

There is growing pressure on the Chancellor to do something about the social care crisis, with more Tory MPs raising the issue, including former minister Dr Andrew Murrison, Kit Malthouse and Sir Hugo Swire.

One in seven (15%) of 14-15 year olds had suffered some form of neglect at home, according to a survey of a representative sample of about 2,000 12-15 year olds in 72 schools by York University for the Children’s Society.  The report, ‘Troubled Teens’ is the first output from a new research programme on adolescent neglect being undertaken by the Children’s Society in partnership with York University.  The forms of neglect included: lack of emotional support; failing to monitor the child’s activities outside the home; and not taking an interest in their education.  Those who had experienced emotional neglect were more than twice as likely to have got drunk recently (at 46%) than their peers, and three times as likely to have smoked.  Those reporting more frequent support from parents were more likely to report higher levels of wellbeing.  The report argues for more advice and support to be made available to parents.
Press release:
The report:

Pharmacists and nurses can be just as effective at prescribing as GPs according to a Cochrane review.  It found outcomes were comparable for a wide range of conditions including high blood pressure, diabetes control and high cholesterol.

Sleep deprivation is costing £40bn to the UK economy in lost productivity every year, equal to 1.9% of GDP, according to the not-for-profit research organisation Rand Europe.  Those sleeping for less than six hours a night have a 13% higher mortality risk than those sleeping for 7-9 hours.  The UK loses just over 200,000 working days a year due to sleep deprivation.  The report looks at five countries, whose lost GDP are: Japan 2.92%, the U.S. 2.28%, the UK 1.86%, Germany 1.56% and Canada 1.35%.

Stroke care has improved considerably in recent years but there is an increasing shortage of consultants according to the third national Sentinel Stroke National Audit Programme from the Royal College of Physicians.  It finds that 40% of units have at least one vacancy for a consultant and 49% of stroke units do not have the recognised minimum number of nurses for good care.
(The stroke story is in the second part of the article)
Press release:

About 9,000 stroke patients a year are missing out on potentially helpful treatment, a thrombectomy, which involves mechanically retrieving the offending clot, according to research from Newcastle and Northumbria universities, the Oxford Academic Health Science Network and the National Institute for Health Research, presented to the UK Stroke Forum national conference.  A national stroke audit suggests part of the problem is a lack of skilled staff to do the procedure.

A third (32%) of children hospitalised for asthma have been exposed to environmental tobacco smoke just beforehand, according to the British Thoracic Society’s national paediatric asthma audit, involving 5,443 children treated as inpatients for asthma in 153 hospitals in November 2015.  The audit found that the treatment of such children continued to be highly effective and efficient.

New waiting time standards for mental health are being introduced by NHS England, the HSJ reports.  Urgent and emergency mental health patients in A&E and hospital wards should be seen by liaison psychiatry staff within one hour, emergency patients should be treated in four hours and urgent patients within 24.  This is part of a series of guides expected to be published in April.  Mental health trusts providing liaison services will have to report on their waiting times.

Life expectancy in the UK continues to rise but the number of years spent in poor health is increasing, according to figures from the ONS.  Over the four years from 2009-11 to 2013-15, life expectancy for a newborn boy increased from 78.5 to 79.2 and for a girl from 82.5 to 82.9.  Years spent in poor health rose by 0.4 to 19 years for women and by 0.3 to 16.1 years for men.  Scottish life expectancy is still the lowest in the UK, according to statistics from the National Records of Scotland.  For babies born in the last three years, life expectancy is 77.1 years for males and 81.1 for females, which is 2 and 1.7 years less respectively than in England.

The number of people swimming at least once a week has fallen by a quarter (24%) in the last decade, according to data from Sport England.  However more than 500 swimming pools have opened since 2006.  The number swimming at least weekly fell from 3.27m to 2.5m between 2005-6 and 2015-16.


28 November 2016

GP workloads are putting patient safety at risk, according to a survey by the BMA of 5,025 family doctors.  It found that 57% felt their workload was unmanageable with a further 27% saying it was excessive.  Only 10% across England thought their workload was manageable.  Solutions to the problems included more community nursing for housebound patients supported by 64%, help for patients to manage conditions themselves, 59%, and more mental health workers in the community, 53%.
Press release (linking to survey results from July):

The level of local government cuts has varied considerably across the UK between 2009-10 and 2016-17, from 0.6% in Surrey to 46% in Westminster, according to an analysis by the Institute for Fiscal Studies.  The authorities that received the largest share of their funding from central government grants experienced the largest cuts to their service spending.  The cuts were much less in two tier areas.  On average, spending in England fell by 22% in real terms but in county areas it was 12.5% and London boroughs 30.9%.

A report on mental health and rough sleeping has been published by St Mungo’s.  It shows that four in ten people sleeping rough have a mental health problem.  Based on freedom of information requests to 110 local authority areas known to have 10 or more people sleeping rough each night, it found that 68% of them failed to commission specialist mental health services.  Independently, Centrepoint says young people with medium to low needs tend to fall through the cracks.
(01/12/16) Article by CEO of St Mungo’s:
(04/12/16) Article mainly about rough sleeping more generally:
The report:
Press release:

Four out of five (78%) of diabetes specialist nurses say their workload is affecting patient safety and care, according to a survey by Diabetes UK of 406 of the 1,400 specialist diabetes nurses.  Almost 90% said they were working above their contracted hours.  29% said there had been cuts of specialist nurses in their team in the last two years.  The number of people diagnosed with diabetes has increased by 72% in little over a decade and is predicted to continue rising.  57% of those responding to the survey were eligible to reitre in 10 years or less, compared to 33% of registered nurses overall.

Racquet sports were most effective in reducing the risk of premature mortality, reducing the risk by 47%, compared to swimming at 28%, aerobics by 27% and cycling by 15%.  Running, football and rugby had no effect on early death.  The study, from a number of universities around the world, is based on 11 annual health surveys for England and Scotland from 1994 to 2008, with data on over 80,000 people, and published in the British Journal of Sports Medicine.  However other studies have found that runners do live longer and it is thought the smaller numbers involved may have influenced the results (only 68 of 4,012 runners died).  It is suggested that the key message is not that one sport is better than another but that sport in general is beneficial.

Hundreds of hospitals are hosting adverts for personal injury lawyers in patient advice leaflets according to the BBC.  Some companies provide racks of advice cards in return for the advertising on the reverse side of the cards. Hospitals are being paid up to £200,000 a year to display such adverts.  Legal claims against NHS clinical services rose by 27% last year to £1.48bn.

A report on how community pharmacy teams can do more to support the public’s health has been published by the Royal Society for Public Health and Public Health England.  A survey found 74% of pharmacy team respondents felt the sector is underutilised.  Capacity was cited by 51% of respondents as a barrier.  There was also a lack of awareness amongst the public of the range of services on offer with only 51% aware that they provided flu vaccination, 48% emergency hormonal contraception and 44% health checks.

A report on how market structure has affected hospital quality for elective procedures has been published by the Centre for Health Economics at York University.  It looks at hip and knee replacements and coronary artery bypass grafts following the increase in choice in 2006.  It finds that there was a reduction in quality as measured by the likelihood of post-operative emergency admission for hip and knee replacement patients but no effect on quality for coronary bypass patients.


26 November 2016

NHS cuts and staff shortages are putting patients at risk, the TUC has warned in a report, ‘NHS Safety: Warnings from all sides’.  It says that the planned rollout of safe staffing ratios has been halted by the need to make savings. [N.B. the report was initially published on 7th November.]

Community perinatal mental health is being boosted by the allocation of £40m to 20 areas by NHS England.  The money will go on specialist staffing including consultants, specialist nurses, nursery nurses and community peer support via ‘buddying’ and phonelines.  This should increase the number of women able to be supported from the existing 14,000 to 44,000.  One in five women suffer psychological problems such as anxiety, depression or psychosis before or after the birth of their child.  Childbirth related mental health problems are estimated to cost the UK £8.1bn a year.  However the NCT said 300,000 women suffer perinatal mental health problems each year, so there was still much further to go.
(28/11/16) (Rgn)


25 November 2016

Rapidly melting arctic ice could trigger uncontrollable climate change globally, scientists have warned.  Air temperatures in the arctic are currently 20C higher than would be normally expected at this time of year.  Sea ice is at its lowest extent ever recorded for this time of year.  The report identifies 19 possible tipping points where there could be sudden or overwhelming change which has knock on effects on surrounding ecosystems.  Aides to Donald Trump have published plans to end funding for climate change research. [On the plus side, US climate change funding is to be diverted instead into deep space research, so maybe we’ll have somewhere to go when this planet become uninhabitable.]

The number of people going to hospital with malnutrition in England has increased significantly over the last ten years, with an almost trebling of the number of bed days from 65,048 in 2006-7 to 180,528 in 2015-16, according to figures given a parliamentary answer.  This is equivalent to 0.4% of the 47.3m total number of bed days.  There has been a 61% rise in the number of bed days for people with a primary or secondary diagnosis of malnutrition in the last five years.  It is thought that reasons for the increase include rising poverty, big cutbacks in meals on wheels services and inadequate social care support, particularly for older people.  The Department of Health said better data collection may also be a factor.

Lower social status damaged the immune systems of Rhesus macaques, causing damage to the body and increasing the risk of other diseases, in findings which are thought to be highly relevant to humans.  Part of the causes for worse health outcomes for people from poorer backgrounds are behaviours such as smoking, diet and exercise, but those factors don’t feature in these experiments, showing there are other mechanisms at work.  The research, involving 45 monkeys, was published in the journal Science.

Rates of mouth cancer have increased by 68% in the last 20 years, from 8 to 13 cases per 100,000 people between 1993-5 and 2012-14, according to Cancer Research UK.
Press release:


24 November 2016

There is a chronic shortage of hospital beds, the Royal College of Surgeons has warned, after figures published by NHS England showed occupancy at over 89% for the fourth consecutive quarter.  The maximum safe level is considered to be 85%.  More beds are set to disappear under the sustainability and transformation plans.
Press release:

Seven day GP opening had no impact on emergency admissions or out of hours services, according to NHS England’s final evaluation of the first £50m wave of pilots.  Minor illness attendance at A&E’s fell by 14% on average, with reductions in 13 of the 20 pilot areas, with a saving of £1.9m, though this has to be set against the costs of the service.  The report said there were promising results from the ‘hub and spoke’ model of federated practices enabling them to deliver a wider range of services over more hours of the week.

The best rated GP practices are twice as big as the smallest, with the 200 top scoring practices having twice as many patients on their lists as the lowest 200, according to the CQC.  The average list size for outstanding practices is 9,598 while for those assessed as inadequate it is 4,755.  Of the 6,000 practices assessed by the CQC so far, 87% are ‘good’ or ‘outstanding’.

A review extolling the benefits of statins was scientifically misleading and fundamentally flawed, because all the raw data on which it was based, published in a Lancet article, has not been made public, according to a group of experts writing in the Prescriber.

An NHS ‘efficiency map’ that helps identify cost improvement programmes has been published by the Healthcare Financial Management Association and NHS Improvement.  It contains links to a range of tools and guidance to help NHS bodies improve their efficiency.

A report showcasing integrated care of older people with frailty has been published by the Royal College of GPs and the British Geriatrics Society.  It highlights 13 case studies from across the UK.


23 November 2016

No extra money for health or social care was forthcoming in the Chancellor’s autumn statement. The only mention of health was in the oral statement when the Chancellor, Philip Hammond, reiterated the claim of £10bn p.a. extra spending for the NHS in England by the end of the Parliament.  In relation to social care, he said local authorities “have to manage the envelope of resource that they are given.”  However, he said discussions are ongoing in government over social care funding.  Most of the planned welfare cuts are to go ahead.  There was widespread criticism at the lack of any action on health and social care, including the continued 1% cap on wage increases.  Former health secretary Stephen Dorrell said on the Andrew Marr show that he is disappointed that the Chancellor failed to give more money to social care:
Health and social care leaders condemn the lack of investment in social care:
26 Key points of the statement:
The effects on local government: responses:
(24/11/16) Andrew Lansley, LGA and others disappointed at no more money:
(24/11/16) The opposition criticise lack of support for health and social care:
Government list of 25 things announced:
Hansard record of the statement and subsequent discussion:
(26/11/16) The leaders of the main parties at the LGA urge the Government to think again and provide more support for social care:

CCGs overspent their allocations by £236m in the first six months of 2016-17, up from £57m in the first quarter according to NHS England’s second quarter performance report.  Of the 209 CCGs, 84 overspent their allocations.  The year-end forecast is now for an overspend of £190m.  However the position for NHS England has improved, with a projected overspend of £10m by the end of the year, though its deficit in the first half of the year was £168m.  They predict that the whole NHS budget for England, including NHSE, CCGs and providers, will balance by the end of the year.

A report on health across Europe has been published by the OECD and the European Commission, ‘Health at a Glance: Europe 2016’.  Average lifespans have increased, to reach 80 for the first time.  However it says more is needed on prevention, with factors such as obesity, smoking and heavy drinking leading to 550,000 premature deaths across the EU each year from heart attacks, strokes, diabetes, cancer and respiratory diseases at a cost of 0.8% of GDP.  The UK is third worst for the number of doctors at 2.8 per 1,000 people (above only Romania and Poland) and the number of hospital beds at 2.7 beds per 1,000 people, compared to the EU average of 5.2  British mothers spend least time in hospital when they give birth, at 1.5 days compared to the EU average of 3.2 days.  The UK has one of the highest proportions of young people using cocaine and the highest rates of gonorrhoea.  The UK lags behind in terms of cancer survival rates. [Coverage of this story varied considerably in which aspects of the report were picked up.]
Press release:
The report:

Only 18% of GPs think the BMA is doing a good job of representing their interests, while 63% say they are not, out of 1,142 GPs surveyed by Pulse magazine.  The survey also found that 45% of 628 GP Partners would support giving up their NHS contracts to work privately instead if the current situation in general practice does not improve.  70% of GPs think their workload has got worse since the GP Forward View was published in April, with 23% saying ‘no change’, 5% ‘don’t know’ and just 2% ‘got better’.

Air pollution causes 467,000 premature deaths a year in Europe the European Environment Agency has said in a report, ‘Air Quality in Europe – 2016’.
Press release:
Links to the report:

NHS pathology services cannot keep up with the increased demand for cancer tests, Cancer Research UK says in a report.  It says there is a need to address staff shortages in imaging, endoscopy and pathology.  20 of 36 laboratories that responded to a survey had at least one full time equivalent consultant vacancy.
Press release:

Ministers’ use of health statistics should be clearer and more exact, the UK Statistics Authority has said, in response to complaints by Labour and the BMA about the Government presentation of a claim that £10bn a year extra is to be spent on the NHS.  The Authority noted that while NHS England spending is increasing, other elements of the DH budget are decreasing.  They suggest presenting the figures for NHS England and total health spending separately.

Fathers’ psychological and emotional involvement with their child is associated with fewer child behavioural issues later, while there is no link between later behaviour and the amount of time spent on childcare or domestic tasks, according to research from Oxford University involving the parents of 10,440 children living with both parents at the age of eight and 6,000 children at the age of 9 and 11.  The research was published in BMJ Open.  Where fathers scored well on having a positive emotional response to their child, the child was 14% less likely to suffer behavioural problems at age nine and 11% less likely at age eleven after taking account of confounding factors such as the family’s socio-economic status and mental health of the parents.

A rise in deaths during July may have been because of a heatwave, according to an analysis by ONS.  Winter deaths fell back to more normal levels following a 15 year high the previous year.

Guidance on effective interventions to promote healthy behaviours and cognitive health for older adults has been published by Public Health England.

A report on ‘The Failure of Privatised Adult Social Care in England’ has been published by the Centre for Health and the Public Interest.


22 November 2016

The NHS’s finances are no long sustainable, the National Audit Office has said. It says the problems are endemic, with two thirds of trusts in deficit to the tune, overall, of £2.45bn in 2015-16.  They are particularly concerned at the transfer, at the end of last financial year, of £950m from capital to revenue, without assessing the long term risks of this.  They also say that assumptions for how the £22bn of efficiency savings could be found have not been properly tested.

There have been more care home insolvencies than previously thought, according to revised figures from the Insolvency Service.  A total of 380 care homes have been declared insolvent since 2010, that is 98 more than previously thought.  Another indicator of financial pressure is that receiverships are also thought to be increasing.

Private firms should be given a bigger role treating NHS patients, says Stephen Dalton, the chief executive of the NHS Confederation, which represents most of the NHS trusts, but also private providers.  He made the proposals in an article for the Guardian.  Former health ministers Dan Poutler and Norman Lamb said they welcome the role of the private sector, but Poulter noted the tendency of private providers to cherry pick the most profitable services and the danger of it fragmenting the health and care system when there was a need for more integration.
Letters in response to the article:

The proportion of older people with dementia in the US is falling, with the rate having fallen between 2000 and 2012 from 11.6% to 8.8%, according to research based on data on 21,057 people over the age of 65, published in JAMA Internal Medicine.  There was an association between increased educational attainment and some of the decline in dementia prevalence but it is still not clear what the full range of factors contributing to the decline are.
Analysis: is dementia becoming more common or less?

Hospital spending on medicines has nearly doubled since 2010-11 while primary care prescribing costs have remained relatively flat, according to figures from NHS Digital.

An STP governance and engagement checklist has been published by NHS Clinical Commissioners in partnership with the NHS Confederation, National Voices and the Centre for Public Scrutiny.  The questions cover four areas: governance, scrutiny and accountability; system-wide control totals; public engagement; and partnerships and collaborative working.


21 November 2016

Care for older people does not meet demand in many parts of the country according to surveys by the Family and Childcare Trust.  They received foi responses from 182 of the 211 local authorities across the UK.  27% of respondents did not have enough data to say whether the supply of older people’s care in the area could meet demand.  Only 32% of authorities said they had enough nursing homes with dementia support and 48% said they had enough home care.  The area where most authorities said they could meet demand was ‘standard care home’ where 84% said they could meet demand.  [The press release and headlines say that four out of five authorities report not having enough care for older people in their area, but it is not clear where that figure comes from.]

The UK Government must redraft its Air Quality Plan within eight months, the High Court has said, following a ruling against it in a case brought by ClientEarth.  A draft plan has to be produced by 24 April 2017 and a final one by 31 July 2017.

‘Just about managing’ families will be worse off by £2,500 a year by 2020, based on cuts still to go through, according to research by consultancy Policy in Practice, based on 187,000 households in 17 councils in England, Scotland and Wales of different types and political control.  Including the impact of welfare cuts on unemployed households, the weekly loss is £41.45 in real terms, compared to a loss of £13.72 between 2013 and 2016.

Patients may have to show a passport and other identification to get non-urgent hospital treatment, to ensure that non-British residents who should pay for services are appropriately charged, the DH Permanent Secretary Chris Wormald said in response to questions from the Public Accounts Committee.  This would not apply to GP surgeries.  Piloting of the idea is said to be at an early stage with no decisions yet made on whether it should be rolled out nationally.  The BMA said the proposals were disproportionate given the scale of the NHS’s financial problems overall.  It is also feared that it may make access to health care harder for marginalised groups such as homeless people and the 13% of the population without a passport.
(22/11/16) Background information:
(22/11/16) Reactions:
(22/11/16) Reaction:
(23/11/16) Jeremy Corbyn condemns the plans:
(22/11/16) Lots of useful background information:

The STPs (sustainability and transformation plans) may be used as a cover for cuts, the BMA council chair, Dr Mark Porter has said.

Homeopathic products in the U.S. will have to be labelled to say they do not work, unless the producers can provide proof that they are effective, the Federal Trade Commission has said.

A report on how mental health needs assessments can prompt local action has been published by the Centre for Mental Health.  It draws lessons from how five local authorities went about producing their joint strategic needs assessments in relation to mental health.


19 November 2016

Women’s incomes will be twice as hard hit by austerity as men’s by 2020, according to an analysis by independent thinktank the Women’s Budget Group.  Taking into account planned tax and benefit changes it finds that by 2020, women will be £1,003 a year worse off on average while for men the figure is £555.  However women on below average incomes will be £1,678 worse off.


18 November 2016

NHS Trusts’ half year deficit was £648m, or £22m over plan, according to NHS Improvement in its quarterly performance report.  However before technical adjustments and allocations from the sustainability and transformation fund (STF), the deficit was £887m, which was £124m more than planned and on this basis the variance is forecast to be £270m by the end of the year, with a total deficit of £1,067m.  Discounting the STF, the deficit is £70m better than the same stage last year.  The target for the year is for a deficit of £250m (after STF funding), although this has been softened to £580m in the combined ‘control totals’ for trusts.  The Nuffield Trust said that after taking account of the STF, the real projected deficit for the end of the year was more like £2.5bn.  [No, me neither …]  Agency spending was less than the previous year but still above target.

Parity of esteem for mental health is not being achieved, according to the campaign group Equality 4 Mental Health, headed by Alastair Campbell, Norman Lamb and Andrew Mitchell.   Nine former health secretaries – all of those from the last 20 years – have written to the Times expressing their ‘alarm and dismay’ that the government has failed to improve mental health services.  Other signatories include former ministers from three parties and the chair of the Health Select Committee, Sarah Wollaston.

Use of antibiotics has decreased across all health settings and use of broad-spectrum antibiotics in primary care has reduced for the second year running, according to an annual PHE survellance report.  GP antibiotic prescribing decreased by 6% in three years.  74% of antibiotic prescribing is in general practice

Antibiotic resistance continued to rise between 2012-15 across the EU for most of the bacteria and drugs being monitored, with concern that last-line antibiotics for serious pneumonia and blood infections are under threat, according to a report from the European Centre for Disease Prevention and Control.

The Government is to sell a majority stake in NHS Professionals, the health service’s in-house staffing bank.  The limited company was set up in 2010, under the sole ownership of the health secretary.  It is said that the reason is to allow for more investment, [though it is not clear why the Government cannot make that investment, particularly with current low interest rates, and reap the benefits itself in future years.]  Another reason given is to bring in greater expertise and offer operational autonomy.

Hospital beds are being lost, services centralised into specialist units and A&E’s downgraded according to an analysis by the Guardian of the 24 STPs (sustainability and transformation plans) published so far.  It says that opposition to the plans is growing amongst campaign groups, councillors and MPs.  It says that dozens of hospitals are likely to have services removed.  This is said to be to improve care, though making savings is also an important driver.

Concern that mental health patients are not being sufficiently involved in their own care have been expressed by the CQC in its annual monitoring report on the Mental Health Act 1983.  As well as inadequate support for people to be involved in their own care, they say they are concerned that some staff are not following the revised code of practice.

The Scottish Whisky Association is to appeal a decision on minimum unit pricing in Scotland, taking it to the UK Supreme Court following a ruling last month by the Court of Session in Edinburgh that the Scottish Government’s proposals were compatible with EU law.  The decision to appeal has been criticised by health campaigners.

The proportion of teenage mothers has fallen to its lowest level for decades according to a report from ONS on the changing composition of families over time.  The report compares the changes in the number of children women of the same age have had over time.

Seven day health services should only happen if it is decided locally, rather than being a national mandate, the NHS Confederation says in a new report.  It says the NHS can’t afford to provide services for which there is either insufficient demand or where the costs outweigh the benefits.  Local commissioners, providers and their partners are best placed to decide what’s needed in their area.

The economic case for early intervention in perinatal mental health is explored in a report from PSSRU (the Personal Social Services Research Unit), funded by NHS England.


17 November 2016

The number of older people not receiving the social care they need has increased by 48% since 2010 to reach 1.2m people, according to analysis by Age UK.  Of the 1.2m, 697k receive no help at all either from paid carers or family or friends and 487k do not receive enough help.  Research from the BBC suggests that councils agreed to help under half of the 1.3m people who approached them for care last year.

The proportion of care workers on zero hours contracts has risen from one in ten to one in seven in the past year according to data from ONS.  Between April and June this year, about 113,000 of 769,000 people providing care in homes or in care homes were on contracts with no guaranteed hours.  The figures were published as part of a Guardian series on people in precarious work in the UK.

Sales of antibiotics for use in animals are at a four year low, according to figures from Defra, DH and the Vetinary Medicines Directorate.  Sales for use in food-producing animals fell by 10% between 2014 to 2105 from 62 milligrams per kilogram (mg/kg) to 56mg/kg, putting the UK on track to hit its target of 50mg/kg by 2018.
Press release:

Numerical targets for adoptions are being used by at least 12 councils in England, according to information from freedom of information requests by the Transparency Project.  There was no evidence that individual social workers were performance managed by reference to targets.  There was a concern, though, that such targets could have an indirect effect on decisions.  There was evidence that targets were not being used in 17 English councils.  There were national adoption targets between 2000 and 2008.
(13/12/16) Feature article:
(14/12/16) Letters:

More money is needed for the NHS than the promised £8bn a year extra by 2020, the chief executive of NHS Providers, Chris Hopson has said in a submission to the Treasury before next week’s autumn statement.  He says more is needed because social care has deteriorated, health demand has increased, general practice is more unstable than thought and the starting deficit amongst provider trusts was larger than allowed for in the initial assumptions in the Five Year Forward View.  Also, the overall health budget was only rising by £4.5bn rather than £8bn because of cuts in other areas such as public health.  The aim of finding £22bn efficiency savings had always been too ambitious.

CCG spending on child mental health varies dramatically across the country, from £2 for each of the area’s under 18’s by the Luton CCG to £135 by the Birmingham South and Central CCG, according to an analysis by the Royal College of Psychiatrists.  Twenty five of the 209 CCGs are spending £25 a head or less.

Nursing associates will not be able to independently administer drugs after all, except within the confines of local employer policies, according to the final version of the curriculum for the new role, contrary to an earlier, leaked version.

Data which could be used to help diagnose dementia has been gathered from a computer game, showing that people’s ability to navigate declines with age.  The game, Sea Hero Quest was funded by Deutsche Telekom and designed by Glitchers and has allowed data to be collected from 2.4m people.  The results were presented at the Neuroscience 2016 conference.  In a part of the game that indicated sense of direction, 74% of 19 year olds were accurate but only 46% of 75 year olds were.


16 November 2016

The NHS is treating more patients than ever before while under great financial pressure as it heads into the winter, according to the King’s Fund’s quarterly monitoring report.  Emergency admissions are 4% higher than the same quarter last year while GP referrals were up by 3%.  There was a 10% increase in GPs’ patient contacts over the last two years according to data from over 200 practices (included for the first time).  Nearly a third of NHS trusts think they will miss their control totals, up from 13% in the previous quarter.  Most CCGs are forecasting surpluses but 70% say they are concerned about meeting efficiency targets.
Press release:
The report:

Commercial and procurement skills in the NHS are lacking and should be addressed by NHS England and NHS Improvement, the Public Accounts Committee says in a damning report on the Cambridgeshire and Peterborough CCG’s failed partnership with UnitedCare.  It accuses the CCG of trying to outsource its responsibility for commissioning local health services.  Meg Hillier, the chair of the committee, said the failure of business acumen “would embarrass a child in a sweet shop.”

Black women in England are almost twice as likely to be diagnosed with advanced breast cancer as white women according to an analysis by Cancer Research UK and Public Health England.  Among the reasons are low awareness of symptoms and screening.

Stop smoking services were cut in a sixth (59%) of local authorities in the last year according to a report from ASH and Cancer Research UK.  The amount of staff time dedicated to tobacco control fell in 43% of authorities.

British children are among the least active in the world, according to report cards drawn up by the Active Healthy Kids Global Alliance for 38 countries in six continents, presented to the International Congress on Physical Activity and Public Health in Bangkok and published in the Journal of Physical Activity and Health.  For each of nine dimensions it gives a score from A to F in quintile bands (so A is ‘we are succeeding with over 80% of children and young people’, while F is less than 20%).  For overall physical activity, England scores D- while the average was D.  Scotland was on the lowest grade of F.  In 2014, England scored C-D.  Common to the most active countries were cultural norms, so being active was not a choice but a way of life.
(20/11/16) Press release:
Link to interactive map and other resources:

Homecare workers do not have enough dementia training, with 38% having no dementia training and 71% no accredited dementia training according to to research by the Alzheimer’s Society which included freedom of information requests to all local authorities in England and a survey of over 1220 people with dementia.  49% of people affected by dementia do not think ‘homecare workers understand the specific needs of people with dementia’ and only 2% say homecare workers have enough dementia training.

A ban on anyone in a mental health crisis being held in a police cell is to be proposed in an amendment to the Policing and Crime Bill in the House of Lords strengthening the existing proposal in the bill applying to under 18’s.

Whistleblowing guidance for staff in primary care has been published by NHS England.

A report on digital technology in the NHS has been published by the Nuffield Trust.  They say that tools such as apps are already transforming patient care and have great potential in the long run.  However, there are also pitfalls.  Many available apps have not been properly tested.  The ‘people’ side of technology also needs to be addressed including supporting people to use the new technology and redesigning systems.  It suggests there are unlikely to be big savings in the short term.


15 November 2016

A report on children’s mental health says allocated funds are not reaching the front line, with only £75m reaching CCGs, of £143 allocated in the first year out of a promised £250m a year over the course of the parliament.  The report, ‘Time to Deliver’ is the result of a year’s work by the Education Policy Institute Independent Commission on Children and Young People’s Mental Health, chaired by Norman Lamb.  The report says specialists are turning away 23% of children and young people referred to them, with high thresholds for accessing care.  It found that 67% of 16-34 year olds who had attempted suicide had not subsequently received medical or psychological help.  It says a significant hindrance to progress is a lack of engagement between health services and schools.  It calls for a ‘prime minister’s challenge’ equivalent to that on dementia.  This is the third in a series of reports from the commission since April.

Experience of community mental health services has not improved in the last year, with 65% of people rating their experience of care as 7 or above on a 0-10 scale according to the CQC’s 2016 survey involving feedback from 13,200 adults receiving treatment from 58 providers of mental health services in England, published alongside an ‘overall patient experience score’ published by NHS England. A quarter of people who suffered a crisis in the last 12 months said they couldn’t get help.  The CQC said it was ‘deeply concerned’ about the lack of improvement.
(16/11/16) (£)

Support for breast feeding is worse in England than the other UK countries, according to information for each of the UK countries published by the World Breastfeeding Trends Initiative (WBTi) which consists of 18 organisations including government agencies, health professional bodies and voluntary groups.  (Similar report cards have been published at other times for 113 countries).  For the score on national policy and co-ordination, England scored 1 out of 10, Wales 4 and Scotland and Northern Ireland 10.  It recommends a range of actions necessary to meet the UNICEF Baby Friendly Initiative standards including giving mothers breaks to breastfeed at work.  Only 1% of babies in the UK are exclusively breastfed at six months, but 63% of those who had stopped breastfeeding by 6-8 months said they would have liked to continue longer.
(24/11/16) (Rgn)
Link to press release and full report:

Having more professional nurses rather than assistants reduces the risk of patient death, after undergoing surgery, with the replacement of a qualified nurse by a nursing assistant on a ward of 25 patients increasing the risk of a patient dying by 21%, according to research involving data on 13,077 nurses in 243 hospitals across six countries, published in BMJ Quality and Safety.  The study is relevant to the forthcoming introduction of nursing associates in England.  However the Department of Health said nursing associates would complement rather than replace existing nurses and nursing care support workers.  NHS Choices points out that this is a cross-country study with many confounding factors making it hard to interpret and with no proof of causation.

A task-based weight loss programme based on CBT techniques was more effetive than a standard, nurse-led approach, according to NIHR funded research by Queen Mary University based on 330 patients in two GP practices in East London.  The Weight Action Programme led to an average weight loss of 4.2kg after a year, compared to 2.3kg in the nurse-led approach.  It was more cost-effective at £7,742 per QALY, though both were deemed highly cost-effective on NICE criteria.

A quarter (27%) of women invited to cervical cancer screening failed to attend in 2015-16, according to figures from NHS digital.  The statistics are for women aged 25-64.  The 72.7% attending was down from 73.5% the previous year and 75.7% the year before that.

The Chancellor has replied to the Health Select Committee defending the use of the £10bn figure for increased spending on the NHS by 2020-21.

The new nursing associate role has been defended by the four most senior nurses in England, who also said, in a statement, that they thought the role should be regulated.

A report on how cities can encourage walking has been published by Arup.  It suggests 40 actions that city leaders can consider to inform walking policy, strategy and design.

Resources to help put people and communities at the heart of health and wellbeing have been published by Nesta for the Realising the Value programme, funded by NHS England to support delivery of the Five Year Forward View.

A series of essays on place based leadership have been published by the New Local Government Network.


14 November 2016

Nearly 30% of child trafficking victims disappeared from care services in one year, that is 167 of 590 children, although the true position is not known because of the lack of data collection by many local authorities, according to research from two organisations, Ecpat UK and Missing People.  When unaccompanied children are included, the figures are much larger with 760 trafficked or unaccompanied children having disappeared of whom 207 have never been found.  The information is drawn largely from freedom of information requests to 217 local authorities.  It found that the child protection response to child victims of trafficking was ‘inadequate’ and more training was needed.

The development of STPs (sustainability and transformation plans) has largely excluded patients, the public and front line staff, an analysis by the King’s Fund says.  Other findings included that: involvement of local government has been patchy; there is a confused process with unclear or changing deadlines and instructions; and there is a lack of formal authority for STP leaders.  Twelve plans have now been published or leaked.  The report also says that some managers interviewed felt that the process had created an industry for management consultants. It also notes that “reconfigurations of acute services rarely save money”.  King’s Fund chief executive Chris Ham is quoted as saying that there is mixed evidence at best that moving services closer to home improves care.  NHS England said that half of the plans should be published by the end of the week.
Sir Bruce Keogh says the proposed changes are common sense and overdue:
Press release:
The publication:

Stroke patients are not receiving good enough care in nearly a third of hospitals, according to the Sentinel Stroke Audit Programme conducted by the Royal College of Physicians. It found that 62 hospitals out of 228 scored a D and 12 scored the bottom rating of E.

Childline calls for help about online abuse have risen by 88% in five years, according to the NSPCC.  The number of counselling sessions rose from 2,410 in 2011-12 to 4,541 in 2015-16.  The charity released the figures at the start of anti-bullying week.

Nearly a quarter of a million people (242k) waited over two weeks for their unemployment benefit to be processed in the last year, with 90,000 people waiting more than three weeks, according to a parliamentary answer to Frank Field M.P.  He called on ministers to set a new, five day target for processing benefit claims so as to reduce the number of people having to resort to food banks.  Campaigners are also worried about the in-built delay of 42 days for processing universal credit payments.

12% of Britons are suffering from a serious health problem that could have been prevented if they had seen a doctor earlier, according to a survey of 2,000 people for Channel 5’s ‘GPs: Behind Closed Doors’.  It also found that 57% of people had put off seeing their GP about health concerns for fear of what they might find out and 40% put off seeing a doctor in the hope that the problem would go away of its own accord.

Dementia has overtaken heart disease as the leading cause of death according to latest ONS figures.  Overall, 11.6% of people died from dementia in 2015-16, though for women the figure was 15.2%, while for men heart disease remained the leading cause.  When different sorts of cancer are combined, that is still the most common cause of death overall.

People diagnosing their own illnesses is dangerous and could lead to the wrong treatment, the Royal Pharmaceutical Society has said.  A survey of 2,046 Britons by YouGov for the society found 78% had sought medical advice from the internet when they wanted to know what was wrong with them, 51% of adults self-diagnosed their ailment and 43% said they had used painkillers not prescribed for them.  The society said severe pain should always be thoroughly investigated by a doctor.
Press release:

A report on patient choice with GP input has been published by the IFS, finding that patients defer to GPs when assessing hospital quality and that GPs consider both quality and financial considerations.


13 November 2016

Young people are still being treated on adult psychiatric wards despite the practice being outlawed in 2010, according to figures from NHS Digital analysed by the Guardian.  In July, there were 47 children and young people aged 17 or under treated on adult wards.  That includes 8 aged 15 or under, who are supposed never to be placed on such wards (while 16 and 17 year olds can be under exceptional circumstances).

Only one person has been fined for smoking in a car with children, in the year since the law was introduced, according to responses to freedom of information requests made by the Press Association to 42 police forces in England and Wales.  The Department of Health said the aim of the law was to change attitudes and behaviour rather than see a large number of people fined.


12 November 2016

More money for social care is being called for by senior Tories, as well as local government and the NHS, with Jeremy Hunt and the Department for Communities and Local Government said to be in favour.  As well as the direct benefits, they say the spending is needed to reduce demand on the NHS.  It is believed the Chancellor could increase spending by between £700m and £1.5bn from next April.

People with a sore throat are to be encouraged to visit a pharmacist rather than a GP, so they can have a swab taken to see whether they should have an antibiotic or if the infection is viral, NHS England has announced.  The results take just five minutes to come through.  The Sore Throat Test and Treat service has been piloted in 35 Boots pharmacies.  The scheme is to be rolled out across England over the coming year.  Initial results showed that of 360 people taking part, only 36 were given a prescription.  The service could save the NHS £35m a year, reducing the number of GP consultations by 800,000.  However the pharmacy industry said cuts could threaten the service. The initiative is part of the NHS innovation accelerator scheme.  The scheme has been criticised as being based on too little evidence and risking encouraging antibiotic use rather than self-care.
(15/11/16) Opinion piece suggesting there is not good evidence for this apprroach:

The denigration of general practice in medical schools needs to be combatted, according to a review by Health Education England which found issues of ‘tribalism, negativity and finance’ which means students perceive primary care to be of lower status.  It says there should be more funding to allow GP trainers to teach in medical schools and there should be a greater focus in medical school curricula on integrated rather than specialist medicine.

Banning junk food advertising before 9pm is the biggest priority for tackling childhood obesity, according to a study by the Food Foundation, a group of 73 health experts from 41 organisations.  It identifies priorities through a new Food Environment Policy Index which it has created.  There should also be a ban on sponsorships by those companies in sporting events such as the Olympics.  The second priority they identified was implementing the sugar tax, which is due to go ahead in 2018.  The third was to reduce the sugar, fat and salt in processed food.

Very stressful events affect the brains of girls and boys in different ways, according to research by Stanford University, which involved scanning the brains of 59 children aged 9-17.  It was published in the journal Depression and Anxiety.  An area of the brain called the insula was found to be smaller in traumatised girls but larger in boys who had suffered trauma.  Girls are more likely than boys to suffer PTSD.


11 November 2016

Virgin Care has been awarded a contract for community health and care services in Bath and North East Somerset worth £70m a year for up to ten years.  The contract was awarded by the council and local CCG, with a start date of 1st April.  The contract is for three statutory services, adult social care, continuing healthcare and children’s community health, covering 200 health and care services such as those for people with diabetes, dementia, mental health conditions, children with learning disabilities and the rehabilitation of frail, eldelry people.  This is said to be the first time a council’s core adult social care services will be delivered by a for-profit private firm.  The company was announced as the preferred bidder in August.

Many vulnerable older people are not getting the care they need, according to a report from Unison, ‘Damage: Care in Crisis’, based on a survey of 1,000 staff working in homecare, residential support and day services.  65% of respondents said they are working alongside fewer staff than six years ago and 63% said they have less time to spend with those they are caring for because of staff shortages.


10 November 2016

The monthly NHS performance figures show delayed discharges were at the highest ever level for the sixth month in a row.  This costs the NHS £800m a year.  The proportion of delays attributable to social care was 34%, up from 30% the previous year, with the rest attributable to the NHS and social care.  Other targets missed included: the four hour A&E wait; referral to treatment within 18 weeks; cancer patients beginning treatment within 62 days; and ambulance red 1 and red 2 responses.

A referendum on increasing council tax by 10% may be held by Liverpool City Council, depending on the outcome of initial soundings.  This would be the first such referendum which government requires for any increases over 2%.  Even if it goes ahead and is passed, the Council faces having to make drastic cuts, with increased income coming in only from 2018.  They are to test the idea of a referendum through an online budget simulator.  Government grants have reduced from 80% to 58% of the council’s budget.

The junior doctors have withdrawn the threat of strike action, saying they would ‘end the current mandate for industrial action’ and would instead engage with the Government and NHS Employers over the implementation of the new contract and would continue to raise any additional issues.  They said they wanted to hold the Government and employers to account for commitments on safe working, training and wider morale and workforce issues.

Being a scout or guide as a child is associated with a lower risk of mental illness later in life, with 21% of former scouts or guides suffering from anxiety or mood disorders at the age of 50, compared to 25% of others, a difference of 15%, according to research from Edinburgh and Glasgow universities based on data on almost 10,000 people born in 1958, part of the National Child Development Study, and published in the Journal of Epidemiology and Community Health.  About a quarter of the participants had been in the scouts or guides.  The reduction in the risk of mental illness also applied to people from poorer backgrounds.  It may be that they developed skills of self-reliance and teamwork which helped build resilience against common stresses later in life, or it could be that they increased the chances of achieving more and so made them less likely to experience stresses.  The same benefits were not seen from participation in other volunteering or church groups.
Pages for the National Child Development Study:
The journal article (pdf):

NHS England does have the power to fund the preventive HIV drug Prep, the Court of Appeal has ruled.  NHS England had argued that local authorities should pay for the drug given their responsibility for prevention through public health.  NHS England said they would now decide whether to fund the drug.  The ruling could also have implications for the funding of other preventive treatments, with decisions on nine other treatments having been put on hold pending the outcome of the case.
NHS England response:

Adult social care complaints and enquiries to the Local Government Ombudsman grew by 6% in 2015-16 compared to the previous year, to 2,969, with increases of 21% about residential care homes and 25% relating to home care.  Of those, the LGO investigated 1,115 of which 58% were upheld, compared to 55% the previous year.

Degree level nursing apprenticeships are to start from September 2017 with £4.5m of funding to four universities, the Government has confirmed.  This is part of 5,200 new degree level apprenticeships across a range of sectors.  The apprenticeships are designed as an alternative to traditional courses with part of the time spent at university and the other part with an employer.

Flavoured e-cigarettes produce unacceptably dangerous levels of carcinogenic toxins, according to researchers in Nevada, based on tests on three different types of e-cigarette and five flavours.  The research was published in Environmental Science and Technology.

A checklist to ensure housing issues have been considered in local health plans has been published by PHE.


09 November 2016

NHS trusts in England are projected to overspend their budgets by £850m this year according to figures provided to the Health Service Journal by 232 of the 237 trusts.  The target, set out in the ‘reset’ in the summer was for an overspend of £250m, although the combined trust plans are for a deficit of £580m.  Those figures are lower than they would otherwise be, though, because of £1.8bn additional funding this year from the sustainability and transformation fund.  Without that, the providers overspent by £1.56bn in the first six months of the year, which was slightly down on the £1.61bn last year.  NHS Improvement chief executive Jim Mackey said the deficit was likely to be ‘around the mid-£600m mark’.

Two families have won their appeal against the bedroom tax in the supreme court, but five other claimants had their challenges dismissed.  In one of the successful cases, an extra room was needed because the couple couldn’t share a bedroom because of the claimant’s disabilities (which is already a valid reason for an extra room for children) while in the other, an additional room was needed for a carer.  In six of the seven cases it was claimed an extra room was needed because of the disability of a family member.  The rejected cases included one where the claimant, a vulnerable, single mother, whose life was at risk because of domestic violence, had had her home adapted by the police, but would now have to move out.  In the other four rejected cases the judges said that while there had been discrimination it was not directly related to a disability but rather to a social need.
More detail about the cases:
(11/11/16) Feature article:

Sugared drinks in hospitals could be limited by having either a ‘tax’ or a total ban on them, under a consultation from NHS England, as a way to make such provision more healthy in hospitals.  The consultation runs until 18th January.  Trials in four NHS hospitals show that either option could work.  A 20% tax on sugared drinks could raise £20m-£40m a year, which would be put into patient charities and health and wellbeing programmes.  It is suggested that the measures would apply to any drinks to which sugar is added, including fruit juices, milk based drinks and coffees, so they would be wider than the Government’s sugar tax which will only apply to soft drinks.
Press release:
The consultation:

NHS admissions rose by 30% in the ten years to 2015-16, compared to a population growth of 8%, according to figures from NHS Digital.  The average age of admission rose over that period from 49 to 53.  The age group (in five year bands) with the highest number of hospital admissions were 65-69 year olds.

Babies delivered by midwives made up only half (53%) of those born in hospitals in England last year, which follows a steady decline from the 75.6% in 1989-90, according to figures from NHS digital.  In the last ten years, the proportion of spontaneous deliveries fell from 64.8% to 60.0% and the number of caesarians rose from 24.1% to 27.1%.  The number of deliveries to mothers under 20 almost halved over those ten years, from 43,572 to 22,032 in 2015-16.  The proportion of deliveries to women over 40 rose by 21.5% from 20,530 in 2005-6 to 24,942 in 2015-16.

An updated menu of local preventive health interventions has been published by Public Health England,   It looks at possible interventions in 14 topic areas with an overview of the evidence and a more detailed description of two in each area.  It identifies at least six interventions that are estimated to produce a positive return on investment over five years: alcohol, identification and brief advice; alcohol care teams in secondary care; tobacco screening, advice and referral; hypertension management in primary care; increased uptake of long-acting reversible contraceptives; and for falls, implementing a fracture liaison service.


08 November 2016

Government plans to allow ministers to disapply children’s legislation for particular councils have been defeated by the House of Lords. Clause 29 of the Children and Social Work Bill, which would allow ministers to approve councils’ requests to opt out of legal obligations to vulnerable children, in order to promote innovation, were defeated by 245 votes to 213.  The Government will now have to decide whether to reintroduce the measures in the Commons.  The proposals had been widely criticised including by social workers and the Education Select Committee.

Social care in England is facing a £1.9bn funding gap next year, according to a joint submission in relation to the autumn statement by the King’s Fund, the Nuffield Trust and the Health Foundation.  They say that the cuts are so severe that families may take legal action against councils.  The number of people getting care help from their council fell by 26% to 850,000 in the four years to 2104.  It is suggested that the pressures will lead to longer NHS waiting times.  They also say that additional funding will be needed for the NHS in future years, with demand peaking in 2018-19 and 2019-20, when there is almost no real terms increase in funding.
Press release:
The briefing document:

The Trussell Trust is on course to deliver its highest ever number of food parcels this year it has said.  They gave out 519,000 food parcels in the six months April-September, compared to 1.1m given out last year.  It said that the biggest single reason why people were signposted to food banks were problems with social security payments such as administrative delays and benefit sanctions.

Meals on wheels are being provided by less than half of councils, with the proportion of single tier and county councils providing them having fallen to 48%, from 66% in 2014 according to research commissioned by the National Association of Care Catering from the Association for Public Service Excellence.

Adult social care budgets in county councils are under great pressure with 88% of directors saying their budgets were ‘severe’ or ‘critical’ and only 12% saying they were ‘manageable’ according to a survey by the County Councils Network for a report, ‘Delivering Adult Social Care in Challenging Times’.  It also found that only one in five directors believe STPs (sustainability and transformation plans) will fulfil their objective of ensuring services are sustainable in the coming years.

Mental health assessments would be required for all children and young people going into care, if an amendment to the Children and Social Work Bill being tabled by Liberal Democrat peer, Claire Tyler, is passed.  There is already a requirement for a physical health check.  Children in care are much more likely than others to develop mental health problems.

The rates of child poverty vary considerably across the country according to an analysis by the End Child Poverty Coalition.  The local authority with the highest proportion of children in poverty was 43.5% with Wokingham having the lowest level at 10.4%.

Better use of occupational therapists could save thousands of bed days a year, according to a report from the College of Occupational Therapists.  A pilot project in a Cardiff hospital, where assessments were made by a frail older person’s assessment and liaison team, saved over 15,000 bed days a year and almost £1m.  (This report is in relation to Wales, with ones for the other UK nations following over later days, with that for England due on 16th November).

A shortage of radiologists could lead to delays in breast cancer diagnosis, according to two reports, one from the Royal College of Radiologists and another from the breast cancer screening programme.  The first said that 8% of consultant posts in NHS breast radiology services are unfilled.  The second said that 15% of posts of radiographers who carry out mammograms are unfilled.

Residential and nursing home care is being damaged by staff shortages and poor access to training, according to an analysis of 100 inspection reports by Community Care and Unison.


07 November 2016

The Government’s austerity policies amount to “systematic violations” of the rights of people with disabilities, according to a United Nations’ enquiry.  Cuts to benefits such as personal independence payments and the independent living fund had hindered disabled people’s rights to live independently.  The bedroom tax and other cuts to housing support had disproportionately impacted on disabled people in terms of debt and eviction.  The report criticised the way disabled people are assessed for social security benefits.  The inquiry report is based on an 11 day visit by two UN envoys in October 2015 including meetings with over 200 officials, MPs, activists and academics.  In 2007, the UK signed the UN convention on the rights of people with disabilities which gives the right to live independently, to work and enjoy social protection without discrimination.  The UK Government rejected the report, saying its findings presented an inaccurate picture of life for disabled people in the UK.  DWP Secretary Damian Green described the report as “patronising and offensive”.

Fundamental changes are needed to mental health services for children and adolescents, with the mental health workforce often feeling excluded and devalued, according to a report by a commission set up by the Royal College of Psychiatrists, the charity Young Minds and the Children and Young People’s Mental Health Coalition.  It makes ten recommendations including that: schools should be able to teach about mental health; mental health impact assessments should be made on education and other government policy; and schools should be able to identify mental health issues and easily signpost pupils to relevant support.  The Commission found services were disjointed, especially in involving schools in improving mental health.

The nationally increased mental health allocations have not been passed on to providers by 46 of 209 CCGs with 8 cutting their budgets, according to an analysis by HSJ of figures from NHS England in the new mental health dashboard.

Cancer targets for diagnosis and treatment were not being met for over 132,000 people a year, according to analysis of the official figures by Cancer Research UK.  This is made up of 101k with suspected cancer not seeing a specialist within 14 days, 7k not receiving their first treatment within 31 days and 24k not treated within 62 days after an urgent referral.

Problems with Capita’s support services for GPs have been set out by the GPs’ Committee of the BMA before a parliamentary debate on the issue.  A snapshot survey of 281 practices found that: 81% of urgent requests for records were not actioned within three weeks; 58% of practices said new patient registrations weren’t processed within the required three days; 31% said they had received incorrect patient records; and 28% had not had records collected or delivered on the agreed date.  A government minister said Capita should consider compensating practices for the financial detriment they have suffered as a result of problems with the service.

Tesco has cut the amount of sugar in its own brand soft drinks, with 50 products having the sugar cut to below 5g per 100ml, as part of a reformulation of its 251 products begun in 2011.  This will bring them below the level of the new soft drinks levy due to come into force in 2018.

18% of people with cancer face discrimination from employers or colleagues on return to work, according to research by the charity Macmillan Cancer Support based on a survey of 1,009 patients, all of whom were in work at the time of diagnosis.  It found that 15% returned to work before feeling ready and 14% gave up work or were made redundant as a result.


06 November 2016

Jeremy Hunt has played down the extent of the NHS’s financial crisis, saying it’s ‘not just about the money’ on the Andrew Marr show.  He admitted more money was needed, but said that that was why they were ‘putting in £4bn more’, but said that it was not just about the money but also about standards.

Hospital superbugs are to be targeted by a series of measures, such as a renewed focus on handwashing (including publishing data on the cleanliness of doctors’ and nurses’ hands), the publication of E. coli rates in hospital wards and publishing data on prescriptions to see which trusts are correctly prescribing antibiotics, the Government has announced.  While MRSA and C. diff have been reducing in the last decade, instances of E. coli have increased by 20% in five years, to 40,000 cases a year, killing more than 5,500 people last year.  It accounts for nearly two thirds of antibiotic infections.  A new national infection tsar, Dr. Ruth May, has been appointed.


05 November 2016

Men are less likely than women to seek help for a mental health problem, with 28% of men saying they had not sought medical help compared to 19% of women, in a YouGov survey of 2,500 people with mental health problems for the Mental Health Foundation.  It also found that a third of women, compared to a quarter of men, had told family and friends about a mental health problem within a month of it arising.–mental-health

Patients need help in how to look after themselves rather than going to the GP or A&E, according to a report from the LGA, ‘Helping People Look After Themselves’.  They say that one in five GP appointments are for ailments that people could treat themselves such as a runny nose, back pain or colic in children.  They say such minor conditions cost the NHS £2bn a year.  The LGA suggests patients should see a pharmacist or get advice from the NHS Choices website for minor ailments.  They suggest GPs could help educate people, including those with long term conditions, to self-manage their health care.  Self-care week runs from 14th to 20th November.
Press release:


04 November 2016

Children need to be protected from the digital marketing of junk food, according to a report from the WHO.  There is increasingly sophisticated targeting of children, for instance by location and behaviour, in games, social media and by vloggers (video bloggers).  Methods include making fast food outlets game locations or paying vloggers who are perceived to have greater authenticity.  Such advertising is typically not regulated like tv advertising and is generally invisible to parents.
Press release:
The report:

E-cigarettes’ ability to help people stop smoking is unproven and countries should consider curbing their use according to a WHO report, published before a major international meeting in India.  However, the public health community is split on the issue, with some arguing that e-cigarettes help people quit while others argue that they are a ‘stalking horse’ for ‘big toboacco’.

Dr Ellen McCourt has resigned as chair of the BMA’s junior doctors’ committee, saying her position had become untenable following criticism after five day long strikes were called and then called off.  She is to be replaced by her deputy, Dr Pete Campbell, a Momentum supporter.  The Mail reports that the committee voted to abondon further strikes and return to negotiations.

There has been an increase in the number of child protection cases, with the number subject to the initial, Section 47 enquiries rising by 7.6% from 160,200 in 2014-15 to 172,290 in 2015-16, according to the Department for Education’s annual characteristics of children in need publication.  The number subject to an initial stage child protection conference rose by 2.3% from 71,400 to 73,050.  However, referrals to children’s social care fell by 2.2% and there were increases in the number of cases where it was decided there should be no further action.

A report on how the healthcare system serves patients with multliple long term conditions has been published by the Royal College of GPs.  It highlights a number of gaps in their health care.


03 November 2016

To relieve pressure on A&E’s, the government needs to address the underfunding of adult social care, the Health Select Committee has said in a report on winter planning in A&E units.  It also said more needs to be done on staffing of such units.  The committee also blamed variations in meeting the 4 hours waiting time target on how trusts manage patient flows in the hospital.  It was also noted that the NHS has among the lowest number of beds per population in Europe.
The report (html):

Theresa May must seriously reconsider the NHS budget, Meg Hillier, Chair of the Public Accounts Committee has said in a letter to her.  She said the prime minister was in denial about the NHS’s financial problems and said the numbers ‘just do not add up’.  Noting the letter sent earlier in the week by Dr Sarah Wollaston MP, chair of the Health Select Committee, Hillier said she “was dismayed that the official government response was to deny there was any issue.”  Noting that NHS whistleblowers often find themselves never working there again, she feared there was a reluctance to talk truth to those in power, extending right up to No. 10.

The new social work regulatory body would have to have any standards it developed approved by ministers (the education and health secretaries), despite the government recently dropping its aim of having a government controlled body and agreeing that it could be independent.  The first chief executive could be appointed by the secretaries of state and all subsequent appointments would have to be approved by the government.  The details were set out in an amendment to the Children and Social Work Bill.  The new body is provisionally to be called Social Work England.  The children’s minister, Edward Timpson, said he wants to hear social workers’ ideas on a professional body to complement the regulatory organisation.

The number of 18-24 year old heroin addicts entering treatment has fallen by 79% in ten years, as the drug has become more unfashionable according to statistics from the National Drug Treatment Monitoring System.  The number accessing treatment from this age group for any addiction fell by 37% over ten years.  The number of all adult opiate users has fallen by 12% since a peak in 2009-10, from 170,000 to 150,000.  Overall, 289,000 adults came into contact with structured treatment for drug addiction in 2015-16, 52% for heroin or another opiate, 21% for alcohol and 19% for cannabis.  For the 13,000 under 25’s coming into contact with the services, the biggest problems were cannabis at 54%, alcohol, 44% and cocaine, 24%.

Children’s obesity levels rose slightly last year after a small fall in 2014-15, with 9.3% of four and five year olds in reception classes in England in 2015-16 classed as obese, compared to 9.1% the previous year according to figures from NHS Digital.  The figures are collected through the National Child Measurement Programme.  For those in year six, the final year of primary school the increase was from 19.1% to 19.8%.  The difference between the most and least deprived areas was, for reception class, 12.5% to 5.5% and for year six children, 26% to 11.7%.

Two STPs have been rejected by the seven councils involved. Hammersmith and Fulham and Ealing councils have rejected the north west London STP (sustainability and transformation plan), because they object to the proposed downgrading of Charing Cross Hospital.  Meanwhile, five authorities in West Yorkshire – Leeds, Bradford, Kirklees, Calderdale and Wakefield – said in a letter to NHS England, that while they mostly supported the West Yorkshire and Harrogate STP, they could not endorse it because the high level outcomes had not been discussed with various council officers and it had not been through any formal council forums.  The social care minister David Mowat has said that the Government wouldn’t sign off STPs if they didn’t address councils’ social care needs.
(05/11/16) Feature article;

The NHS’s complex and confusing structure is hindering its ability to meet its challenges, according to a review by consultants PwC, chaired by former health secretary Alan Milburn.  The report, ‘Redrawing the Health and Social Care Architecture’ drew on a survey of over 1,000 NHS staff and 2,000 members of the public in England.  It said there should be an evolution of structures, with a gradual merging of national bodies, and new, democratically accountable regional bodies with the budgets for both NHS and council run services.  It suggested such changes could take up to a decade.  The DH said there was no need for reform as plans were being delivered within existing structures.

The cost of looking after asylum seeking children is only being half met by the government, with councils having to pay for the rest, according to a report from the Association of Directors of Children’s Services.  This could leave councils facing costs of £3.4m per 100 children.

The Children and Social Work Bill has been criticised by Labour’s shadow children’s minister, Emma Lewell-Buck, who said it was “one of the most dangerous pieces of legislation” she has seen in her time as an MP.  She said that the power to release councils from statutory obligations would not address the barriers faced by social workers, with many of the inhibitive burdens being in secondary legislation.  She said the government was not getting the basics right such as reducing caseloads, preventing social workers leaving the profession and training them holistically.  One of the overriding problems was increased demand because of the cuts to services as part of austerity measures.

Creating county-wide unitary authorities could save £2.9bn nationally over five years, according to a study by consultants EY for the County Councils Network.  Splitting the counties into two unitaries would save between £1.2bn and £1.7bn.  Other options would not produce a net saving.

A report on ‘A New Public Service Ethos’ has been published by right of centre think tank Localis, sponsored by Grant Thornton UK LLP.  It found that council and NHS staff see the characteristics of the public service ethos as: accountability; community responsibility; customer service; and integrity.  The report suggests there is a misalignment of culture between public and private sector organisations creating suspicion of the private sector in the public sector.  It suggests the public have not seen a decline in service quality.  It suggests that private sector companies that have been working in the public sector for decades have assimilated social justice values.


02 November 2016

The Government has breached air pollution rules and failed to take enough action on emissions, the High Court has ruled, in a case brought by the environmental legal group ClientEarth.  The judge said that Defra had knowlingly relied on an optimistic forecast as a basis for their modelling and was wrong to decide only to comply with the law by 2020 (or 2025 in London) saying the Environment Secretary should aim for compliance as soon as possible.  Around 40,000 people die a year in the UK as a result of air pollution according to government estimates.

A deficit in adult social care of £441m this year is being predicted by Directors of Adult Social Services according to the responses of 129 out of 152 (84%) of them in an ADASS survey.  Other findings were that 62% of councils have had residential and nursing home closures and 57% have had care providers handing back contracts in the last six months.  Various pressures from the NHS were reported, with 68% of directors having discussions about reductions in NHS funded continuing healthcare, 57% reporting high demand from people with very high support needs not being admitted to hospital and 56% saying social care staff were being expected to undertake health duties.
Press release:

Social care services face an ‘existential crisis’, according to a ‘State of the Nation’ report by the LGA.  Two thirds (62%) of people think social care should receive a higher proportion of health and care spending according to a survey by Populus Data Solutions for the LGA.  The report suggests that the service is in crisis because of cuts, the ageing population, rising costs and the difficulties of recruiting staff.  The report is a series of essays by sector leaders and experts.
Press release:
Link to the report:

NHS Improvement’s rating system for NHS trusts does not align with the CQC’s, the HSJ reports, based on the CQC’s response to NHSI proposals, obtained through a freedom of information request.  The CQC said that NHSI’s system risked ‘creating a parallel definition of success’.  The NHSI financial measures would not be suitable for the CQC, though they were intending to work together to develop new ones.  The CQC said NHSI had a ‘narrow view’ for measuring how well led a trust was.

42% of disabled adults who say they need social care do not receive any support at all, according to Leonard Cheshire Disability and it calls one million people without support a ‘national scandal’.  Its report, ‘The state of social care in Great Britain 2016’ draws on two online surveys it has commissioned, of 1,032 British disabled adults aged 18-65, by ComRes and 1,704 British adults by YouGov.  They also found that 40% of disabled adults feel isolated or lonely and 56% of of those who do not receive enough support maintaining social and community links are unable to leave home when they would like to at least once a week.  9% say they have spent more time in hospital due to ill health as a result of lack of social care.  Although the number of working age adults with a disability has increased by 1.4 million since 2010, there are 400,000 fewer people now receiving social care.
Feature article:

Care homes will have to reveal how many people they have evicted against their will and how many relatives of elderly patients have been banned from visiting them, the CQC has said.  This follows revelations on the BBC’s Victoria Derbyshire programme about homes banning visits from relatives who had made complaints.

Prisoners should receive the same level of health care as the rest of the population, according to guidelines from the NICE funded National Guidance Centre.  The recommendations include carrying out a healthcare assessment on arrival and offering tailored advice on health and lifestyle.
Press release:
The guidance:

£20m for women’s refuges has been approved by Theresa May, as part of £40m promised in last year’s spending review for tackling domestic violence.  Under new guidance, councils will have to accommodate women from outside their area who are escaping violent partners.

Pre-clinical Alzheimers was associated with loneliness, with those with high levels of amyloid (a protein associated with the disease) seven times more likely to be lonely than others, after adjusting for a range of other factors.  The US led research used brain imaging techniques on 79 apparently healthy people with an average age of 76.  It was published in JAMA Psychiatry.  No causation could be shown and if there were any, loneliness might be either a cause or symptom of the disease.

People with mental health problems in the workplace add much greater value than the costs, according to a report by the Mental Health Foundation and employee benefits company Unum, with research from Oxford Economics.  The report is “Added value: mental health as a workplace asset”.  It also notes that work is a key factor in protecting mental health.  Only 10% of line managers surveyed felt they had sufficient training to deal with mental health problems at work.

GPs could be taken off Australia’s Shortage Occupation List that makes it easier to get a visa, as it has been flagged as an occupation where there is emerging evidence of excess supply in the labour market.  The number of GPs considering working abroad increased earlier in the year when Jeremy Hunt said he was proceeding with pushing through seven day working.


01 November 2016

Nearly 320,000 children will be affected by the new, lower benefit cap to be introduced from 7th November, according to the Chartered Institute of Housing.  The new cap limits household benefits to £20,000 (or £23k in London).  The CIH says 116,000 households will be affected by the cap which could make housing unaffordable in many parts of the country and worsen the homelessness problem.
Article by CE of CIH:
Feature article:
(03/11/16) Background information:

Up to a quarter of care home beds, 100,000, could be at risk, unless the Chancellor increases funding to the social care sector in this month’s autumn statement, leading care sector providers have told the government.  They are believed to have told the Department of Health privately that between 50,000 and 100,000 beds could close in the next four years if more money isn’t found.  They say that half of care homes are losing money because councils are paying below break even levels.  There are fears that a break-down in social care could push the NHS further into crisis.

Adverse experiences in childhood impact on adult health, with those experiencing four or more such experiences, such as abuse, violence or trauma, being twice as likely to be diagnosed with a chronic disease and three times more likely to get lung or heart disease in later life, according to research from Public Health Wales, involving interviews with 2,000 adults who gave information about their childhood experiences.  Those with four or more adverse experiences were also three times as likely to have gone to A&E or spent a night in hospital, twice as likely to be frequent visitors to a GP and four times more likely to develop Type 2 diabetes than a child with no such experiences.  The authors suggest that this is not only because the children develop harmful lifestyle factors such as smoking and drug use, but also that the stress causes strain on the body.

The number of mental health nurses working in England has fallen by 15% since 2010 from 45,384 to 38,774 according to a Parliamentary written answer from health minister Philip Dunne to Labour MP Luciana Berger.

Only 46% of trainee GPs have a training placement in a mental health setting, with the only option being in psychiatry, which is secondary care based, according to information from freedom of information requests obtained by Mind from Health Education England and the Welsh Deanery.  None of the continuing professional development which GPs have to undertake needs to be mental health focussed.  All this is despite an estimated one in three GP appointments being mental health related and the GP being the first point of contact for mental health serivces for 81% of people with mental health problems .  For practice nurses, 42% said they had had no mental health training and 82% said they feel ill-equipped to deal with mental health issues for which they are responsible.  The Royal College of GPs said that mental health is a key part of GPs’ training curriculum, although they would like to see the training period extended from 3 to 4 years to allow more time on it.

Women are bearing the brunt of the social care crisis according to a report from the Political Studies Association Commission on Care, produced after a year long enquiry by academics from the University of Warwick and the Women’s Budget group, together with the Fawcett Society and Sheffield University.  It also found that the complexity of rules denies care to many and BAME communities are poorly served by the care system.  Amongst its recommendations are: a national care service, free at the point of delivery equal to the NHS; greater investment in social care infrastructure; professionalisation and support of the care workforce; and greater recognition of the work of unpaid carers.

Ways to supported disabled people or those with a long term condition into employment are to be tested with the help of £70m over four years from NHS England, DWP and DH.  They will be working with the Sheffield City Region and the West Midlands Combined Authority.  The trials are to focus on mental health and musculoskeletal conditions.


31 October 2016

A Green Paper on disabled people’s employment prospects has been published by DWP, aiming to halve the current employment gap between disabled and non-disabled people (5 in 10 vs 8 in 10 employed), to get 1 million disabled people into work and to overhaul the work capability assessment.  There is also to be a review of the ‘sick’ and ‘fit note’ system.  The responses included some welcoming of the ambition, but noted the lack of a timescale for meeting its targets, the fact that funding for disability programmes was due to be halved in this parliament, and the juxtaposition of the aim to confront negative attitudes and prejudices, on the one hand, with the contribution to them the Government had made over the last six years, on the other.

The Government hasn’t given the health service the money it asked for, contrary to the claims of the prime minister and others, the chair and some members of the Health Select Committee have said in a letter to the Chancellor, Philip Hammond.  The letter, signed by the chair, Sarah Wollaston and four other members, follows oral hearings of the Committee.  It says that the frequently quoted £10bn figure is incorrect and gives the false impression that the NHS is awash with cash.  The figure counts only NHS England spending not the whole health budget (so ignoring cuts to public health and health education funding) and adds a year to the spending review period.  Over the spending review period, the health budget increases by only £4.5bn.  The signatories ask for more capital spending to support STPs, for the crisis in social care provision to be addressed and for more resources in the middle years of the spending review period.  The Prime Minister’s official spokesman is reported as rejecting the claims and saying their statements have been correct, though conceding that the service is under pressure.  However Jeremy Hunt admitted in the Commons that other parts of the heatlh budget are being cut.  Labour has asked the UK Statistics Authority to investigate the Government’s statements.
Background information:
Labour asks the UK Statistics Authority to investigate:

Children’s counselling sessions for anxiety with the NSPCC’s Childline service increased by 35% last year, the charity has said, with an increasing number of concerns being about world affairs.  The increase was from 8,642 in 2014-15 to 11,706 in the last year.

More councils have published the STPs for their areas. Harletpool Borough Council published the sustainability and transformation plan for Durham, Darlington, Tees, Hambleton, Richmondshire and Whitby.  Beford Borough Council has published the plan for Luton, Bedford and Milton Keynes.

The new Nursing Associates will be able to dispense medications unsupervised, according to leaked internal HEE documents showing the proposed curriculum for the new role.  Concern has been expressed at overlaps with the role of registered nurses and the risks of staffing on the cheap.  The first batch of training for the new role starts in January.

The voluntary ‘living wage’ has been increased by 4% in London to £9.75 and by 2.4% elsewhere in the UK, to £8.45 an hour.  The levels are set by the independent Living Wage Foundation, based on research by the Resolution Foundation and the Living Wage Commission.  Both rates are higher than the government set ‘national living wage’.

Data on death rates following surgery cannot identify poor performance of individual surgeons, because they do not perform enough operations each to accurately identify differences, according to research from Edinburgh University looking at patient outcomes from six common surgical procedures between 2010 and 2014.  For instance, surgeons carrying out lower risk operations such as hip replacements would need to carry out 500 operations a year to identify those with poor success rates, whereas they generally perform between about 48 and 75 a year.  So for such surgery, less than 20% of surgeons with death rates five times the national average would be detected under the current system.  It was also noted that surgery is performed by teams so it does not necessarily make sense to look at the outcomes for just one surgeon.  It was suggested that patient recovery and satisfaction would be better measures of performance.
Press release:


30 October 2016

The Government watered down the child obesity strategy, a Channel 4 Dispatches programme claims, reducing the 37 page draft produced under David Cameron’s government to 13 pages after Theresa May became prime minister.  Among the things cut, were said to be restrictions on junk food advertising, unhealthy product placement in supermarkets, requiring food outlets to put calore information on menus and a promise to half the number of child obesity cases by 2026 to 800,000.


29 October 2016

Prison suicides have reached record levels, with 107 self-inflicted deaths in the year to September, compared to 57 in 2012 and 16 in 1978, when the current recording system started.


28 October 2016

Recovery of health costs from overseas visitors is likely to be below target, according to the National Audit Office.  The original £500m a year target has been ‘refined’ to £346m for 2017-18.  £289m was recovered in 2015-16.  The amount paid has increased in recent years, but this is partly because of increased charges.  The NAO found that only half of debts from patients outside the European Economic Area were recovered

The option of GPs leaving the NHS and setting up privately is being considered by some LMCs (local medical committees which represent GPs locally), Pulse Magazine reports.  It appears it is being more seriously considered in Northern Ireland which would reflect the situation in the Republic, but it might also be one of a range of options being drawn up for the Berkshire, Buckinghamshire and Oxfordshire LMCs.

There was no ‘weekend effect’ for patients treated at major trauma centres according to research led by Oxford University which examined data on 49,000 patients from 22 major trauma centres in England.  Those services were reorganised in 2012 into a smaller number of specialised hospitals which have consultants available every day and round the clock access to diagnostic and treatment facilities.–study.html

Disabled young people are not being given the support they need to do what they want in their lives, according to research from Scope based on 25 face to face and telephone interviews and a survey of 228 people aged 17-30 targeted by location, age and support needed, to make it as representative as possible.  It found that 60% of survey respondents didn’t think they were getting the help needed to get into work. While a fifth would like to access information and advice on smartphones only 1% were able to do so.  Two thirds had had a significant social care setback that that stopped them living independently but 82% of these had had to wait at least six months for a solution, despite this being an obligation for local authorities under the Care Act.
Press release:
Link to the report:

Stroke survival chances are boosed by having more specialist nurses, with one extra trained nurse for 10 beds reducing the chance of death after 30 days by 28% and after one year by 12%, according to research from the universities of Aberdeen and East Anglia.

Case studies of police and public health collaboration have been published by Public Health England.


27 October 2016

The British and French governments have been accused of breaching the human rights of children, after 50 teenagers in Calais were abandoned by the authorities and left to sleep in makeshift conditions.  It is reported that the children were lured out of the camp, which is being destroyed, with the promise of transport to a reception centre, but were then kettled by police with riot shields, tear gas and taser guns.  Despite protests from the British Government, the promised accommodation did not materialise and instead they were allowed to sleep in an abandonded, unheated school building.

The General Medical Council has warned that poor morale amongst doctors could put patients at risk. It made the comments in its annual report, saying that levels of alienation following the junior doctors’ dispute ‘should cause everyone to pause and reflect.’  It also said that 582 fewer doctors had gone into speciality training in 2015 following their two foundation years, with 87% of those saying it was because of work-life balance, with 47% of those citing burnout from their clinical placement as the reason.  The GMC said that years of financial constraint and pressures on social care were leaving services struggling to cope with rising demand.
Five doctors speak about their experience:
Press release:

Benefit sanctions are associated with higher food bank use, according to research from Oxford University based on data in 259 local authority areas between 2012 and 2016.  The study found that every three-month increase of 10 benefit sanctions per 100,000 of population over a four year period was associated with five more instances of adults referred for charity food parcels.  Areas where higher sanctions weren’t associated with more food bank use typically had fewer Trussell Trust charity food distribution centres.  Food bank usage remained relatively high even when sanctions reduced, possibly because the sanctions led to ongoing financial crisis.  The researchers say there are problems with both official santions data and food bank figures and suggest the UK government should collect more robust data on food insecurity.  The DWP is quoted as saying, ““The reasons for food bank use are complex, and it is misleading to link them to any one issue.”

CCGs’ payment to private providers for health care has increased by 18% over the past three years, according to foi responses from 83 CCGs received by Pulse Magazine.  Of the 83, the amount spent on NHS care in private hospitals for the three years 2013-4 to 2015-16 was respectively, £435m, £473m and £513m.  The CCGs say they have to use private providers because of waiting list pressures with NHS providers [although presumably some is also down to patient choice, albeit possibly also driven by waiting times].  Meanwhile, NHS trusts increased their income from private patients by 14% in the four years between 2012-13 to 2015-16 according to foi responses from 54 trusts.

Private health providers’ revenues and profits have been increasing, driven by growing NHS waiting lists motivating many people to pay for help, according to an analysis by Pulse magazine.  They say that all private providers have seen their revenues increase and many annual reports cite the problems with the NHS as driving this.

Maternity care needs improving in three quarters of CCGs according to an assessment by NHS England based on data in four areas: stillbirth and neonatal mortality rates, maternal smoking rates at delivery, women’s experience of maternity services and women’s choice.  The assessment was part of the CCG Improvement and Assessment Framework and also included a report on mental health services.  Of 209 CCGs, 144 needed improvement with 11 having the greatest need, while 53 were performing well and one was scored top performing.
Press release:
Further details on the maternity assessment:

Mental health assessments by CCG and a national dashboard have been published by NHS England.  The ratings under the CCG Improvement and Assessment Framework were published alongisde those for maternity services.  The scores are based on the IAPT recovery rate and two week wait for early intervention in psychosis.  127 or 61% were in need of improvement.  The number of CCGs in each category were: 21 “greatest need for improvement”; 106 “needs improvement”; 69 “performing well”; and 12 “top performing”.
(28/10/16) (Rgn)
Press release:
Information about, and links to, the dashboard:

Patients should be given more information about their operations and make their own choice of treatment, according to new guidance from the Royal College of Surgeons.  This follows the case of Nadine Montgomery who last year was awarded £5.25m in compensation after her son suffered brain damage during the birth in 1999.  The RCS says a consultant should tell the patient not only what they think they need to know but also the risks that might matter to the patient.  Enough time needs to be allowed for an informed decision to be made, rather than “a paper tick-box exercise, hurriedly done in the minutes before a patient is wheeled into theatre for their procedure.”  NHS trusts in England paid out more than £1.4bn in claims in 2015-16.
(02/11/16) Letters suggesting use should be made of doctors’ professional knowledge and it should be seen as shared decision making rather than just providing information for the patient to choose.

The NHS could save £1bn a year, as a quarter of admissions are unnecessary, according to research commissioned by the LGA.  The research, by consultants Newton Europe, involved health and care workers examining 700-750 anonymised case notes in each of five areas (Kent, Pennine Lancashire, Greenwich, Swindon and Sunderland).  They found that 45% of decisions about patient care could be improved and 26% of hospital admissions could have been avoided if if opportunities to intervene had been available or were not missed.


26 October 2016

Three STPs (sustainability and transformation plans) have been published, despite an NHS England directive that they should not be revealed until they have been reviewed by the centre.  Three councils – Birmingham, Camden and Sutton – have published the plans for their areas: Birmingham and Solihull; north central London; and south west London.  The councils expressed concern about transparency and that the secrecy was generating worries over the content and process of the plans.

The Competition and Markets Authority has launched an investigation into drugs companies accused of charging the NHS excessive prices.  This follows an investigation by the Times in the summer which suggested companies were buying off-patent drugs which faced limited competition and then increasing the price, with 32 drugs having had price rises of over 1000% in five years.

Statistics on the ‘weekend effect’ have been published by NHS Digital, in the light of the Secretary of State’s commitment to seven day services, with a view to providing “a starting point for discussions” on improvement and variation in care provision across the week.  They find that patients admitted to an NHS hospital at a weekend in 2015-16 were 15% more likely to die within the next 30 days than those admitted during the week.  Those discharged at a weekend were more likely to be readmitted as an emergency within seven days.  The BMJ notes that the mortality rates are similar to a study it published previously, which is not surprising as the same methodology was used.

Only 27% of maternity units had consultants physically present overnight on weekdays and only 15% at weekends, according to a survey of 165 units by the Royal College of Obstetricians and Gynaecologists.  However, all would have had access to consultants on call.  However some studies have suggested that such cover is only needed on the busiest wards.

Lack of funding for transformation is putting delivery of the Five Year Forward View at risk, according to a report by the King’s Fund.  It notes that £1.8bn of the £2.1bn allocated to the sustainability and transformation fund will go to paying off trusts’ deficits (sustainability) rather than investment in new ways of doing things (transformation).  It also looks as though the same may happen in the next two years.  It says that most progress in implementing the Forward View has been made in the new care models programme, sustainability and transformation plans and devolution in Greater Manchester.
Press release:


25 October 2016

The biggest barrier to STP implementation is likely to be funding and resources, closely followed by ‘organisational priorities trumping the whole system’ and ‘political opposition to planned changes’, according to a survey by the HSJ to which there were 99 responses from CCG chairs and accountable officers, representing 47% of CCGs.  The most commonly mentioned service changes in the plans were ‘discouraging unhealthy behaviour’ at nearly 75%, ‘developing neighbourhood primary/community teams’ and ‘more records and data sharing’ (both over 70%).  52% said they expected to close or downgrade community hospitals, 46% expected an overall reduction in inpatient hospital beds and 31% are planning to close or downgrade A&E units.  The most common system wide changes were ‘CCGs role dominated by work to improve relationships’ at over 75% and ‘Whole system financial control total’ at nearly 70%.  Of the 99 respondents, their confidence that their STP would have its planned impact on financial and operational performance in 2017-18 was: very low -18; low – 47; moderate – 33; high – 1; and very high – 0.
(£) survey comments on reasons for lack of confidence in delivery:

People with severe mental illness die on average 10-20 years earlier than others, according to a report from the Royal College of Psychiatrists and the Academy of Medical Royal Colleges.  People with a severe mental illness (such as schizophrenia, bi polar or psychosis) are three times more likely to have a physical health problem, twice as likely to smoke, and 50% more likely to be obese.  46% of people with a severe mental illness have a long-term physical health condition.  Recommendations include developing appropriate strategies, training for healthcare staff and improving infrastructure such as systems and technology.

Councils have been accused of not paying enough for home care, by the industry body, the UK Home Care Association.  It said nine out of ten councils were failing to pay a realistic price, with £16.70 per hour being the minimum that should be paid, but with the average being £2 less at £14.58, according to foi responses from 186 of the 208 councils that were asked for information.

Autistic children’s symptoms and behaviour were improved after a training programme with their parents in research led from the University of Manchester and published in the Lancet.  The trial involved 152 children (77 in the intervention group and 62 in a control group), of whom 121 were followed up six years later.  The programme involved training for the families, twice a week for six months.  While other support has involved therapy for the child, this approach meant the parents were able to continue the help in their everyday life.  At the start of the trial, 55% of the intervention group and 50% of the control group were assessed as severely autistic, but after six years, the figures were 46% and 63% respectively, but this was not statistically significant.  While there were improvements in social communications and repetitive behaviours, there was no change in child anxiety, challenging behaviours or depression.
(26/10/16) (Rgn)

Publication of STPs (sustainability and transformation plans) under freedom of information legislation has been refused by NHS Improvement, on the grounds that the plans are to be published at some, as yet undecided, date.  In the decision it is said that there is to be a communications plan to accompany the release, which is necessary for effective engagement on the plans, so publication at this time would not be in the public interest.

The government’s response to the Health Select Committee report on primary care has been published by DH, setting out the actions which have been taken to support primary care.

Long term residential exposure to noise and air pollution was associated with self-reported hypertension, but not with measured hypertension, in a study on over 41,000 people in five countries (Spain, Germany, Norway, Sweden and Denmark) for up to nine years.  The research was published in the European Heart Journal.  An expert noted that self-reported hypertension is only weakly correlated with measured hypertension, so there should be a note of caution about the research.

Lessons for NHS contracting are considered in a literature review which looks at alliance contracting, prime contracting and outcome based contracting using lessons from other sectors and countries.  It has been produced by PRUComm (the Policy Research Unit in Commissioning and the Healthcare System).

A standard for involving patients and service users in health research has been published by National Voices.  It was produced as part of the Accelerated Access Review.  It defines the standards by using a series of ‘I’ statements, such as ” I am confident that I will have access to information about relevant research and opportunities to get involved.”  The standards cover four areas: setting research priorities; research design; making treatments available; and individual decisions on using new treatments.
Press release:
Link to the publication:


24 October 2016

Innovative drugs should be available up to four years sooner, according to the Accelerated Access Review, which has been published by the Department of Health.  The review was commissioned by the Government, with an independent chair, Sir Hugh Taylor.  It proposes more partnership working between bodies such as NHS England, NHS Improvement, NICE and the Medicines and Healthcare Products Regulatory Agency, as well as more streamlined processes.  [As the HSJ drily notes, it is somewhat ironic that the publication of a report urging speedier processes was delayed from the spring.]
Press release:
General web page for the review:
The final report:

A 30 second GP conversation about weight loss was effective and did not offend patients, in a randomised controlled trial involving 137 GPs and 1,882 patients.  The research was published in the Lancet.  One group was offered an NHS funded place on a 12 week weight management programme, the other was offered advice on losing weight.  Of those offered the weight management, 77% said yes, and of those, 40% attended all the sessions.  At the end of the year, that group had lost an average of 2.43kg while the advice only group had lost 1.04kg.  Less than 1% of patients thought the intervention was inappropriate and unhelpful while 81% thought it was appropriate and helpful.

No one in a coma should be allowed to die without a court judgement according to instructions by senior judges, overturning provisions of the 2005 Mental Capacity Act, under which doctors who ignored a ‘living will’ and provided nourishment and fluids to keep a patient alive against their wishes, could be charged with a criminal offence.  The direction was made last year but has now been made public in a speech published last week.

Women globally now drink as much alcohol as men, according to research from the National Drug and Alcohol Research Centre of the University of New South Wales, Australia,  based on the records of four million people over a century.  The research pools the results of 68 international studies published since 1980.  It was published in the journal BMJ Open.  Men born between 1891 and 1910 were twice as likely as women from the same period to drink alcohol, but for those born between 1991 and 2000, women were drinking almost as much as men.

Seven day GP access will cost £1.5bn by 2021 but on current plans it will not fulfil the Conservative manifesto promise of access from 8am to 8pm, seven days a week, according to analysis by Pulse magazine.

Forty treatments that bring little or no benefit to patients have been named by the Academy of Medical Royal Colleges, as part of a campaign to reduce the number of unnecessary treatments.  The treatments which might not be needed include: x-ray for lower back pain, using tap water rather than saline solution for cleaning cuts and chemotherapy for terminal cancer.

The £350m a week for the NHS promise made during the EU referendum campaign should be honoured, 41 MPs have urged, in a letter to the Chancellor.  They say that this was the single most visible promise of the EU referendum leave campaign, and must be considered a key part of the ‘mandate’ from the British people to which the Government has committed to listening.  They say that the extra £350m a week, or £18.2bn a year should be on top of what has already been promised for the NHS.


23 October 2016

Self-harm among children and young people has risen dramatically, particularly among girls, over the last ten years, according to figures from NHS England.  The number of girls needing hospital treatment after poisoning themselves has risen by 42% in ten years, from 9,741 in 2005-6 to 13,853 with most of the increase occuring since 2011-12.  The number of girls treated as inpatients after cuttng themselves has risen by 385% over that period, from 600 to 2,311.  The number of boys ending up in hospital after cutting themselves rose by 285% from 160 in 2005-6 to 457 in 2014-15.

Help for people dependent on prescription drugs is needed, including a UK-wide 24 hour helpline, according to senior doctors.


22 October 2016

Support for disabled job seekers is to be cut by almost half, according to a report to be published by the umbrella group for companies on the programme, the Employment Related Services Association.  Around 300,000 disabled people were offered help between 2012-15 but it is due to be 160,000 between 2017-20 as a result of an 80% cut in funding.  Funding was £750m in 2013-14 but is due to be only £130m next year.  A Green Paper on the new Health and Work Scheme is due to be published next week.
(24/10/16) (The report on which the original story was based has now been published)


21 October 2016

Minimum unit pricing for alcohol can finally go ahead in Scotland following a ruling by the Court of Session that it did not breach European law, in a case brought by the Scottish drinks industry.  The legislation was originally passed by the Holyrood Parliament in 2012, with cross party support.  A case was brought to the court of session which referred it to the European Court of Justice, which said in December 2015 that  the measure would not breach European Law if it was more proportionate and effective than using general taxation, but which also referred it back to the Scottish courts for a final decision.

NHS trusts have been segmented according to how much support they require, by NHS Improvement, with four categories: (1) no potential support needs; (2) targeted support in one or more areas; (3) mandated support for significant concerns; and (4) providers in special measures.  Trusts are rated across five themes: quality of care; finance and use of resources; operational performance; strategic change; and leadership and improvement capacity.  At the moment the judgements are in shadow form, until the ‘Single Oversight Framework’ (SOF) comes into effect in November 2016.  The number of trusts currently in each category are: (1) – 35; (2) – 106; (3) – 74; (4) – 22.  [There appears to be a distribution of score by type of body, with community and mental health trusts appearing predominantly higher up the list, with more acute trusts having lower scores.]

The supply of nurses faces a ‘perfect storm’, of rising demand, an ageing workforce, an insufficient number of trainees and threats to international recruitment from Brexit, the Royal College of Nurses says in a report, ‘Unheeded Warnings: health care in crisis.’  Half of the workforce is now aged 45 or over, so within ten years of being able to take early retirement.


20 October 2016

The planned new social work regulatory body is to be independent of government, reversing the previous proposal in the Children and Social Work Bill, that it should be directly controlled by the Department for Education, which had been strongly criticised.  It is still not clear what form the new regulatory body will take.  The British Association of Social Workers and the Association of Directors of Children’s Services welcomed the change.

Funding for pharmacies is to be reduced, the Government has confirmed, following a consultation.  The £2.8bn cost is to be reduced by more than £200m over the next few years which could lead to the closure of 3,000 of the 11,700 existing pharmacies.  The Government says that 40% of pharmacies are located close to each other.  Funding is to be provided to help pharmacies in isolated areas and to set up more in GP surgeries and hospitals.  Funding is to be changed to reduce the amount of fixed payment, with more emphasis on ‘rewarding pharmacies for the quality of services provided to the public.’  NHS England announced a £42m pharmcy integration fund “to support the development of clinical pharmacy practice in a wider range of primary care settings”.
The response of the National Pharmacy Association:
Press release:
Policy details:

Jeremy Hunt has said he wants to move services from secondary to primary care, in what he is calling a ‘GP one-stop programme’.  Speaking at the Best Practice conference in Birmingham, he said he wants to work through condition by condition to see what could be transferred to general practice, supported by the necessary funding.  The sorts of things that might be taken over by general practice include diabetes and end-stage renal.

Adult and children’s social care will face a combined funding gap of £3.2bn by 2020 according to the LGA’s submission to the Treasury in advance of next month’s Autumn Statement.  £1.9bn of the gap between funding and need related to children’s services and £1.25bn to adults.

HEE has filled more GP training places than ever before but has not met its target for 2016 of 3,250 places, having managed to fill 2,936.  There are big variations between different areas with some having improved their numbers considerably while others have seen falls.

More than 850,000 public sector jobs could be lost to automation by 2030, with administrative jobs being most vulnerable, according to research from Oxford University and Deloitte in collaboration with Reform, reported in the latter’s State of the State 2016-17 report.  A survey of 1,000 people also found that 57% feel the NHS is top priority compared to Brexit at 33% and public support for taxes to fund public spending is increasing for the first time since the 1990s.

Mental health services for children and young people are the NHS’s biggest weakness, Jeremy Hunt has said, speaking to the Health Service Journal.  He promised to improve diagnosis and treatment and said he wanted schools and CAMHS teams to work more closely together.

The future of clinical commissioning is explored in a report published by NHS Clinical Commissioners.  It suggests that the role is likely to evolve, with no single model, but that what should be preserved is the local dimension with credible clinical leadership, expertise and knowledge of the communities served.
(19/10/16) (£)


19 October 2016

Psychological therapy in GP practices for people with long term conditions is to be provided in a £11m scheme, with a further £24m available in 2017-18, NHS England has announced.  Initially, 30 CCGs will receive funding, covering 22 schemes providing support for people with long term conditions such as diabetes, respiratory disease and cardiovascular disease.

Higher death rates of patients admitted to hospital at weekends is linked to the severity of their illness, according to research from the University of Manchester, using data on 3m patients admitted to hospital in England via A&E in 2013-14, published in the journal BMA Quality and Safety.  The analysis was based on the proportion of patients arriving at hospital by ambulance, as a marker of the how seriously ill they were.  A high proportion of patients admitted at night and at weekends arrived by ambulance.

The GPs’ QOF (quality and outcomes framework) has reached the end of its useful life and is likely to be gradually phased out, Simon Stevens has said, speaking at a conference.

More than a third of maternity units have had to close temporarily during the last year, according to a survey by the Royal College of Midwives of 53% of the heads of midwifery from around the UK.  Nine in ten thought their unit was dealing with more complex cases than the previous year and nearly four in ten said they did not have enough midwives to cope with the demands on the service.
(25/10/16) (Rgn)

Doctors should receive more training on lifestyle, including diet and exercise, because many lack the basic knowledge necessary to help people live more healthy lives, according to a letter by some senior doctors to the Medical Schools Council and the General Medical Council.

The number of vasectomies in England has fallen by 64% in ten years, from 31,216 in 2004-5 to 11,113 in 2014-15 according to figures from NHS Digital on sexual and reproductive health services.  Some CCGs are reducing the number of vasectomies they will pay for or stopping funding them altogether.

Resources on oral health improvement of children have been published by PHE to help local authority commissioning of services for pre-school children.  It includes the return on investment for different interventions.

A report on collaboration in healthcare has been published by KPMG, based on interviews with NHS CEOs and prominent industry figures.


18 October 2016

The £1.8bn funding for NHS trusts will be made available again in the next two years but is likely to be used for ‘sustainability’ – meeting trust deficits, rather than ‘transformation’ – improving efficiency and effectiveness to reduce future costs, according to the Nuffield Trust.  NHS England is reported as confirming those figures, with £1.1bn over that period to go towards transformation.
Nuffield Trust briefing on some of the financial numbers:

Recovery from common mental health problems is lower in more deprived areas, according to the annual report on the IAPT (Improving Access to Pscyhological Therapies) programme.  954k people  were seen last year out of 1.4m referrals with a 46% average recovery rate.  200k referrals were made from the 10% most deprived areas of England and 92k from the 10% least deprived.  The recovery rate was 35% from the most deprived areas and 55% from the least deprived.  There were also variations by gender and ethnicity.  Of those finishing a course of treatment, 81% were seen within six weeks, so meeting the government target of 75%, although there were wide variations round the country.

The number of ambulance waits for over an hour at A&E has nearly trebled in two years, in England, from 28,000 in 2013-14 to 76,000 in 2015-16 according to figures obtained by Labour.  It is said that these delays make it hard for ambulance services to meet their response targets.  Ambulances are late to a third of life threatening injuries, the Mail reports.
(16/10/16) Data on ambulance waits from an foi request (not strictly the same story, but relevant information):

Midwives are leaving the profession because of inadequate staffing levels, according to a survey for the Royal College of Midwives, of 2,700 midwives, made up of 31% who had left the profession in the last two years and 69% who were intending to leave in the next two years.  For those who had already left, the main reasons were staffing levels (52%), not being satisfied with the quality of care they were able to give (48%) and being unhappy with the workload (39%).  35% were unhappy with the level of support from their managers.
(20/10/16) (Rgn)

Self-employed people are earning £60 a week less than in 2001-2, while their numbers have gone up by 45% according to a report by the Resolution Foundation.  Another report, from the Social Market Foundation says the self-employed are likely to lose out from the introduction of universal credit since benefits they could claim would be based on the assumption that they were earning the national living wage whereas 45% were actually earning below that.

The NHS in England did not get its requested funding in three out of five years, Simon Stevens has told the Health Select Committee.  He said he was repeating the points he made to the Public Accounts Committee, that while funding in 2016-17 and 2020-21 was ‘in the zone’ requested in the Five Year Forward View, in the intervening years it was not, including a reduction in per person funding in 2018-19.  He also pointed out that the level of funding requested depended on a number of other conditions being in place, including the ‘continuing availability of social care relative to rising need’, the availability of capital investment and the availability of preventive services through local authorities.  The committee chair noted that based on traditional accounting standards and the spending review period, the increase for the NHS was £4.5bn rather than the £10bn figure being quoted (traditionally the whole DH budget has been used, but the Government quote just the NHS England portion, while there have been cuts in the rest of the health budget).
(20/10/16) Background information on the figures:

Smoking quit rates doubled after a short talk with a nurse in hospital, in US research involving 1,528 patients in five community hospitals in Michigan.  Six months after discharge, 16.5% of patients who had had the chat said they had quit, compared with 5.7% from those in other hospitals.  The nurses had one hour of training in the intervention.  The research was reported in the American Journal of Preventive Medicine.

Air pollution and climate should be tackled together according to a report from the UK Health Alliance on Climate Change, ‘A Breath of Fresh Air’.


17 October 2016

Measures to address maternity safety have been announced by Jeremy Hunt, including publishing ratings for the safety of maternity wards in England, and allowing the NHS to offer compensation for babies stillborn or left brain damaged because of poor care, rather than having to go through litigation, which takes an average of 11 years.  There is also funding to help improvement of maternity units.  There is now to be consultation on the Rapid Resolution and Redress Scheme.

The Government’s ‘troubled families’ programme has had no significant impact, according to research which included face to face interviews with 495 families going through the programme and a comparison sample of 314 families before they started the programme, and an analysis of administrative data to identify impacts in each local area.  It found no significant impact across the key areas of the programme, employment, benefit receipt, school attendance, safeguarding and child welfare.  However, the families involved in the programme did experience increased levels of confidence and optimism.  The research was undertaken by a consortium that included the NIESR and was led by Ecorys.  The findings were leaked earlier in the summer (8/8/16).  The programme has been defended by practitioners, charities and researchers, who say key parts should be retained, despite problems of government spending cuts and centrally imposed targets.
(31/10/16) (£) analysis
(18/10/16) Practitioners and others say key parts of the initiative should be retained:

At least 70% of Britons would pay an extra 1p in the pound income tax if it was guaranteed to go to the NHS, according to a poll of 1,002 people by Survation for ITV’s The Agenda programme.  It also found that 66% of respondents said they would not pay £5 to visit a GP, while 27% said they would.  46% thought the NHS was performng badly while 23% said it was performing well.

Adults get more of their calories from alcohol than sugary drinks, in the UK and in most other countries, according to data from Euromonitor.  This suggests that action to reduce obesity should include alcohol as well as other sugary drinks.  In the UK, adults get an average of 106 calories per person per day from alcohol and 98 from sugar sweetened drinks.  Alcoholic drinks above 1.2% ABV are currently exempt from having to provide calorie information.

A consultation on “Providing a ‘safe space’ in healthcare safety investigations” has been launched by DH.  The aim is to ensure the confidentiality of information provided as part of a health safety investigation.  It runs until 16th December.

A resource to help local authorities adopt ‘health in all policies’ has been published by Public Health England.  It includes examples of how local authorities in the UK and overseas have implemented the approach.

A briefing on the health benefits of green spaces has been produced by the Parliamentary Office of Science and Technology.  Reviewing the evidence, it suggests that areas with more accessible green space are associated with better mental and physical health.


16 October 2016

£613m has been saved on spending on agency staff in the year to this October, compared to the previous year, by the NHS in England according to figures from NHS Improvement.  This followed the introduction of restrictions on agency spending in October 2015.  Hospitals are now paying 18% less on average for agency nurses.  NHS Improvement has said it will publish league tables of spending on agency staff, later this year.  The Royal College of Nursing said the caps were not dealing with the root cause of the problem, a national nursing shortage as a result of poor workforce planning.
(17/10/16) (Rgn)

The UK is expected to accept about 20 children from the Calais camp this week but there has been no deal for a larger scale plan.


15 October 2016

About 300 migrant children in Calais could be resettled in the UK, starting in the next few days.  The refugee camp, ‘the jungle’ is due to be demolished very shortly.


14 October 2016

The Prime Minister is reported to have said there will be no more money for the NHS in the autumn statement on 23 November.  She is reported to have told Simon Stevens and Jim Mackey, at their first meeting with her, on 8th September, that the NHS should urgently focus on making efficiencies to balance its budget.  Comments from the King’s Fund, Nuffield Trust and BMA included that Downing Street does not fully understand the impact on patients of the pressures on the NHS, and that without more money there would have to be such things as reducing access and services, closures and reductions in staff.  The BMA said that the NHS is already the most efficient health system in the world and what are happening now are cuts, leading the system to the brink of collapse.

Mental health budgets are being cut, despite promises of increased funding, with 40% of 58 mental health trusts having had their budgets cut in 2015-16, according to analysis by the King’s Fund.  However the NHS said overall spending rose 8.4% in 2015-16 compared to the previous year.  CCGs were instructed to increase spending on mental health for the current year in line with increases in their budgets.  NHS Commissioners were reported as saying that spending on mental health also goes on services outside trusts including prevention and recovery and services provided by voluntary and third sector providers.

Spending on agency midwives was £25m last year, more than double the figure in 2013, according to responses by 123 NHS trusts in England with maternity units, to foi requests from the Royal College of Midwives.  However this is in the context of an overall reduction of £600m on spending on agency staff according to figures released separately by NHS Improvement.
(15/10/16) (Rgn)

Mental health budgets are being cut, despite promises of increased funding, with 40% of 58 mental health trusts having had their budgets cut in 2015-16, according to analysis by the King’s Fund.  However the NHS said overall spending rose 8.4% in 2015-16 compared to the previous year.  CCGs were instructed to increase spending on mental health for the current year in line with increases in their budgets.  NHS Commissioners were reported as saying that spending on mental health also goes on services outside trusts including prevention and recovery and services provided by voluntary and third sector providers.

Spending on agency midwives was £25m last year, more than double the figure in 2013, according to responses by 123 NHS trusts in England with maternity units, to foi requests from the Royal College of Midwives.  However this is in the context of an overall reduction of £600m on spending on agency staff according to figures released separately by NHS Improvement.

The new mandate for Health Education England has been published, giving them a year to produce proposals to reduce the health and care sectors’ reliance on international migration.

Car parking charges in hospitals have risen by an average of 15% since 2014, according to an analysis by the Press Association of figures from NHS Digital and NHS trusts.  Of 209 trusts reporting figures for both 2014-15 and 2015-16, 33% increased their average hourly charge (calculated across three hours), 60% showed no change and 7% decreased the charges.  Car parking is free at most hospitals in Scotland, Wales and Northern Ireland.


13 October 2016

The CQC’s annual State of Care assessment says that social care cuts are reaching a tipping point, and are impacting on health services through increased A&E attendance and delayed discharges from hospital.  Between 2012 and 2016, there was a 70% rise in the number of bed days lost through social care not being available to allow safe discharge.  Safety concerns were raised about two thirds of A&Es in England.  CQC chief executive David Behan was amongst a number of people calling on the Government to find more money for social care.  The report also says that 800,000 patients are registered with a GP practice deemed inadequate on safety grounds, although that is only 3% of practices.  There were also many examples of good practice.

The monthly performance figures for the NHS in England show continued problems, with A&E waiting times in the summer worse than 11 out of 12 of the last winters.  The latest figures show 90.6% seen within four hours.  Other targets missed included those for cancer, routine operations and ambulance response times.  Dr Mark Holland, president of the Society for Acute Medicine is quoted as saying that parts of the NHS will implode this winter.

A fast-track option for NICE appraisal of technologies offering exceptional value for money is to be introduced, subject to a consulation by NICE and NHS England, which is open for twelve weeks.  For treatments with a cost per QALY of up to £10,000, final guidance would be published by NICE immediately after the treatment receives its licence.  Technologies recommended through that fast track process would be funded by NHS England within 30 days of NICE publishing its final guidance rather than the current 90.  A new ‘budget impact threshold’ of £20m a year is being proposed to manage treatments that are cost effective but have a high cost.


12 October 2016

Social work reforms introduced by the government over the last six years have largely failed to produce improvement, according to a report from the National Audit Office.  It suggests that the problems are systemic and that the reforms have been piecemeal.  The number of children and young people on child proection plans rose by 94% over the last decade.  The report says that one of the main predictors of a good quality service is financial investment in ensuring manageable case loads for social workers and retaining a stable workforce.

Obese parents are passing on health problems to their children, increasing future health pressures, according to a series of studies published in the Lancet Diabetes and Endocrinology.  Among the risks such babies are at risk from are stroke, heart attack, asthma, autism, ADHD or cancer in adulthood.  The possible mechanisms for the effects include exposure to hormones and nutrient supply and epigenetic processes where parents’ lifestyles affect the way the baby’s genes operate.

Hospital admissions for allergic reactions have risen by more than a third over the last five years, according to figures from NHS Digital.  The rise was from 22,206 in 2011-12 to 29,544 in 2015-16.

A list of environmental risk factors for developing dementia has been drawn up based on a review of previous studies by researchers from Edinburgh University’s Alzheimer Scotland Dementia Research Centre.  They suggest that future research should focus on this shortlist.  Among the factors are exposure to air pollution and a lack of vitamin D.

A briefing on mental health crisis care has been published by the NHS Confederation.  It says there are times when there are no mental health assessment beds available anywhere in the country which they suggest is a national scandal symbolising the inequalities between mental and physical health.  It suggests that mental health should be embedded in the re-organisation of services happening within sustainability and transformation plans.

A report on mental health services for older people has been published by Age UK.  The report, ‘Hidden in Plain Sight’, argues that mental health services aren’t meeting the increasing demand from the ageing population.  It says the target of 12% of talking therapies referrals being for older people, has been missed by almost half.


11 October 2016

Many STPs (sustainability and transformation plans) are over-ambitious, with the people drawing them up not believing they can be delivered, according to Chris Hopson, chief executive of NHS Providers, speaking to the Health Select Committee.  He said that local areas had been told they had to produce plans which would provide the desired savings, which meant they were considered not deliverable and usually involved major, structural service changes.

The backlog of high risk maintenance issues in NHS trust estates rose by 70% last year, with reductions in capital investment.  Costs of £775m were faced in 2015-16 compared to £458m the year before and £357m the year before that, 2013-14.

Provision of care for older and disabled people could be at risk, according to the CQC which is worried at the pace of care home closures.  The concerns were raised in a document shared at an internal meeting of the CQC with industry and care sector representatives in September.  It is based on evidence provided by 39 of the largest providers, representing about a quarter of the market, and is designed to guard against sudden market failure.  The number of beds availlable in care homes fell between 2010 and 2016 from 255,289 to 235,799.

The trends for being obese or overweight are diverging for boys of different social class, but not for girls.  60% of deprived boys aged 5-11 are predicted to be overweight or obese by 2020, but only 16% of boys in the most affluent group are, based on projections from the Health Survey for England between 2008 and 2012 by the UK Health Forum for the Obesity Health Alliance.  The same trend is not seen in girls, however, with about 20% expected to be overweight or obese by 2020.

The WHO has backed a tax on sugary food and drinks in a report.  It found that raising prices by 20% reduces consumption and improves nutrition.  Subsidising fruit and vegetables by 10-30% is also effective, they said.  The findings were based on a meeting of global experts and review of the evidence.

The NHS is not sufficiently transgender friendly, it is said, with 76% of a survey of 1,200 nursing staff saying more training was needed for all health care staff.  Of those who had directly cared for a trans patient, 87% said they felt unprepared to meet the patient’s needs.  56% had cared for trans patients direclty.

Patients are put off making a GP appointment because of receptionists, according to a survey of 2,000 adults for Cancer Research UK published in the Journal of Public Health.  The top three barriers to seeing a GP were: difficulty getting an appointment with a particular doctor (42%); difficulty getting an appointment at a convenient time (41%); and dislike of having to speak to the GP receptionist about symptoms (40%).  About a third did not want to be seen as the kind of person who made a fuss.

Inequalities in health and longevity are revealed in the latest figures from ONS.  Men can expect to live 80% of their lives in good health while women can expect 78%.

Stress was the top health and safety concern in a TUC survey of 1,000 union health and safety representatives across the UK, with 7 out of 10 saying stress is a problem.

A report on the new models of care vanguards has been published by the King’s Fund, looking at funding and governance issues in the 23 sites piloting the multispeciality community provider (MCP) and primary and acute care system (PACS) models.

A report, ‘Understanding Patient Flow in Hospitals’ has been published by the Nuffield Trust, arguing that the minimum of 5.5% free beds needed to allow satisfactory flow is not being met much of the time. They suggest that another 12,000 beds would be needed for the ideal occupancy rate of 85% to be achieved.  They also suggest a change is needed from the traditional practice of counting patients at midnight, to allow better management of crunch points during the day.

A clear and transparent funding system for mental health is needed, according to a report from the University of York’s Centre for Health Economics, which found a large degree of variability in costs between hospital trusts.  It suggests there should be a move away from block contracts to a system where patients are categorised into one of 21 clusters based on need.


10 October 2016

Prescriptions for Type 2 diabetes have increased by a third in five years, from 26m to 35m a year, between 2010 and 2016, according to an analysis of NHS data by company Exasol, which also mapped the results.  There were hotspots in London, the East Midlands and Lincolnshire.

Children having one or both parents absent before the age of 7 was associated with a greater likelihood of smoking or drinking at the age of 11, according to research from University College London, looking at records of 10,940 children from the Millennium Cohort Study, published in the Archives of Disease in Childhood.  Absence could be because of such things as parental death or separation.  Children who had experienced an absent parent were 1.5 times more likely to smoke after taking account of confounding factors, and were 27% more likely to have tried alcohol.

Children born in 1970 were more depressed at age 42 than those born in 1958, according to a study of 19,000 Britons born in one week in each of those years.  The younger group were also more likely to be anxious or irritable and to have had conduct problems at 16 and to be single at 33.  The difference in the proportion who were distressed between 1958 and 1970 for men was 10% and 16% respectively, and for women 16% and 20%.  The research was published in Psychological Medicine.  It is suggested that if these trends are seen more generally, it could imply a coming problem in mental health.

The stigma faced by young people experiencing mental health difficulties is explored in a report published by the YMCA, ‘I Am Whole’, based on young people’s stories.

School league tables should include measures of children’s wellbeing, Sir Anthony Seldon, Vice-Chancellor of the University of Buckinghamshire and former head of Wellington College, says.

A toolkit on measuring and monitoring the mental wellbeing of children and young people has been published as an aid for schools and colleges, by the Anna Freud National Centre for Children and Families in partnership with Public Health England.  It provides information about various psychometrically sound and effective wellbeing instruments, with examples of how to use them.


09 October 2016

The British Government is accused of failing hundreds of vulnerable, unaccompanied child refugees in Calais, for whom it has some responsibility.  There are 1,000 unaccompanied minors in the refugee camp, which is due to be demolished in the next few weeks, of whom at least 400 are eligible to enter the UK, but the Home Office is accused of failing to respond to French requests to accept such children.  Faith leaders have written to the Prime Minister urging her to allow 400 children into the UK before the camp is demolished.  The situation is described in a Red Cross report, ‘No Place for Children’.  Three children with family in the UK who therefore have a right to come here, have died trying to make their own way here.

A crisis in paying for the care of older people is looming, with the UK “well behind the curve”, according to a leaked memo, written last May, by former pensions minister Baroness Altmann.  She notes that no money has been set aside in the public or private sectors for such care, with needs funded as they arise.  It is said that Jeremy Hunt is amongst those in government in favour of encouraging people to save for their older age care.  It is also understood that the Dilnot proposals for limiting the amount people have to pay, which were shelved by the Government until 2020, are unlikely to be implemented.

The NHS has risen up the public’s issues of concern and was the most mentioned matter, with 40% of adults mentioning it as a concern to them, compared to 39% for immigration and 25% for the EU, according to an Ipsos Mori survey of 980 UK adults.  This is the first time it has been the most widely held concern since July 2015, when it was at 44%.  However, when asked what was the single most important issue facing Britain today, only 10% said the NHS while 23% said Europe and 20% said immigration or immigrants.

The police are being used in mental health crisis situations, with a 50% increase in detentions under the Mental Health Act in a decade, according to senior police figures.  The College of Policing has launched guidelines to try to get police to avoid using force when dealing with people who they believe may have mental health problems.


07 October 2016

Jonathan Ashworth has been appointed shadow Health Secretary, replacing Diane Abbott.
(08/10/16) (Rgn)

NHS Improvement is tightening controls over NHS trust spending on agency staff with trusts having to provide much more detail about such spending.  Trusts’ spending on such staffing could also be published.

Children’s weight and subsequent health problems are rising round the world because of the spread of heavily marketed fast-food according to researchers from the World Obesity Forum who have produced data on the the extent of the problem round the world.  The research is published in the journal Pediatric Obesity.  The research provides a forecast of levels of obesity and related health problems by 2025.

GPs were being recruited to do private work, at the Royal College of GPs conference, by new firm Babylon which offers online appointments for people on their smartphones.  The company was a sponsor at the conference and recruitment flyers were put in delegates’ bags.


06 October 2016

The number of suicides by mental health patients has increased while homicides committed by them has decreased according to a report from the National Confidential Inquiry into Suicide and Homicide by researchers from Manchester University.  About 1,700 mental health patients commit suicide each year.  Of all suicides between 2004-14, 28% were receiving NHS help for mental ill-health.  Around 200 patients kill themselves each year after being put under the care of community-based crisis teams looked after in their homes  – three times the number in hospitals – and the inquiry questioned whether this was always the most suitable setting, and whether it was because of lack of inpatient beds.  A third of that 200 had been discharged from hospital in the previous fortnight.  There were 870 homicides across the UK in the ten years years between 2004 and 2014, with the number falling from 87 in 2004 to 67 in 2014.  That represented 11% of killings in that time.  Clinical care is thought to be a factor in the decline.
Press release:

Extra funding for GP services does not appear in most STPs (sustainability and transformation plans) seen by the Royal College of GPs, according to its chairwoman Dr Maureen Baker, who called on NHS England to reject plans if they didn’t include investment in general practice.  NHS guidance says that STPs should invest 15-20% of their budgets, or up to £760m in general practice by 2020.  She also said that CCGs were on course to underspend their allocation for general practice by £33m this year.

Life expectancy globally has increased by 10 years in the past 35 years, but more time is spent living with illness and disability, according to the latest results of the Global Burden of Disease Study published in the Lancet.  Smoking is the leading risk factor for poor health in the UK.

Teenage girls are more likely to abuse alcohol than teenage boys in the UK according to a report from the OECD.  It found 31% of 15 year old girls reported having been drunk at least twice compared to 26% of boys.

A scheme supporting GPs returning after a career break or working overseas is to be made more attactive, including an increase in the monthly bursary from £2,300 to £3,500, NHS England has announced.   The ‘Induction and Refresher Scheme’ also offers other benefits, including funding towards indemnity and other costs.  The criteria have also been changed so ‘suitably trained and experienced’ GPs will not have to go through the process of a supervised placement.  In addition, £19.5m is to be put towards improving access to mental health support for GPs and trainees.

Alcohol continues to be available at very low prices, including a range of products found in supermarkets at 25p per unit, with little having changed in the last five years according to a study from the Health Alcohol Alliance which studied 480 products..  The lowest price was 16p per unit for some strong white cider.  Many health bodies and charities recommend a minimum price of 50p a unit.

The next president of SOLACE is to be Jo Miller, currently Chief Executive of Doncaster MBC (and for a while at the LGA).  She will be president for the next two years.
(Rgn £)


05 October 2016

Councils are not meeting Care Act requirements to review care plans at least once a year, with 55% of those who had been receiving care for at least a year not receiving a review in 2015-16, according to data published by NHS Digital, ‘Community Care Statistics, Social Services Activity, England – 2015-16’.  Of the 1.81m requests for support from councils received in 2015-16, 57% resulted in no direct support from the council including 28% signposted to other services.

Data on adult safeguarding has been published by NHS Digital, showing there there were 102,970 enquiries on individuals in the year to March 2016, with 60% involving females and 63% those aged 65 and above.  The most common risks were acts of omission where professionals failed to meet the standards required, at 34% of risks with a further 26% of cases involving physical abuse.  Risks were said to have been reduced in 47% of cases.  Incidents most frequently took place in the home, (43% of enquires) or a care home, (36%).  In 27% of cases the person lacked the capacity to make decisions about their protection.

Mental health patients were kept in inpatient facilities for too long, according to research based on the sudden closure of 30 out of 54 acute psychiatric beds in Cornwall following the closure of a mental health facility after a fire safety problem was found.  The research was published in the Royal Society of Medicine Open.  When the 26 patients were being assessed to see what facility they should be taken to, only 10 were deemed to require an acute bed.  None of the 7 patients who had been at the facilitiy longer than nine weeks were thought to need an acute bed.  The researchers noted that funding was immediately made available in this emergency situation when in normal circumstances it would be very time consuming.


04 October 2016

‘Reliance on foreign doctors’ is to be ended by increasing the number of medical school places by 25%, from 6,000 to 7,500 a year, Jeremy Hunt has announced at the Conservative Party conference.  He said this would be so that the NHS in England would be self-sufficient and not have to rely on doctors from abroad.  There would also be a requirement that medical students would have to work for the NHS for four years or face penalties, including repaying the cost of their training, currently £220,000 over five years.  Theresa May was criticised for saying that there would be overseas staff for an “interim period”.  Nigel Edwards of the Nuffield Trust said that simply replacing overseas doctors with UK trained ones wouldn’t solve the problem of the current shortage.  There were also suggestions that more should be done for retention as well as recruitment.  A consultation paper on the proposals is expected in the autumn.

The 2015 Cancer Plan’s ambitions are only being met in 29 of the 209 CCGs, with that number, 14% of the total, assessed as doing ‘well’ or better, according to an analysis by NHS England.  24 were assessed as in greatest need of improvement, while 156 were classed as ‘need improvement’.  Two thirds of areas are not meeting the target of 85% of patients starting treatment within 62 days of referral.  Over a half are not meeting the target of at least 70% of patients surviving for a year.  The assessments were based on four measures: early diagnosis, one year survival, 62 day waits after referral and overall patient experience.
(Rgn £)

Child and adolescent mental health services (CAMHS) are inadequate according to seven out of ten specialist nurses working with young people, in a survey by the Royal College of Nursing for the Guardian.  Of the 631 mental health nurses working in CAMHS surveyed, 43% said services were getting worse, with just over 20% saying they were improving and around 35% saying they were staying the same.  The main problems identified were under-staffing, delays in getting appointments and a lack of beds, including young people being sent out of area.  Eight out of ten thought the problems with CAMHS were making the suffering of young people with mental health problems worse.

The proportion of girls and young women feeling confident about their looks has fallen from 73% in 2011 to 61% in 2016, according to a representative survey of 1,627, seven to 21 year olds by Childwise for Girlguiding (this was not just of Girlguiding members).  Of the 1,000 plus 11-21 year olds, 80% felt their looks were the most important thing about them and 66% felt they were not pretty enough.  Of all the 7-21 year olds, 69% said they felt as though they are not good enough.

Fitness trackers increased activity but not enough to noticeably improve health outcomes, in a randomised controlled trial involving 800 people aged 21-65 in Singapore, followed up after a year. The research was published in The Lancet Diabetes and Endocrinology.  The participants were split into four groups: one with no tracker, one with just a tracker, one with a tracker plus incentive payment and a fourth with a tracker plus incentive of a payment to a charity.  The cash incentive group increased the number of steps per day after six months, but this fell back to baseline by the end of the year.  In contrast, the fitbit-only group did not increase their step count but did increase the amount of moderate to vigoroous physical activity by 16 minutes a week by the end of the trial.


03 October 2016

Over 235,000 under 18’s are receiving NHS mental health services, in the 60% of mental health trusts providing data to NHS Digital.  The Guardian revealed the figures at the start of a two day series on children’s mental health.  NHS Digital started collating the figures in January, but 40% of trusts have not returned data.


02 October 2016

The ‘Time to Change’, anti-mental health stigma campaign, is to receive £20m from the Department of Health, Comic Relief and the Big Lottery Fund.  Time to Change, run by the charities Mind and Rethink Mental Illness, works with schools, employers and local communities to change attitudes and tackle discrimination.


01 October 2016

Re-testing of some chronically sick and disabled people to allow continued access to benefits is to be ended, the Work and Pensions Secretary Damian Green has announced.  People with conditions that are not going to get better, will no longer have to be regularly re-assessed, currently every three months to two years.  The precise criteria are yet to be drawn up, but it is likely that severe Huntington’s, autism and congenital heart disease will in future qualify for continuous payment.