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2017 Q1 January-March

Health and Wellbeing Policy Update: January – March 2017

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 March 2017

The Five Year Forward View refresh has been published by NHS England. Simon Stevens has said that to meet other objectives, waiting times for non-urgent operations are likely to rise, leading the Royal College of Surgeons to say that the 18 week target has been jettisoned in all but name.  The target is not being formally scrapped – it is a guarantee in the NHS constitution – but trusts will no longer be penalised for failing to meet it. There are plans to improve A&E, cancer, GPs and mental health services.  The proposals include:

– A&Es to have clinical triage at the front door

– every patient to have access to GP appointments at evenings and weekends by 2019.

– a new network of 150 urgent treatment centres

– an aim to release 2,000-3,000 hospital beds to reduce delayed discharges from hospitals

– cancer patients to receive a diagnosis or all clear within 28 days, with other improvements aiming to save 5,000 lives a year

– boosting mental health with more children’s and perinatal in-patient beds

– more nurses are to be trained with a fast-track ‘Nurse First’ graduate programme

– hospital trusts will mostly not procure IT systems but will adopt those developed by ‘exemplar’ trusts, making minor changes to adapt to local circumstances

– Nine areas are listed as those most likely to develop into ‘accountable care systems’
The key points:
Press release:
Press release on changes to primary care:
Press release on the Nurses’ First scheme:
The document (75 pp):

A £1bn deficit for the NHS in England is likely in 2017-18, the head of NHS Providers, Chris Hopson has told the HSJ.  He said NHS trusts were likely to overspend by £500m-600m, with CCGs overspending by a similar amount.

£10bn more capital funding is needed to deliver the proposals in sustainability and transformation plans and make NHS facilities fit for purpose, according to a review of the NHS’s property and estates by Sir Robert Naylor.  The review makes recommendations for how extra funding can be found, including from local land sales and by increased government funding.  It suggests there should be incentives for STPs to be able to retain capital receipts from the sale of assets.

Care home self-funders are subsidising council places, and the practice must stop, the Communities and Local Government select committee has said.  Some councils were suggesting to care homes that they should increase the charges to those who were paying for themselves.  The report quotes research from the County Councils’ Network that found self-funders were paying on average 43% more than councils for an identical care home place.

Depression is now the leading cause of disability world wide, with the number of cases having increased by 20% in a decade, the WHO has said.

The conditions on the £2bn for social care have been announced in he Better Care Fund policy guidance for 2017-19, which has been published by DCLG and DH.  The guidance also sets out proposals for moving towards further integration by 2020.  The £2bn over two years is to be pooled into the BCF and cannot be used to offset existing contributions to the fund.  The money can be spent on reducing pressures on the NHS or supporting the social care provider market such as by covering the costs of the national living wage.

The ‘Primary Care Home’ model has reduced A&E attendances, reduced prescribing costs and reduced waiting times to see GPs, according to a report by PA Consulting for the National Association of Primary Care that devised the programme.  It involves GP practices collaborating through ‘hubs’ covering populations of 30,000-50,000 and providing an extended range of services via multidisciplinary clinical teams.  This research looked at three sites covering a population of 110,000.  The model has so far been rolled out to 92 sites.
(04/04/17) (£)

Research on a possible standard to measure progress towards integration of health and social care has been published by the Social Care Institute for Excellence.  The research took the Department of Health’s initial ideas on what a standard might look like, tested it out with stakeholders and makes suggestions for further development of the standard.
Blog about the publication:
The publication:


30 March 2017

Reducing sugar content by 20% voluntarily in nine food groups is being recommended by Public Health England.  Because of the difficulties of reformulating products, they suggest the change could come by making sweets and chocolate bars smaller.  The nine types of food are: biscuits, breakfast cereals, cakes and pastries, chocolate, confectionery, ice cream, puddings, sweet spreads and yoghurts. There are specific recommendations such as that chocolate bars should not contain more than 200 calories and ice creams not more than 220.  The guidelines apply to small cafés and fast food outlets, as well as manufacturers and retailers.  PHE said they would publish a ‘barometer’ of the top 20 products that children consume to show whether sugar levels were reducing.
Press release:

Every £1 spent on public health brings an extra £14 on the original investment, on average, according to a systematic review published in the Journal of Epidemiology and Community Health.  The researchers identified 52 suitable studies over 40 years which looked at the value for money of 29 different initiatives internationally.  The average cost-benefit ratio was 8.3, meaning that the £200m cuts to public health spending will actually cost £1.6bn.

8% of British people have low or very low food security, with a quarter of low income households struggling to eat regularly or healthily because of a lack of money, according to official statistics from the Food Standards Agency, based on a representative sample of 3,118 over 16 year olds in England, Wales and Northern Ireland conducted in 2016.  The survey covers a wide range of issues related to “the public’s reported behaviours, attitudes and knowledge relating to food safety and food issues.”  It found that 16% of 16-24 year olds were food insecure compared to 1-2% of over 65’s.

A quarter (26%) of British adults fail to do 30 minutes moderate physical activity a week, according to a report from NHS Digital bringing together figures on obesity, physical activity and diet.  61% did 150 minutes of at least moderate physical activity a week.  In 2015, 58% of women and 68% of men were overweight or obese.  Only 26% of adults said they ate the recommended five portions of fruit and vegetables a day.  In 2015-16 there were 525,000 hospital admissions in England where obesity was recorded as a factor.

The public’s satisfaction with the NHS remained steady in 2016, according to findings from the British Social Attitudes Survey by the National Centre for Social Research, published by the King’s Fund.  63% of people were satisfied with the NHS, which was similar to last year, but below the 70% peak of 2010.  These are public perceptions rather than necessarily reflecting patient experience.
Press release:

The latest NHS workforce statistics show full time equivalent numbers having increased by 2.2% since 2015. There was a net fall of 1.3% in the number of GPs in the three months September to December 2016, from 34,495 to 34,050, according to figures from NHS Digital.  A record number of non-UK EU citizens left the NHS last year although there was a net increase in EU staff numbers.  17,197 doctors, nurses and other NHS staff from the rest of the EU left in 2016 compared to 13,321 in 2015.
Press release:
Links to the figures:

In a study of care co-ordination in primary care, the UK did best out of 11 countries. The study was based on data collected from the Commonwealth Fund’s 2013 International Health Policy Survey.


29 March 2017

A campaign to get people talking about mental health has been launched by Prince Harry and the Duke and Duchess of Cambridge. As part of the ‘Heads Together’ campaign, a survey of 5,000 people on mental health, conducted by YouGov, was released.  It found that nearly half the population had had a conversation about mental health in the last three months but only 3% had approached someone from a local support organisation and 2% spoke to someone from their human resources department.

Deaths from air pollution internationally from the production and distribution of goods is revealed in a study involving the University of East Anglia and published in Nature.  It found that 3.45m people died as the result of pollution associated with the transport of goods in 228 countries in 2007.  Across the world, 16.3% of deaths were caused by pollution produced in a different region.

Remote monitoring technology could save the NHS billions of pounds, a report by the Institution of Mechanical Engineers says.  It says that the roll out of digital and mobile technology could have saved the NHS £1bn over the last five years by enabling patients to leave hospital sooner.  It calls on the Department of Health to create a secure remote health management network by 2020 to allow remote monitoring and access to patient data.
Press release and link to report:

A report on how climate change can affect mental health has been published by the American Psychological Association and ecoAmerica.  As well as direct effects such as trauma from extreme weather events, indirect effects can come from weakened infrastructure, less secure food systems and increased international migration.


28 March 2017

The Government’s 1% pay cap for the NHS is creating concerns about recruitment, retention and motivation, and the policy will soon need to be modified, the NHS pay review body that advises government, has said.  They say the concerns are shared amongst employers as well as staff.  The decision to keep the cap at 1% has also been strongly condemned by unions and MPs.  The coming year (2017-18) will be the sixth year in a row when the NHS pay rise has been lower than the increase in inflation.  The cap is due to continue until the end of this parliament in 2020.

Nurses from other parts of the EU are leaving the UK because of Brexit, the Royal College of Nursing has said, after a freedom of information request showed 2,700 EU nurses working in the UK leaving the Nursing and Midwifery Council register in 2016.


27 March 2017

The Government has missed important opportunities to tackle child obesity, including failing to take robust action on discounting and price promotions of unhealthy food and drink, the Health Select Committee has said.  The Committee says it was retailers themselves who wanted regulation, so that those acting responsibly were not undermined by others.  Tighter restrictions on junk food advertising that might reach children were also recommended.  The levy on sugary drinks is welcomed but they say it should be extended to milk-based drinks.
Press release:
The report (html):
The report (pdf):

Prescriptions for some items, many available over the counter, may not be allowed in future, pending a review and consultation by NHS England, Simon Stevens has said in an interview with the Daily Mail.  Some painkillers, cough remedies, indigestion pills and gluten free food, are the kinds of things that GPs could be told not to prescribe.  NHS Clinical Commissioners, which prompted the review, drew up an initial list of 10 items which also included travel vaccines, rubs and ointments and omega 3 and fish oils.  It is estimated that stopping prescribing these items could save £100m a year, and it is hoped eventually that adding more items could save £400m a year.  It is argued that this will hit the poorest hardest who receive free prescriptions, whilst those who pay are often advised to buy the products over the counter already.  Norman Lamb called it a ‘creeping retreat of the NHS’.
(28/03/17) Letter to the paper:
(28/03/17) Press release:

A report on growing up in poverty has been published by the Children’s Society.  The three year study, in partnership with the University of Bath, follows the lives of 60 children.
Press release:

Council tax bills are being increased in 9 out of 10 English councils. Only 22 of 353 councils are freezing council tax, with one reducing it.  Over two thirds of the 152 councils with social care responsibilites are making use of the 3% social care precept allowed by government this year without triggering a referendum.


26 March 2017

Almost half the £2bn allocated to the health service in 2014 was spent on non-NHS providers, according to he Health Foundation in analysis for the Financial Times.  They say that £901m was spent outside the health service in 2015-16, with £800m spent buying care from NHS trusts.  The think tank says that commissioners now spend £1 in every £8 on non-NHS organisations.  They say that the figures show that NHS providers do not have the capacity to deal with rising demand.  The report also finds that consultant productivity is falling, but not because they are not working extremely hard.  Rather it is due to systemic factors such as not having the right balance of nurse and other supporting staff.
(27/03/17) (Covered in second half of article):
Press release:

Four out of five 12-16 year olds said they felt they had mental health problems, in a survey of 500 secondary school pupils for the charity stem4 [it is not clear how representative the survey was].  However, only 1 in 20 would turn to a teacher if they had mental health problems.  A third of respondents thought providing mental health first aid for teachers was a good idea and a fifth would prefer to see properly trained mental health professionals in school.  79% of respondents said they experienced emotional distress after starting secondary school.


24 March 2017

PHE’s Workplace Wellbeing Charter has been evaluated by the Rand Corporation.  Public Health England set the standards for the Charter in June 2014.  Rand identified a number of benefits that had come out of it, but lack of robust data meant it was not possible to definitively attribute improvements to the Charter.


23 March 2017

Social workers are struggling with heavy case loads and long hours, taking many to the brink of burnout according to a study by Unison and Community Care magazine, based on feedback from 2,000 social workers.  48% of respondents said that the volume of cases they were responsible for left them feeling ‘over the limit.’  80% had experienced emotional distress on the day on which they were surveyed.

About three quarters of people’s social care problems could be resolved at first contact, rather than having to go through a full social work assessment, according to a report on managing demand, from the Institute for Public Care at Oxford Brookes University.

A survey of public health involvement in STPs shows extensive strategic level input from Directors of Public Health (90%), but also identifies a number of weakness in the processes, including only 14% of respondents reporting evidence of patient and carer involvement.  The online survey was undertaken by the Faculty of Public Health and received 22 responses, which is 46% of the 44 STP areas.  The faculty says that the survey “suggests STPs are falling some way short of translating aspirations into achievable targets and commitments.”  It suggests there is a failure to tackle the wider determinants of health.  It says evidence is lacking that there is a focus on prevention as a priority.

Almost three quarters (73%) of women start breastfeeding but less than half (44%) are still doing so after two months, according to NHS and Public Health England data.  According to a survey of 500 mothers commissioned by PHE, reasons for not breastfeeding included: that it could be painful (74%), it might prevent them taking medication (71%) and embarrassment in front of strangers (63%).
(27/03/17) Press release:

Subsidising health foods would do more to change the eating habits of overweight and obese people than taxing unhealthy foods, according to research based on detailed mathematical modelling, from the University of Bath published in the Bulletin of Economic Research.  They suggest that over the course of a lifetime, a 10% subsidy of healthy foods would cost £991m but could save up to £7.2bn.
Press release:


22 March 2017

Major food and drink manufacturers are refusing to meet targets for reducing sugar, as set by Public Health England.  The Food and Drink Federation, representing companies such as Mars, Nestle, PepsiCo and Kellogs, says it would not be technically possible or acceptable to UK consumers to reduce sugar content by 20% between 2015 and 2020.  The Obesity Health Alliance says if they refuse to make voluntary reductions, the law should be changed to force them.
Response from the Royal College of Paediatrics and Child Health:
FDF press release:

A standard for improving children’s mental health services set by NHS England was missed  by 73% of CCGs, and only 32% of CCGs had a fully funded plan to improve crisis care which is necessary to meet the standard for crisis care performance, according to a report, using official figures, by the Education Policy Institute.  It found a wide variation in performance across England.

Weekend emergency surgery is not associated with higher mortality, according to research from Edinburgh University analysing over 50,000 operations in a three year period from 2005, with outcomes monitored until 2012.  The research was published in the British Journal of Surgery.

Teenage pregnancy rates are at the lowest level since records began, in England and Wales, having halved in the last eight years according to ONS statistics on conceptions.  When comparable records began in 1969, there were 47 pregnancies per 1,000 girls under 18.  in 2007 the rate was 42 per 1,000 and in 2015 it had fallen to 21 per 1,000.


21 March 2017

The NHS Litigation Authority is to be renamed and overhauled, Jeremy Hunt has announced.  From 1st April it is to be known as NHS Resolution, with a bigger role in sharing knowledge and developing new interventions to reduce mistakes in health care.  It will also do more to intervene earlier in maternity cases.  The aim is to move the focus away from claims management and towards earlier intervention to support families as well as sharing learning to prevent mistakes in future.  The cost of clinical negligence claims to the NHS is now about £1.5bn a year.

The Government’s annual Mandate to NHS England requires concrete progress on STPs (sustainability and transformation plans) as a way of delivering the Five Year Forward View, with performance at a local level “more explicitly linked to national accountability.”  The mandate is published three months later than usual: it is thought partly because of disagreement between the Government and NHS England, and also because the Government’s attention has been focussed on Brexit.  The four hour emergency waiting time target will have to be met by the end of the 2018 calendar year.  There is also a target to reduce NHS-related delayed transfers of care to 3.5%.
The Mandate 2016-17:
The Mandate 2017-18:

The home care market is ‘broken’ and is only “being held together by hope and goodwill” which will only hold for so long, the LGIU has warned, in a publication produced with care provider the Mears Group, “Paying for It: the human cost of cut-price care.”  It says that care is being purchased at prices that are not sustainable.
The publication:

Waits to get wheelchairs are exceeding NHS Constitution guarantees for a fifth of children and a sixth of adults, according to figures from NHS England seen by the Health Service Journal.  The NHS Constitution guarantees access to a wheelchair in at least 18 weeks, but between October and December, 7,200 people waited at least 19 weeks.

Almost three quarters (73%) of older people are lonely and more than half (56%) of those have never spoken to anyone about how they feel, according to an online poll of just over 1,000 people, by the social networking site for over 50’s, Gransnet, for the Jo Cox commission on loneliness.  Respondents said that better public awareness was the best way to combat loneliness.

People living close to trees and green spaces are likely to be healthier and are less likely to be obese or have depression, according to a summary of over 200 existing research papers by the Institute for European Environmental Policy (IEEP).  Amongst the findings were that middle-aged Scottish men with homes in deprived but green areas had a death rate 16% lower than those in urban areas.  Doctors prescribe fewer anti-depressants in urban areas that contain more trees.  Obesity and inactivity levels are higher amongst people people with less access to nature.
The summary publication:
Press release:
Link to longer report from July 2016:

Dental surgery on young children has been gradually increasing, with the number of tooth extractions from under 4’s have increased by 24% in ten years, from 7,444 in 2006-07 to 9,206 in 2015-16, while the number of children in that age group rose by 16%.  The information was obtained by the faculty of dental surgery at the Royal College of Surgeons.  42% of children did not see a dentist in 2015-16.

At least £17.6m has been spent on management consultants to develop STPs (sustainability and transformation plans) according to responses to freedom of information requests by the Press Association.  Firms employed include KPMG, McKinsey and PwC.   Of the 44 areas, 8 did not respond to the request.

An online system for booking care home places is helping reduce delayed hospital discharges in Hertfordshire.  The system, ‘Bed Finder’, developed by the OLM group, is said to have cut bed booking times by 50%.

A summary of research evidence on patient experience of primary care has been published by the National Institute for Health Research.

Self-care and the role of the third sector is explored in a briefing and a discussion paper from Regional Voices.


20 March 2017

Children’s social services are facing a funding crisis, with 9 out of 10 struggling to meet their legal duties, according to a report by the All Party Parliamentary Group for Children.  It also found big differences between different parts of the country, with seven times more children taken into care in Blackpool compared with Richmond in London.  The report found that councils were dealing with the financial squeeze by increasing the thresholds at which children were classified as being in need.  The chair of the inquiry, former Children’s Minister Tim Loughton, said that £1 was being spent on preventive help for every £4 on reactive services, when the opposite should be the case.
(21/03/17) Feature article by Tim Loughton:

Home care contracts have been cancelled with 95 councils, according to research for the BBC’s Panorama by Opus Restructuring and Company Watch, based on freedom of information responses from 97 of 212 UK councils.  They also found that a quarter of the UK’s 2,500 home care companies is at risk of insolvency.

NHS whistleblowers would be protected from discrimination if they apply for another health service job, in proposals out for consultation until 12 May.  Under the plans, job applicants would be able to complain to an employment tribunal if they had been discriminated against because of previously having raised concerns about patient safety.  The changes are being made using the Small Business and Employment Act 2015.
Press release:
The consultation:

Government plans to cut air pollution are to be subject to a joint investigation by four select committees, Health, Transport, Environmental Audit and Environment, Food and Rural Affairs.  The joint enquiry will look at the scale of harm caused and the action necessary to tackle it and whether revised government plans go far enough.

Salt reduction targets for 2017 are unlikely to be met, with bread and rolls the only foodstuff likely to meet them, according to Consensus Action on Salt and Health (Cash) which is monitoring the success of the voluntary scheme.  Cash examined 28 different categories of processed food.  The targets for 2017, under the ‘responsibility deal’, were set in 2014.  One of the findings from the latest research was that Galaxy Ultimate Marshmallow Hot Chocolate is saltier than some sea water.
Public Health Responsibility Deal page on salt:

The UN’s World Happiness Report shows Norway as the happiest country in the world, followed by Denmark, Iceland, Switzerland and Finland.  Based on scores from 0 to 10, the lowest placed country, the Central African Republic averages 2.69 while Norway scores 7.54.  The UK was 19th.  It also looks at other factors impacting on wellbeing such as GDP, social support, life expectancy, freedom of choice, generosity and perceived corruption.

Growing numbers of pregnant women without legal status are not seeking medical care because of fears they will be reported to the Home Office or face high medical bills, according to charities that work with vulnerable migrant women.  A letter from one trust warns that “Failure to pay a deposit for treatment may result in your future appointments being cancelled”, although NHS guidelines say that maternity care should never be denied.  The same letter says that “overseas visitors who incur costs for treatment and do not pay will be reported by the trust to the Home Office and debt collecting agencies.”  The trust says it has now updated its standard letter to make clear that maternity care would not be withdrawn.

There has been a big increase in online treatment of mental health conditions, with a nearly nine-fold increase in online appointments for Talking Therapies, from 5,738 in 2012-13 to 49,475 in 2015-16.  This compares to a 144% increase in appointments overall.  Online methods include the use of instant messenger, webcams and guided, computerised CBT.  There was some criticism of online methods as providing insufficient human contact, but they were praised by others as fulfilling a need which could not be met in other ways.


19 March 2017

Hitting targets while balancing the budget is ‘mission impossible’ for the health service, NHS Providers (which represents hospital, mental health and ambulance trusts) has said.  It predicts that its members will get a 2.6% budget increase next year, compared to a growth in demand of 5.2%.  The report found that 30% of trusts have not yet signed up to a ‘control total’ (financial target) for 2017-18 and that those targets had a median efficiency requirement of 6.4% (where the highest estimates for average efficiency actually achieved in recent years is 1.4%).  The savings requirement across all trusts is 4.2% next financial year compared to 4% in 2016-17.
(22/03/17) (£)
Press release:
The report (html):


18 March 2017

The number of non-UK EU nationals registering as nurses has fallen by 92% in England, from 1,304 in July 2016 to 96 in December 2016.  Freedom of information responses received from 80 of the 136 NHS acute trusts in England by the Liberal Democrats showed that 2,700 EU nurses left the NHS in 2016 compared to 1,600 in 2014, an increase of 68%.


17 March 2017

Regular restructuring of the NHS is demoralising staff and is a key reason for problems of staff retention, according to a survey of more than 2,000 nurses, GPs and hospital doctors across the UK by Wilmington Healthcare UK.  It found that 64% blamed staff retention problems on the continuous and demoralising national changes in NHS workforce planning since 2000.  NHS England said this survey did not accord with its own staff survey which had 423,000 responses.

Suicide risk is highest for men working in the construction industry and women working in culture media and sport, healthcare and primary school teaching, according to research commissioned by PHE from ONS based on the 18,998 people aged 20 to 64 who killed themselves in England between 2011 and 2015.  The highest paid occupational group, managers, directors and senior officials, had the lowest risk of suicide.  The ONS said an occupation may be at higher risk of suicide because of low pay and job security and/or knowledge of and access to the means of suicide.

Google’s Deep Mind’s links with the Royal Free Hospital in London have been criticised in an academic paper.  Google and the hospital said the report contained a number of errors and they were preparing a rebuttal.


16 March 2017

Child poverty is at its highest level since 2010, with 30% of children in the UK classed as poor, of whom two-thirds are from working families, according to government statistics.  The Work and Pensions secretary, Damian Green said the “figures confirm that work is the best route out of poverty.”  Poverty is expected to increase over the next three years with cuts to working-age benefits.  The IFS said income for working age adults was no higher than eight years ago.

£800m that CCGs had been required to set aside is to be used to cover hospitals’ deficits, the NHS England head of finance Paul Baumann has said in a letter seen by the HSJ.  The CCGs were required, at the start of the year, to allocate 1% of their budgets as a ‘non-recurrent reserve’ which was designed to cover the risk of providers overspending.  This is reported as ‘Money earmarked for mental health diverted to balance NHS books’ (Guardian) or money destined for GP surgeries (Mail), apparently on the basis that Simon Stevens said last year that it was ““funding that would have been available from CCGs for mental health services, community health services, primary care and other things”.  However it had not been specifically allocated for mental health and there has been awareness for some months that it might be used to balance the trusts’ deficits.

The number of patients not seen within four hours has doubled in two years, from 1m in 2013-14 to 2.2m in 2015-16, with rises of more than 300% in some hospitals according to figures from the Royal College of Emergency Medicine.  The RCEM said there was a systemic problem due to the shortage of hospital beds.

The Government’s suicide prevention strategy needs a bigger focus on implementation, the Health Select Committee has said.  It says more should be done to drive practical prevention for vulnerable groups, there should be more information sharing about those at risk and there should be better record keeping so that the most effective preventive measures can be identified.  About a third of patients who had committed suicide had been in contact with their GP the preceding year but were not sent to a mental health specialist.  About 40% of people who have self-harmed who go to A&E are not being given a psychological assessment.  TV dramas should be restricted from showing suicides.

Income tax should be increase by 1p to provide £4.6bn for the health service while cross-party attempts are made to find a longer term solution, Norman Lamb has proposed, on behalf of the Liberal Democrats.  He has said he will make the case for a cross-party investigation, lasting about a year, to make recommendations for long-term reform.

About 70% of secondary school pupils have experienced negative feelings in the last year with 11% describing themselves as unhappy overall, according to a survey of a representative sample of over 1,000 UK-based 11-16 year olds for the BBC.  They said the most important thing schools could do to support pupils’ mental wellbeing was to provide someone trustworthy to talk to confidentially.  66% said the support they were offered at school for their worries and concerns was ‘good’ while 18% said it was ‘poor’.  Separate research on over 700 teachers found that a third had not had any training on how to deal with mental health issues and a quarter would not know when to refer a young person in mental distress for help.

Ill health and deprivation in rural areas are in danger of being overlooked, because of the way data is captured and because of the idyllic image of the countryside that is often portrayed, according to a report from Public Health England and the Local Government Association.  19% of people live in rural areas but 24% of their population is over 65, compared to 16% in urban areas.  Only 55% of rural households live within 8km of a hospital compared to 97% of urban ones.  Reductions in government grant mean that services such as transport, libraries and grants to voluntary organisations have been cut, affecting health and wellbeing.

The number of patients treated in mixed sex wards has trebled in two years according to figures from NHS England.  There were 7,749 mixed-sex breaches in the year to February 2017, compared to 4,834 for the same period in 2015-16 and 2,564 in 2014-15.

The cost of prescriptions is to rise by 20p from £8.40 to £8.60, in England, the Government has announced.  Prescriptions are free in the rest of the UK.  The cost of dental care is also increasing.


15 March 2017

A cap of £20m a year on new drugs has been agreed by NICE following a three month consultation.  For expensive drugs, NHS England will be able to apply for an extension, of up to three years, to the existing 90 day deadline for making them available, to allow for discussions with the manufacturers to try and bring the price down.  NICE has also agreed to a fast track process for cheaper drugs.  The changes come into effect in April 2017.

Four times more incurable cancers were found when smokers received free CT scans in shopping centres, the evaluation of a Manchester scheme has found.  The scheme offered a free health check and CT scan to smokers and ex-smokers in three deprived areas of Manchester.  More than 2,500 people took part in the month long trial in June 2016.  The scheme led to 42 cancers being discovered.  The proportion of people discovered at stage 4, which is normally incurable, fell from nearly 50% to just over 10%.

The pay of public sector workers has fallen in real terms and the median real pay for the average public sector worker is predicted to fall below 2004 levels by 2020 according to the Resolution Foundation.  The think tank predicts that falls could affect the rest of the workforce later this year.

48% of NHS psychological therapists experience depression, according to a survey by the British Psychological Society of 1,227 NHS staff members of the New Savoy Partnership, a coalition of organisations supporting psychological therapies free on the NHS.

Safe staffing advice in mental health services has been published by NHS Improvement.  It says that mental health trusts must carry out evidence based reviews of staffing levels to ensure patients are cared for safely.
(16/03/17) (£)


14 March 2017

New doctors could be forced to work for the NHS for five years after they qualify or pay a proportion of the costs back, the Government has proposed in a consultation document.  The BMA has opposed the proposals saying they risked demotivating doctors further.  The government is proposing to increase the number of university training places for doctors by 25%, from 6,000 to 7,500 from September 2018.
Press release:

Financial pressures are increasingly affecting patient care, often in unseen ways, according to a report from the King’s Fund which looks at district nursing, sexual health, hip replacement and neonatal care.  It found that there are not enough district nurses to meet demand, leading to people at the end of their life having to wait up to eight hours for pain relief.  There has been a loss of 15% of district nursing posts in the last two years.  The report said more work was being ‘deflected’ to district nurses and patients face tougher scrutiny for whether they quality for help.  It says access to hip and knee replacements is starting to be restricted.
Press release:
The publication:

Marks and Spencer is hosting mental health drop-ins, where people feeling overwhelmed by the stresses of modern life can go to talk about their feelings. The Frazzled Café project is fronted by Ruby Wax.  There are to be fortnightly sessions in the store’s restaurants which have been closed for the day, hosted by trained volunteers.  They will be in 11 stores to start with, but are to rolled out to others in the coming months.–marks-and-spencer-frazzled-cafes

Doctors did not diagnose more people with dementia when more older people who were forgetful or confused were encouraged to see them, in research from University College London, based on 14,558 patients at 22 surgeries in North and East London, Hertfordshire and Essex, and published in PLOS Medicine.  Half of the practices sent letters and leaflets to patients over 70 urging them to see the GP if they suffered from confusion or forgetfulness.  Although this increased the number of people seeing the GP, it did not increase diagnosis rates.

Children’s levels of exercise start to tail off from age seven, according to research from the universities of Strathclyde, Newcastle and Qatar, involving 400 children living in the Gateshead area and tracked between 2006 and 2015.  It was published in the British Journal of Sports Medicine.  The children’s exercise was measured at the ages of 7, 9, 12 and 15.  Between the ages of 7 and 15, the girls’ exercise fell from 63 to 41 minutes a day while the boys’s fell from 75 to 51.

A report on the clinical requirements for information and digital technologies has been published by the Academy of Medical Royal Colleges.


13 March 2017

An overhaul of the Deprivation of Liberty Safeguards (DoLs) arrangements has been proposed by the Law Commission, in a major report to Parliament.  With long delays, the current system is not working properly, meaning that tens of thousands of vulnerable people are being illegally detained in hospitals and care homes.  A supreme court judgement in 2014 dramatically increased the number of people subject to the orders, from 13,700 in 2013-14 to 195,840 in 2015-16.  The Law Commission was asked by the Department of Health to come up with an alternative to the scheme.  The proposed replacement would allow previous assessments made in care plans to be relied on rather than requiring six new assessments.  The new scheme would cost about £235m a year.  This would only save about £10m, but if the current system was working properly, it would cost £2.2bn a year.

The NHS ought to be exempt from the Immigration Skills Charge coming into effect in April, which would mean the health service having to pay £1,000 per year for workers from outside the EU, the BMA and Royal College of Nursing are arguing.  Although funds from the charge are to be reinvested in the NHS, the two unions say there is no guarantee of this.  The charge aims to cut down recruitment of migrant workers and incentivise training but the nationally directed training has not produced enough doctors and nurses and there are now long timescales to train new ones.

The 500,000 undelivered pieces of NHS confidential correspondence has been subject to five different investigations, the health minister, Nicola Blackwood, has said in a parliamentary answer.  In addition to investigations by the firm involved, NHS Shared Business Services, and by the Department of Health and NHS England, the incident is also being examined by the NAO and the Information Commissioner’s Office (ICO).  The minister said none of the three completed investigations would be published, leading to claims of a cover up, although she said it was not appropriate to publish them until the NAO and ICO investigations had concluded.

Children spending more than three hours a day in front of a screen were more likely to have risk factors for diabetes, including more body fat and insulin resistance, according to research from St George’s, University of London, involving data on 4,495 children aged 9-10 collected between 2004-07, published in Archives of Disease in Childhood.  18% of the sample spent 3 or more hours in front of a screen each day.

Hospital admissions for rickets, gout, syphilis and scarlet fever have increased in recent years, according to figures from PHE, reported by the Sun.  Between 2009-10 and 20015-16, the number of cases of rickets rose from 675 to 937, cases of gout from 6,908 to 9,708, syphilis from 2,646 to 5,217 and of scarlet fever from 381 to 1,135.  Amongst the causes were said to be falling living standards, financial inequality and poor diets.

An update on the official national physical framework for England has been published, by Public Health England, in ‘Everybody Active Every Day: two years on’.


11 March 2017

Pharmacists will no longer be able to refuse to prescribe drugs on moral or religious grounds, the so-called ‘conscience clause’, the General Pharmaceutical Council (GPhC) has said.  The change means pharmacists would no longer be able to refuse to prescibe, for instance, the morning-after pill on the grounds that they considered it an abortion.  There was objection to the changes from various religious groups.

Control of illegal pharmacies selling drugs online is impossible, the Medicines and Healthcare products Regulatory Agency (MHRA) has told the Independent.  The MHRA, CQC and other regulatory bodies have launched an investigation into the 43 pharmacies registered to trade online in the UK.


10 March 2017

CCGs should avoid ‘arbitrary rationing’, NHS England has told them in an email seen by HSJ, sent last month.  They should avoid arbitrary cut-off points for knee and hip replacement and restricting surgery for smokers and people who are obese, as opposed to requiring a period for slimming or smoking cessation support.

Health professionals need to be alert for signs of sepsis and treat it within an hour according to a new quality standard produced by NICE.  The condition kills 44,000 people a year in the UK.

GP practice waiting times are to be published in new league tables, NHS England chief executive Simon Stevens has said, speaking to the Public Accounts Committee.  However, Prof Helen Stokes-Lampard, Chair of the RCGPs said that data on GP waiting times should not be used as a measure of performance as it is affected by too many varaibles, such as local demographics and deprivation levels and recruitment difficulties.

A report on how public health has worked with community organisations has been published by the LGA.  The case studies show examples of public health working with the voluntary, community and social enterprise (VCSE) sector.


09 March 2017

A&E figures were the worst ever in January, with 85.1% of patients waiting for up to four hours, compared to the target of 95% according to January’s combined performance figures.  The target has been missed since July 2015.  Other targets missed included those on cancer and planned care, while delayed transfers of care were also at an all time high.  Jeremy Hunt has said hospitals must get back to meeting the target.  The heads of NHS England and NHS Improvement have written to trust chief executives giving them a deadline of March 2018 to meet the target.  Chris Hopson, of NHS Providers said this was unrealistic.  Amongst the things trusts have to do are: ‘comprehensive front door screening’ by October; better medical care for older people in care homes; ambulances treating more people in situ rather than taking them to hospital; and closer working between health and councils.  The 30% element of transformation and sustainability funding which is accessed by meeting performance criteria will now be released as long as A&E targets are met.
The key figures in charts:

Cancer drugs should be tested on children more routinely according to cancer experts.  EU regulations allow drug companies to opt out of testing on children. Since 2012, 62% of cancer drugs approved by the EU have not been tested in children.  A consultation is currently running on the EU rules on clinical trials.

An association between excess expected deaths and the number of doctors per 100 beds has been found in analysis for the BBC by Prof Sir Brian Jarman using the Summary Hospital-Level Mortality Indicator (SHMI) measure.  The areas with the worse staffing ratios also tended to be those where the population was more sick and in need.  NHS Digital said it was wrong to rank trusts according to their SHMI.

Parents should use pram covers to protect babies and young children from pollution, researchers have suggested as part of research by the University of Surrey, published in Environmental Pollution.  Young children are more at risk because their bodies are developing.  The research looked at the exposure of babies in prams to air pollution in the school run.  Concentrations of fine pollutant particles were higher in the morning and particularly round traffic intersections and bus stops.  Coarser particles were more concentrated in the afternoon.  There was no difference between pollution levels at pram and adult height.

The improvement of public health and wellbeing by councils is illustrated in a series of case studies published by the LGA.  The report, “Public health transformation four years on: Maximising the use of limited resources” (64pp) first looks at general themes and lessons before describing the eight case studies.  At the same time, the LGA has published a series of short essays (11, mostly of 1 or 2 pages, total 20pp) to recognise four years of public health being part of local government.


08 March 2017

The budget promised £2bn for social care over three years, £325 for STPs over three years and £100m towards A&E. – Social care is promised £2bn over three years with £1bn this year, £674m in 2018-19 and £337m in 2019-20.  Organisations within the sector said this may not be enough.  90% of the funding is to be allocated through the ‘Improved Better Care Fund’ (iBCF).   There is to be a green paper later in the year on longer term funding, although the Chancellor ruled out a ‘death tax’ as an option for future funding.  There have been 12 reviews and consultations in the last 20 years.

– £325m over three years is to go towards capital investment for the strongest STPs (sustainability and transformation plans).  However while that capital money was being given with one hand, Jeremy Hunt is moving £1.2bn from capital to revenue this year to cover hospital deficits, £1bn is to be transferred next year with further raids in the following years.  The NHS will also be expected to play “its part in raising proceeds from unused land.”

– £100m is to go towards triage in A&E departments but the BMA and NHS Providers say there may not be enough GPs to staff such services.  The HSJ says the aim is to copy the model used at Luton and Dunstable and that there will be £1m per A&E for capital, including IT, but trusts will not be allowed to use it to pay for the employment of GPs.

– £5.9bn has been ‘set aside’ to protect the NHS from the effects of the changes to the personal injury discount rate.

– The soft drinks levy was confirmed, with a rate of 18p per litre where sugar is over 5g per 100ml and 24p where it is over 8g.  It is predicted to raise £385m a year, £135m less than expected as producers are already starting to take sugar out of their drinks.
Budget summary (all aspects, not just health):
(09/03/17) How the £2bn social care funding is allocated amongst councils:
The budget speech:
Links to all the budget documents:

The NHS staff survey finds 56% are working unpaid overtime each week. The survey had responses from 423,000 healthcare professionals, a third of the workforce and the highest response rate in its 14 years.  It found that 70% of respondents would be happy for a friend or relative to receive care from their organisation, the proportion feeling unwell because of work related stress was at its lowest since 2012 at 37%, but 56% had attended work despite feeling unwell in the last three months, although that is a fall from 64% in 2012.
NHS England press release:

NHS 111 is to be revamped to allow more access to health professionals, NHS England has said.  The service is to be better integrated with other urgent and emergency care services, becoming more of a ‘front door’ to the NHS.  The changes are to be phased in across England from next month.  About 30% of callers will be able to speak to a health professional such as a doctor, nurse, dentist or social worker.  This new Clinical Assessment Service will also be available to provide advice to other professionals such as paramedics.

Girls were less positive about being in care than boys, with 25% of girls in care being unhappy with their lives compared to 14% for all girls, according to research from Bristol University and the charity Coram Voice, based on a survey of 611 children from six local authority areas.  Almost a third of 11-18 year olds said they were allocated three or more different social workers within a year.  Half of 4-7 year olds and over a quarter of teenagers said they did not fully understand why they were in care.  Of all respondents, 83% said that being in care had improved their lives and 90% said they trusted their carers.

Cancer treatment targets have been missed for the last three years, with 17% of cancer patients now waiting longer than the 62 day target, according to Macmillan Cancer Support.


07 March 2017

Hospitals had to find 4,500 extra beds a day at the height of the winter crisis, according to an analysis of performance over the winter by NHS Providers, which represents the majority of NHS trusts.  These ‘escalation beds’ were the equivalent of more than eight extra hospitals.  In the busiest week, over 32,000 additional beds had to be found.  Bed occupancy reached 96%, against the safe level of 85%.  NHS Providers says the current position is not sustainable and it is calling for a national, open review of how the NHS has managed the winter pressures, to learn the lessons before next year.
Press release:

The number of smokers in the UK has fallen to the lowest level since records began in 1974, according to data from the ONS.  The rate of people smoking is highest in Scotland, at 19.1% and lowest in England, at 16.9%.  The proportion of smokers is highest in the 25-34 age range at 23%.  Meanwhile, 2.3m said they were e-cigarette users in England, Scotland and Wales in 2015, about half of whom said they were using them to help quit smoking.  Another 4 million people describe themselves as former e-cigarette users.

Surrey CC had a ‘gentleman’s agreement’ with the Government which led it to withdraw from a referendum to increase its council tax by 15%, according to a recording of a private meeting that has been revealed.  Surrey CC leader David Hodge also suggested he had something in writing linked to the agreement and if promises from Government were not honoured, he would revisit the possibility of holding a referendum.  Theresa May repeatedly denied there was any deal, when questionned by Jeremy Corbyn.  The Chancellor, Philip Hammond, was one of a number of MPs lobbying on behalf of Surrey CC, according to letters and emails released under freedom of information laws.  Labour claim that Surrey will get the largest increase in share of the new £2bn social care funding in 2019-20.  However, funding is being allocated by established formulae, mostly that used for the Better Care Fund.

A compensation scheme for people who received tainted blood is to be scaled back to save money, the Government has proposed, in a consultation that runs until 17th April.  The scheme provides compensation to the thousands of haemophiliacs given blood contaminated with hepatitis C in the 1970s and 1980s.

The Government has been accused of abdicating responsibility for social care, by Martin Green, the chief executive of Care England which represents adult care providers in England, speaking to the Guardian.  He also said that ageism underlies many of the problems in social care.

Research on improving mental health in schools is being tendered by the Department for Education to begin in May.  The Government is inviting expressions of interest for two multi-arm trials to test established approaches.  The first, three arm trial, in 135 secondary schools, tests ‘Youth Aware of Mental Health (YAM) and the ‘Mental Health and High School Curriculum Guide’ against a wait list.  The second trial, in about 100 primaries and 50 secondaries tests more general approaches: mindfulness, ‘protective behaviours’ and ‘relaxation and breathing based techniques’.  Expressions of interest have to be submitted by 24th March with tender submissions by 2nd May a contract award of 11 May with the work to start mid-May.  There is to be a one year follow up with the project ending in summer 2019.  [Comment: this appears to be an extremely ambitious timescale, to assemble a team, refine the methodology, undertake consultation, obtain ethics approval, recruit researchers and schools etc. in such a short space of time.]
(pdf) Expressions of interest invitation:

A minority of councils are avoiding have a peer challenge for fear of being ‘found out’, according to research by Cardiff University’s Centre for Local and Regional Government Research for the LGA.  The report says about two thirds of councils have had a peer challenge since the scheme was established in 2011 as a sector-led replacement for Audit Commission inspection.  The report, ‘Rising to the Challenge’ was due to be considered by the LGA on 8th March.

Data on the wider determinants of health has been published in a new tool, by Public Health England.  The data can be viewed by local authority area with comparisons with other authorities.


06 March 2017

Inequality of happiness is highest in Wales of the UK countries, according to research based on ONS data from 160,000 people, by the What Works Centre for Wellbeing, supported by the New Economics Foundation.

A report on how inequality is linked with a higher risk of suicide has been published by the Samaritans.
Initial press release:
(10/03/17) Press release on publication of the full report:


05 March 2017

Continuation of the housing benefit freeze risks increasing homelessness and should be abandoned in next week’s budget, Shelter and other housing organisations are saying.  Many people are having to find extra sums to cover rising rents and many of those now being made homeless are in full time work.  Research by Shelter found that in a quarter of areas of England, a family with one or two children will need to find an extra £100 a month to cover the rent.  The number of households that have become homeless after an eviction has increased by 12% in the last year and there has been a 9% increase in the number of families in temporary accommodation.  There is also concern about the effects on people in supported housing.  The LGA also warns of extra costs falling on local authorities.

More than half (57%) of the public think the NHS’s ability to provide care worsened in the last six months, with the same proportion pessimistic about its future according to a survey by Ipsos Mori.  A separate study by the company found Britons more pessimistic about their health service than those in 22 other countries, with 47% believing the quality of care is likely to get worse in coming years.  However they were also more positive about the care they currently received with 69% saying they or their family get good quality healthcare, compared to an average of 47% across the 23 countries.


04 March 2017

The Government should provide £1.5bn for social care as a short term, emergency measure, the Communities and Local Government select committee has said.  It suggests the money should be taken from the Better Care Fund, which pools (mainly) health and local government funds.  The committee is due to produce a report next month on the wider structural, funding and other issues facing social care.

Hospital attendances for sleep disorders in children under 14 have tripled in ten years, to just over 8,000 a year in English hospitals according to NHS data analysed by BBC Panorama.  Poorer sleep in children has been linked to weight gain, lower immunity and mental health issues.


03 March 2017

Over 60% of NHS trusts had to issue high level alerts at some point this winter, with 37 trusts, almost a quarter, reporting one or more of the highest level, Opel 4, alerts between December and February and 93 reporting Opel 3s.

The social care funding gap will be £2bn in 2017-18, according to analysis by the Health Foundation of STPs (sustainability and transformation plans).  The report also includes interviews with STP health and social care leaders.  It also finds that local authority spending on social care for vulnerable and older adults fell by 9% in real terms between 2009-10 and 2014-15, the equivalent of 400,000 fewer people receiving care.  Unmet needs for help in people’s own homes is greater for those on low incomes, so increasing inequality.

92% of GPs think that social care services are failing to give people sufficient care, 89% think reductions in social care are leading to increased pressure in their surgeries and 93% think it is leading to extra pressure on A&Es, according to a survey of 1,006 ‘regionally representative’ GPs by Medeconnect, for the Care and Support Alliance, a coalition of 90 leading charities.
Press release:

Entitlement to housing benefit for 18-21 year olds is to be removed, as previously proposed.  There had been hopes that this government would reverse the Cameron government’s decision.  Homelessness charities fear that it will lead to more young people being homeless and sleeping rough.  There are now to be some exemptions for young people considered vulnerable or unable to live with their parents.  The National Landlords Association said the changes could put off most of its members from offering housing to young tenants on benefits, as the exemptions would be bureaucratic and hard to prove.

An allowance for widows and widowers with children is to be cut. The allowance to widowed parents, which has been in place since 1925 and which provided an allowance till the children were 16 years old is to be replaced by an allowance lasting only 18 months.  The minister defended the change on the grounds that a societal shift meant women were now more likely to work and the allowance just allowed them to adjust to being single.  The allowance was not to be extended to cohabiting couples as it might be too upsetting for them to provide the necessary evidence.  More than 3,200 people have written to MPs about the issue.

Moving people with learning disabilities out of mental health hospitals and into the community is progressing but is not on track to achieve value for money, according to a report by the NAO.  Transforming Care Partnerships had reduced the number of people in mental health hospitals by 11% between October 2015 and December 2016.  Money is not being released from the hospitals to pay for extra community support quickly enough.  Partnerships are also struggling to put the necessary accommodation locally into place.

Mental health patients were sent out of area more than 2,000 times in the four months to January 2017, according to figures from NHS Digital.  The figures are only just being collected, to monitor the policy of reducing out of area placements, and only record those which have happened since October 2016.

Some online prescription services give cause for significant concern over patient safety, a CQC inspection has found.  It is advising people to be careful if they buy prescriptions over the internet.  It said that some providers were selling medications too quickly without enough checks.  It has produced guidance on what patients should expect, such as uploading photo ID and a detailed medical history.


02 March 2017

The NHS’s finances are facing a ‘nasty hangover’ after cancelling operations to avoid a winter crisis, the King’s Fund has said in its latest quarterly monitoring report.  There were also additional costs from transferring operations to private providers and taking on extra staff to cope with increased demand.  The Fund’s survey found that 53% of trusts and 63% of CCGs were fairly or very pessimistic about ending the next financial year, 2017-18, in balance, and even more (74% and 86% respectively) doubt they will meet the Five Year Forward View savings by 2020. The main reason for increased pressure on A&E departments is increasing numbers of patients with complex health needs rather than lack of access to GPs, according to the responses from NHS finance directors.  While STPs may provide part of the answer to finance and performance problems for the future, “few think they can provide an answer quickly enough for there to be any optimism about the near future.”
Press release:
The report:

Safety at four out of five hospitals is not good enough, according to a review of hospital inspections by the CQC which has now inspected all trusts.  It found that for safety, 11% were rated ‘inadequate’ and 70% ‘requires improvement’.  Of the five areas against which trusts are assessed, ‘caring’ receives the highest ratings with none ‘inadequate’.  The Chief Inspector of Hospitals, Sir Mike Richards, said that the NHS now stands on a ‘burning platform’ and needs to transform the way it works, but acknowledged the difficulties of doing that with existing pressures.  Overall, a third of trusts were rated good or outstanding.

Inequality is rising as living standards see their weakest growth for 60 years, according to analysis for the Joseph Rowntree Foundation by the IFS, based on official figures.  It says that income for the average family will not grow at all over the next two years.  It says that average household incomes will be 18% lower in 2021-22 than could have been expected in 2007-08, making a couple with two children £8,300 a year worse off.  Child poverty is projected to rise from 27.5% in 2014-15 to 30% in 2021-22 which would be a return to its pre-recession level.  The IFS said that “tax and benefit changes planned for this parliament explain all of the projected increase in absolute child poverty between 2014-15 and 2021-22.”

Proposals to allow councils to be exempted from children’s social care legislation have been dropped from the Children and Social Work Bill by the Government, after substantial opposition.  The aim of the clauses was to promote innovation without the constraint of existing legislation.  The proposal was defeated in the Lords but had then been reinstated in the Commons.
(03/03/17) (£)

Hospital bed closures are to be made harder, with new rules to ensure patient care does not suffer, NHS England Chief Executive Simon Stevens has said.  New rules to come into effect from April will only allow ‘significant bed closures’ if it can be shown that there is adequate provision outside of the hospital to ensure patients receive good care or that there is a new medical treatment which means fewer beds are needed.

A progress report on the Five Year Forward View for Mental Health, one year on, has been published by NHS England.


01 March 2017

Moving care out of hospitals will not save money, though it may benefit patients, according to a review by the Nuffield Trust.  Such moves are a key plank of many of the STPs (sustainability and transformation plans).  The report reviews 27 initiatives to move care out of hospitals and looks at the impacts, costs and lessons on what has contributed to success or otherwise.

Universal credit will cut the incomes of families with children the most, according to research by the Child Poverty Action Group and IPPR.  Lone parents will on average be £2,380 a year worse off.  Families with two children will be £1,100 worse off and those with three children will be £2,540 worse off.  The cuts will affect about one million children.

A quarter of 16-24 year old young men self-harm as a way of dealing with stress, anxiety and depression, according to a survey of 500 of them by YouGov for three charities, the Mix, Self-Harm UK and YoungMinds.  Responses to stress included drinking heavily (21%), punching walls (19%) and controlled eating (16%).

Young people are more likely to feel lonely than older people, according to a survey of 5,000 people by YouGov for Relate.  Overall, 18% of people said they felt lonely most or all of the time.  However for 16-24 year olds this was 32%, and for over 65’s it was 11%.  It was suggested that social media could be playing a part in this.  One in eight people (13%) said they had no close friends.

A quarter (24%) of 16-25 year olds would not confide in someone if they had a mental health problem, and three quarters (78%) think there is a stigma attached to mental health issues, according to an online survey by YouGov of a representative sample of 2,215 young people as part of the Prince’s Trust Macquarie Index.  The survey found that 47% had experienced a mental health issue.

Facebook has started identifying people at risk of suicide by using artificial intelligence, using algorithms to spot warning signs.  A human team then reviews the situation and if confirmed, the company will contact the person to suggest ways they can seek help.  Facebook has been identifying people at risk for some time, but up until now it has been done by people rather than AI.  It is currently just being used in the U.S.

Almost three quarters (73.5%) of prisoners faced delays in being transferred to a mental health unit, that is more than the 14 days target, according to the response to a parliamentary question by Labour MP Luciana Berger.

Women are generally not aware of the symptoms of ovarian cancer and would go to the doctor for their children or partner much sooner than for themselves, according to a survey of 1,000 British women for the charity Ovarian Cancer Action.  It found that on average women would take 15 days to seek professional advice for themselves, 5 for their children, 6 for a partner and 8 for their parents.  32% of respondents could not name any symptoms of ovarian cancer and 90% could not name them all.

Early warning signs of heart attacks could have been missed in one in six cases, according to research from Imperial College based on the records of all 158,711 deaths in England due to heart attacks in the four years between 2006 and 2010, published in the Lancet.  The research found that 16% of those who died had been admitted to hospital in the previous 28 days with another condition.  Further research is needed to discover whether warning signs were missed in such cases.  Half the people who died of a heart attack had not been admitted to hospital.

There are over 145,000 NHS and care workers from the rest of the EU working in the UK who could lose their right to live and work here following Brexit according to analysis by the TUC.  It says that the regions that would suffer the most are London, the South East and the East of England.

Sleeping for too long or not enough increased weight in people with a genetic predisposition to obesity according to research from the University of Glasgow, involving data on nearly 120,000 UK Biobank participants, and published in the American Journal of Clinical Nutrition.  The effect was seen regardless of diet, heatlh or socio-demographic group.  For those with a risk of obesity, long sleepers were 4kg heavier and short sleepers 2kg heavier than those with normal sleep durations.

A briefing on air pollution for Directors of Public Health has been produced by the LGA, DEFRA and PHE (116 pages).


28 February 2017

The sugary drinks levy is to provide £415m for sports and healthy eating in English schools, the Education Secretary, Justine Greening, has said.  All schools will receive a slice of the money, to help with mental health as well as physical exercise and encouraging healthy eating, but there will also be a bidding process for specific projects.  The money cannot be used to pay for staff.

Prosecutions are rare for allegations of abuse by carers working in people’s homes according to research by the BBC’s File on 4, based on freedom of information requests.  Although only half of councils provided data, there were at least 23,428 safeguarding alerts across the UK between 2013-14 and 2015-16, but only 700 resulted in police involvement and there were only 15 prosecutions.
(01/03/17) Comment piece by CE of Action on Elder Abuse:

Children from poorer areas are ten times more likely to be taken into care or placed on a child protection plan than those from affluent areas according to research from the Nuffield Foundation funded Child Welfare Inequality Project.  On average, each 10% increase in neighbourhood deprivation levels led to a 30% increase in rates of looked after children.

Hospital admissions for drug related mental health issues are at the highest level for ten years, according to a report from NHS Digital, bringing together some new and some existing figures on drugs misuse.  Mental health issues had drugs as a cause in 81,904 cases.  Public health experts have said that falling investment in drug treatment services may be behind the increase.

60% of doctors from other parts of the EU are considering leaving the UK, according to a survey of 2,106 doctors from the EEA (about 10% of those working in the UK)  by the GMC, reported to the Health Select Committee.

Better financial planning and organisation are needed in hospitals, social care and other public services to avoid a cycle of “crisis, cash, repeat”, the Institute for Government and CIPFA have said in a report.  It analyses government data on five services: hospitals, adult social care, police, prisons and schools.  They say the austerity programme of cutting spending but still delivering good services, ran out of steam in 2015.  Any measures in next week’s budget should have good evidence behind them.  They say the assumptions behind spending decisions should be open to independent scrutiny.
Feature and comment:

There is wide variation in the palliative care commissioned across England, but it is hard to get a clear picture because information held about population and services is not standardised, according to research based on freedom of information requests to English CCGs.  The research was led by Baroness Ilora Finlay and published in BMJ Supportive and Palliative Care.  Of 81 CCGs responding, only 29 provided information on the number of patients with palliative care needs.  Their budgets ranged from £52 to £2,329 per person per annum.  Of 204 CCG respondents, 83% commissioned seven day specialist palliative care in patients’ own homes.

The NHS logo must be displayed correctly, its organisations are being told, which could create costs to undertake the changes.  It is argued that inconsistencies can be confusing for the public and can lead to more people attending A&E.  Emails from NHS England ‘identity managers’ say that changes to logos in online publications should be made within a year and elsewhere when practical.

Being overweight has been linked with 11 types of cancer in research based on 204 previous studies, published in the BMJ.

Doctors’ experiences on the front line of the current NHS crisis are set out in a report by the Royal College of Physicians, based on a survey with 50 doctors.


27 February 2017

Some STPs will “effectively end the purchaser-provider split for the first time since 1990”, Simon Stevens has said, speaking to the Public Accounts Committee.  He said that this would be done by between 6 and 10 STPs becoming accountable care organisations or systems.  He said that NHS England would give ‘governance rights’ to the heads of all STPs, enabling them to ‘marshal the forces’ of local CCGs and local NHS England staff.  However, STPs would have to achieve their plans within the confines of existing legislation.  The BBC’s Hugh Pym calls this potentially the biggest change of its kind in a quarter of a century.  The HSJ subsequently reported that the NHS Partners Network, which represents private providers, warned that STPs must act within competition law and said there should not be a move to ‘inflexible monopoly provision of health services’.
(01/03/17) (£)

NHS England and the Government need to stop bickering and work together to tackle the huge challenges facing the NHS, the Public Accounts Committee has said in its latest report on the subject.  The committee says that the transformation that is needed is hard to achieve given the financial pressure the service is under and few trusts have a credible plan for meeting the targets they have been set by the Government.  It says there is a risk that trying to restore financial stability is affecting patient care and says the Government must review this.  It also warns of the risks of raiding capital to fund revenue spending.  It says the Government needs to set out a clear and transparent recovery plan.

Half a million items of confidential medical correspondence went undelivered in the six years from 2011-16, with the possible consequential harm to patients.  NHS England has launched an enquiry to find how many patients have been affected.  The documents included the results of diagnostic tests and summaries of care received in hospital.  In all, 708,000 items of correspondence were undelivered, but 200,000 were temporary change of address forms.  The firm responsible was NHS Shared Business Services, a private company co-owned by the Department of Health and French firm Sopra Steria.  Jeremy Hunt made a statement to MPs last July, but it did not indicate the scale of the problem and he was criticised by shadow health secretary Jonathan Ashworth who said it “… looks like he has tried to hide the scandal…”.
(02/03/17) Response by the Secretary of State in a letter to the Guardian:

New antibiotics are urgently needed to combat resistant bacteria, according to the WHO which has drawn up a list of twelve key families of bacteria for which new drugs are needed.  They said that many of them have ‘built-in abilities to find new ways to resist treatment’ and can pass on genetic material allowing other bacteria to become drug resistant.  They said governments need to invest in developing new drugs because market forces cannot be relied on to do so.

54% of parents with children in mental health hospitals said they are not improving, and 24% said their condition had got worse, according to a survey of 448 parents whose children have been in a tier 4 CAMHS unit in the last five years, undertaken by YoungMinds and the National Autistic Society [it is not clear how representative the survey was].  A third of parents said they were not consulted about decisions on medication and 44% felt they were unable to challenge decisions about their child’s treatment.  The two charities have launched a campaign based on the ‘Always’ charter, which sets out 12 rights to which young people in inpatient units and their families should be entitled.

A third of people with eating disorders were not referred to mental health services for treatment and 55% felt the doctor did not understand the importance of early intervention, according to a survey by eating disorder charity Beat, of 1,420 people with eating disorders.   34% said they thought their doctor did know how to help them.

Health and social care agency workers could lose up to 30% of their salaries because of tax changes due to come into effect in April, creating concerns that it could lead to skill shortages and increased charges, reports the Guardian.  The Mail Online says, “Crackdown on tax dodges of locum NHS staff.”  The changes only affect workers in the public sector.  The changes mean agency workers will have tax and national insurance deducted at source, rather than allowing them to calculate their own tax on a self-employed basis.

Changes to the way injuries are calculated could cost the NHS £1bn a year, according to the insurance industry.  The figure was accepted as broadly correct by the Government.

Progress made by poor pupils in primary school is virtually wiped out at secondary level, and the gap has widened since 2012, according to research commissioned by the Social Mobility Commission.  The research was carried out by LKMco and Education Datalab.  It suggests that among the causes are how children on free school meals are treated and the expectations made of them and the level of support provided at home.
Press release:
The research:

Cycling in England could be much more widespread with the right policies and investments, according to a briefing from the Centre for Diet and Activity Research (CEDAR), which uses data to assess the extent of the potential.

A review of the way commissioning for health has changed since 2012 has been published by the DH funded PRUComm.

A guide to community engagement has been produced by the LGA. Called ‘New Conversations’, it is based on four pilot projects, in Hackney, the Greater Manchester Combined Authority, Staffordshire and Harlow.


26 February 2017

All pregnant women should be tested to see if they smoke and offered help to quit if they do, the head of Public Health England, Duncan Selbie, has said, in an open letter to NHS trusts, as part of a campaign to make the NHS tobacco free.  He sugests they should be given a carbon monoxide test at all of their antenatal appointments.  Smoking should be banned in shelters used by staff and patients.  Pregnant smokers should be given nicotine patches or gum, be offered help to stop smoking or be encouraged to switch to e-cigarettes.  The Royal College of Midwives backed such testing, as long as the women had the right to refuse.  However, there had to be an understanding of the stresses and psychological, social or economic circumstances of the women, which led them to keep smoking.


25 February 2017

Depression, stress and anxiety were reduced by seeing more birds, according to research from Exeter University on 274 people in Milton Keynes, Bedford and Luton.  It was published in the journal Bioscience.  The results did not vary according to the type of birds seen.

The number of care workers from the rest of the EU has risen by 40% in the last three years, from 65,000 in December 2013 to 92,000 in September 2016, to make up 7% of the 1.34m workforce, according to a parliamentary answer to Liberal Democrat MP Tom Brake.  Dr Sarah Wollaston, chair of the Health Select Committee called on the Government to make plans to allow EU citizens to come to work in the NHS and social care after Brexit.  David Davis, the Brexit Secretary, said last week that it would take “years and years” to fill the jobs that would otherwise have been done by people from the EU.


24 February 2017

British cancer patients could be worse off through less collaboration with Europe post-Brexit according to six leading cancer experts, in an editorial in the e-Cancer Medical Science journal.  There could be problems in relation to joint research, access to confidential patient data, the regulation of trials and of medicines and attracting and retaining researchers.

Greater Manchester is to provide seven-day GP access by using ‘clusters’ of practices and ‘neighbourhood hubs’ rather than extended opening hours in every GP surgery.

A doctor’s ‘prescription’ to increase daily step count led to health improvements in a randomised controlled trial of 364 adult patients with either or both type 2 diabetes or hypertension, from McGill University, published in the journal Diabetes, Obesity and Metabolism.  Among the health benefits were reduced blood glucose levels and insulin resistance.

Sugar consumption by 11-18 olds is typically 73g a day, compared to the recommended 30g, according to analysis by the Obesity Health Alliance, based on the most recent national diet and nutrition survey.  They found that 19-64 year olds were consuming 60g and 4-10 year olds were eating 54g of sugar a day (against the recommended level of 19g for 4-6 year olds and 24g for 7-10 year olds).  The Alliance is calling on the food industry to reduce the amount of sugar in everyday foods.


23 February 2017

42% of doctors from other parts of the EU are considering leaving the UK according to a BMA survey of 1,193 doctors from the European Economic Area.  European doctors said they felt less appreciated by the Government since the vote to leave the EU, with appreciation falling from an average of 7 out of 10 to 4 out of 10.

The NHS must invest in disruptive technology to meet its Five Year Forward View (5YFV) targets, according to a paper by former chair of NHS Digital, Kingsley Manning.  He says that a focus on productivity and efficiency is not a priority either in STPs or in NHS trusts.  None of the STPs analyse current workforce productivity or give details of how it will be improved.  He says that previous spending on technology has had limited impact on productivity and there is little appetite for the disruption that would occur if it was used for efficiency improvement.  The technologies that could make a difference already exist – e.g. digital alternatives to current service delivery, operational support and logisitical systems and decision support [not much detail than that is given of such technologies].  He says that if the current approach continues, there are three likely outcomes: the 5YFV targets won’t be met except by forced cuts; health spending will require an ever increasing share of GDP with cuts elsewhere impacting on health; and third, the digital revolution in health will happen outside the NHS, with profound implications for its role.
(£) article by Kingsley Manning:

10 portions (800g) of fruit and vegetables a day is even better for you then 5, according to research from Imperial College, London, which pooled the results of 95 studies, involving about 2m people, and was published in the International Journal of Epidemiology.  However even two and a half portions (200g) reduce the risk of cardiovascular problems, cancer and premature death.  There was no information on the benefits of more than 10 portions as there was not enough information from existing studies.


22 February 2017

Fewer disabled children are qualifying for council support despite a 50% increase in the number of disabled children with complex needs since 2004, according to a report by the National Children’s Bureau (NCB).  The NCB suggests that the threshold for disabled children assessed as being in need of support has increased.  They also said the data is not good enough to enable proper planning for the future.  The increase, since 2004, in the number of children and young people with complex needs from 49,300 to 73,000 is thought to be largely because of people with severe disabilities living longer.

Just 7% of mothers with post-natal depression are referred to a specialist, according to a survey of 2,300 women who had given birth in the last five years, by the Royal College of Obstetricians and Gynaecologists, supported by the Maternal Mental Health Alliance.  81% of respondents had experienced at least some mental health problem during or after their pregnancy: two thirds experiencing low mood; half anxiety and just over a third depression.  For 38% of women who were referred to a specialist, it took over 4 weeks to be seen.  It costs £83 to treat a woman with post-natal depression, on top of the £2,800 average cost of maternity care.  The cost of treatment can be as high as £10,000 if it is not caught early.

Life expectancy of poorer women in a retirement village in Surrey matched affluent women elsewhere, according to research by the Cass Business School with the International Longevity Centre.  Whiteley Village was set up 100 years ago for people of ‘limited financial means’ and houses 500 people.  The study looked at the records of 2,500 people over the last 100 years and found that the women lived on average between 1.3 and 4.9 years longer than the average for England and Wales.  Although coming from the poorest 20% of the population, a woman aged 67 arriving in 1980 could expect to live for a further 17.9 years, compared to 18.1 years for women in the top 20% and 15.2 years for those in the bottom 20% in the rest of the country.  The effect is less pronounced for men.  One of the authors said that the lesson “is that it is possible to create a socially stimulating and safe environment in which older people can enjoy a longer retirement in peace and comfort”.

Thousands of UK pensioners living abroad may be left with no healthcare after Brexit, either in the UK or the country in which they are currently living, the Health Select Committee has heard.  Reciprocal arrangements with EU countries would no longer operate, but currently such people can only access health care in the UK with the EHIC (European Health Insurance Card), which might no longer be available.

NHS 111 is sending more people to A&E, according to research by the Nuffield Trust.  It found that the service is now either sending an ambulance or recommending someone goes to A&E in 20%-22% of cases, compared to an average of 18%-19% in the three years since the service was set up in 2013.  It suggests that the service is too risk averse in some cases.  The research also found considerable variability around the country in what proportion of people were sent to A&E.  NHS111 nevertheless sends fewer people to A&E than say they would go there if left to their own devices.

High quality care for dying people could not be provided because of lack of time according to two thirds (67%) of UK nurses, in a survey of 996 nurses and healthcare assistants by the charity Marie Curie and the Nursing Standard magazine.  Another significant barrier was staffing levels, identified by 68% of respondents.

Redirection of the new homes bonus to social care is threatening the sustainability of some district councils according to an analysis by the Local Government Chronicle that found that 108 of the 201 distrcts face a reduction of 10% or more of their settlement funding.  In the worst case (Basingstoke and Deane), it represents a cut of 69% and for 31 councils it is 25% or more.

A screening test for bowel cancer cut the number of new cases by 35% and the number of deaths by 40%, according to research from Imperial College published in the Lancet.  The test, bowel scope screening, involves inserting a small camera into the lower part of the bowel.  The research involved data on over 170,000 people over 17 years, of whom over 40,000 had the bowel scope test.  The test is being gradually rolled out across England to people aged over 55.  The devolved governments in the rest of the UK have not yet committed to introducing the test.

Proposals for the future of children’s social care inspection have been published by Ofsted following a consultation.  It is to include councils undertaking self-evaluation audits and sending them to Ofsted in advance of inspections.
Press release:
The framework:

Mexico’s tax on sugary drinks has led to reduced consumption for a second year according to researchers from Mexico and the US, published in the journal Health Affairs.  There was a fall of 5.5% in the first year and 9.7% in the second.  The impact was biggest on the poorest households.


21 February 2017

STPs offer the best hope for the NHS, the King’s Fund has said in a report, ‘Delivering Sustainability and Transformation Plans’.  Although supportive of the plans in principle (more so than they have been in the past, leading some to call this a u-turn), the report says proposals need to be carefully scrutinised and considered on their merits.  The King’s Fund said that where there was evidence for changes, politicians should support them, even if they were unpopular.  They said there was a risk of closing hospital beds before other facilities were ready.  There is also concern that funds are not available to invest in new facilities, with the £1.8bn sustainability and transformation fund for this year being largely used up in easing deficits in running costs.  Cuts to public health and social care could affect the ability of the NHS to implement the STPs.  Meaningful engagement is now needed with staff, the public, local authorities and the third sector.
Press release:
The report:

STPs in 28 of the 44 areas are proposing that hospital services be cut or scaled back, according to an analysis of the plans by the BBC.  Changes include moving from hospital to community care and centralising specialist services.

Benefit sanctions are being imposed unevenly across the country, with some Work Programme providers and job centres imposing twice as many as others in the same area, according to a report by the Public Accounts Committee.  The Committee says that the DWP has poor data on which to judge the effect of sanctions and is unable to estimate the wider cost or benefit to the taxpayer.  It calls on the government to review the use of sanctions, which it says can have serious consequences such as pushing people into homelessness.  They suggested that warnings should be issued for the first offence.

Life expectancy is increasing around the world, and could exceed 90, for women to be born in South Korea in 2030, according to research from an international team funded by the MRC in the UK and the Environmental Protection Agency in the US, published in the Lancet.  For the UK, predicted life expectancy at birth in 2030 is expected to be 85.2 years for women and 82.5 years for men.  The study uses 21 different models of life expectancy, but there is still uncertainty in the predictions.  The projections raise issues about the health and social care that will be needed.

A summary of research on health in pregnancy has been published by the National Institute of Health Research.

Feature article on the e-numbers used for food safety and what the implications and options are when the UK leaves the EU (for instance, does it continue with voluntary compliance with the e-number system and if so, how should that be managed?).


20 February 2017

NHS trusts had a £886m deficit in the first nine months of the financial year, according to the latest figures from NHS Improvement.  135 out of 238 trusts were in deficit.  That is already £300m over the target for the whole year, although NISI said it may be reduced before the end of the financial year, possibly to £750m-£850m.  The deficit is less than it would otherwise have been because of the additional £1.8bn sustainability and transformation fund.  Chris Hopson of NHS Providers said the NHS’s underlying financial position was unsustainable.  A survey of NHS providers found that two thirds were only staying on track because of one-off savings that would not be available next year.  Among the underlying problems were rising demand, insufficient beds and cuts in social care delaying discharges.

Councils are to receive no additional funding next year, the Government has indicated, in the local government finance settlement.  Total revenue support grant is £4.98bn.  The chair of the LGA, Lord Gary Porter said this meant there would have to be further cuts to a range of essential services.  The council tax increases this year would be swallowed up by the cost of implementing the government’s ‘national living wage’.  Porter said that social care faces a funding gap of at least £2.6bn by 2020, while local government as a whole faced a gap of £5.8bn, meaning services such as road repair, parks, leisure centres and libraries were likely to be hit.  The Government confirmed that no new money is available for social care (other than ‘allowing’ councils to raise more through the social care precept and transferring money from the new homes bonus, with a consequential impact on district councils).  However, there are reports (in the HSJ)  that ‘short term stabilisation’ funding may be provided in the forthcoming budget, with the CQC given additional inspection roles in councils to monitor how it is used.
(22/02/17) Press release:
(23/02/17) (£) Rumours of funding for social care in the forthcoming budget:

More cuts in local services will be necessary, despite council tax rises of up to 4.99% in many areas, the Local Government Association is warning.  It says that 147 of 151 councils with social care responsibilities will raise £540m through the precept next year, but this will be taken up by the extra cost of paying care workers the national living wage.  They said that 108 authorities are intending to implement a 3% social care precept and 39 one of 2%.  Some people will see higher council tax rises as the 4.99% is based on average across the area.

The BMA says the NHS is at a breaking point. It says the number of hospital beds fell by a fifth between 2006-7 and 2015-16.  Between 2000 and 2015, the number of beds per 1,000 population fell from 3.8 to 2.4.  Over that period the fall in the number of mental health beds was 44%.  The Department of Health said comparisons with bed numbers before 2010 were unreliable because the figures were collected in a different way.

Sepsis may affect 70% more people than previously thought, and could cost the UK economy up to £15.6bn a year, according to a report from the York Health Economics Consortium.  They suggest that 260,000 people contract the condition every year rather than 150,000 as previously estimated.  It means that as many as 65,000 people may die from it, rather than 44,000.

A report reviewing the evidence on parenting and how public policy can support parents has been published by the Social Mobility Commission.  “The research finds that an authoritative parenting style which combines warmth with firmness in setting boundaries, secure attachment between children and parents and the provision of a supportive home learning environment can improve children’s outcomes.” (Press release).  There is evidence for the effectiveness of some programmes, but generally there is a lack of long term evidence about what interventions work best.
Press release:
The report:


19 February 2017

A call for a Royal Commission on the future of the health service has been made by Tory peer and former Conservative chairman, Lord Saatchi, writing in a paper for the Centre for Policy Studies think tank.  He said a Royal Commissiion would allow a cross party position on the long term future of the NHS.

Smoking cessation services are being cut back in some parts of the country, leading to a postcode lottery, despite such services paying for themselves in the long run.  Such services have been cut back in three out of five local authorities, where they are funded by public health and in an increasing number of CCGs.


18 February 2017

Access to clinical trials could be harder after Brexit, since the EU is streamlining the process, so that there will be a single approval process for clinical trials in all 28 countries.  That may encourage researchers to limit participants to the EU rather than going through a separate application process for the UK.  It is estimated that this could affect 600,000 patients a year in getting access to cutting edge treatments, (though without any certainty of their effectiveness).

A call for NHS England to stop rationing treatment for people with rare and complex conditions has been made by about 30 charities.  They say treatment for seriously ill patients is being rationed because of underfunding, without proper public scrutiny.  There is also concern about the financial pressure on the NHS arising from cuts to social care.  However No 10 and the Treasury appear to be firmly against giving the NHS any more money.


17 February 2017

A rise in mortality in 2015 is likely to be linked to spending restrictions in the NHS and social care, according to research from the London School of Hygiene and Tropical Medicine, Oxford University and Blackburn with Darwen Council.  The research was published in the Journal of the Royal Society of Medicine.  The increase of 30,000 more people dying than the previous year was the largest such rise since the second world war.  The research examines, and rejects, other possible causes of the mortality spike in the year and particularly in the January, such as it being a ‘data artefact’, an environmental shock or an epidemic such as flu.  A Department of Health spokesman is quoted as calling the study “a triumph of personal bias over research.”  He quoted a different set of figures with a fall in excess winter deaths from 43,000 in 2014-15 to 24,000 in 2015-16.  The report was peer reviewed and is open access.  One of the co-authors, the DPH for Blackburn with Darwen, suggested the spike in deaths in January 2015 represented a failed service response to a surge in demand, because of lack of funding.
Press release from the London School of Hygiene and Tropical Medicine:

The 3% precept for social care is being taken up by 68% of eligible authorities, that is 100 out of 152 single tier and county councils, according to an analysis by the Local Government Chronicle.  Just under half, 48%, are also raising the council tax precept by just under a further 2% (to stay below the level at which a referendum is required) meaning their council tax will rise by the maximum 4.99%.  That means that the amount raised for social care will be below the £652m assumed by the Government.  42% of the councils are intending to increase the social care precept by 2%.  Four authorities are not intending to use the social care precept at all.

Free wi-fi is to be available in all GP practices by the end of 2017 according to NHS Digital.  It is to be installed in 991 surgeries in England by the end of March 2017.  CCGs will be able to source wi-fi services from any commerical provider able to meet national standards.  It is then to be available in the rest of the NHS by spring 2019.

Confirmation that mental health funding is reaching the front line will have to be provided by trust chief executives as well as CCGs, according to a letter signed by three NHS England directors reported in the HSJ.  A letter has to be provided by 27th February, to include a refresh of financial and operational plans, jointly signed by the CCG and relevant mental health trust, and confirming that their finance returns accurately reflect actual investment and meet national expectations in the Five Year Forward View for Mental Health.  Mental health spending is supposed to rise by at least as much as the CCG’s overall budget increase, but there have been reports of allocations not reaching mental health trusts or being used for the designated purpose.

Cancer doctors suffer relatively high levels of stress, sleep problems and depression, according to a meta-analysis of 43 previous studies from 14 countries carried out between 1990 and 2014.  The research, from Birkbeck, University of London, was published in Psycho-Oncology.  It found that a third of oncologists were suffering from high burnout and a quarter had mental health problems.


16 February 2017

Age UK says that adult social care in England is facing collapse in the worst affected areas.  They say the Government’s approach to supporting social care, namely financial transfers from the NHS, allowing a slightly higher precept for social care and calling on family and friends to do more, is inadequate.  The report says that 1.2m people are not getting the care they need, an increase of 18% since last year and 48% since 2010.  An estimated 140,000 are left virtually bedbound without care.  The report found that while there had been a small increase in care provided by family and friends (2% up on 2002-03) this was not enough to fill the gap from the declining provision of .formal care services.

A report arguing that STPs in their current form are not going to work has been published by the Reform think tank.  It suggests there are three key barriers to success: lack of engagement across the whole of health and local government; mixed messages from national bodies, with NHS England focussing on system transformation and NHS Improvement on balancing the books; and a lack of authoritative leadership with accountability remaining with the statutory bodies while the STP is not a legal body in its own right.

Household spending on alcohol, tobacco and narcotics has fallen below £12 a week for the first time since comparable records began, according to statistics from the ONS.  However, more is being spent on restaurants and hotels.  Average household spending was unchanged from the previous year at about £529 a week.

The statutory definition of child sexual exploitation has been revised by the Government.  The child safeguarding guidance, Working Together, has been updated.  A new Centre for Expertise is to be set up, to be an authoritive source of information, research, innovation and best practice.  A progress report on the government’s strategy to tackle child sexual exploitation has also been published.|SCSC|SCDDB-20170217
Definition and guidance on child sexual exploitation:
Statutory guidance on safeguarding children:–2

Babies born to mothers with gestational diabetes were more at risk of health complications and death, according to research involving nearly 800,000 births in France, published in Diabetologia.  There was a 70% increased risk of pre-eclampsia or eclampsia and a 30% increased risk of babies being born pre-term.

Children’s social workers have an average caseload of 16, the Government has estimated.  The figure is given in a Department for Education report on the social care workforce.  The number of agency social workers in children’s services increased by 9.6% over the previous year.  The number of permanently employed children’s social workers rose by 4.7% between 2015 and 2016.  The turnover rate fell from 16% to 15.1%.


15 February 2017

A final warning on air pollution has been issued to the UK by the European Commission, meaning it needs to take action on nitrogen dioxide pollution within two months or it could face fines of millions of pounds.  Germany, France, Italy and Spain have also received warnings.  More than 130 cities across Europe had breached air quality limits.

Using the threat of hospital closures to impose seven day working is counterproductive, the Nuffield Trust says, in a review of the London Quality Standards (LQS), the precursor to Seven Day Service Standards being incorporated in plans across England.  Where it was successful, it was because of high levels of engagement from clinicians, which disappeared when the threat of closures or downgrades was used as a ‘stick’.  The standards worked well as a quality improvement programme, improving care and ways of working in over half of cases, although it did not meet its aims of improving weekend mortality rates or rates of discharge.

Care leavers are seven times more likely to die than others between the ages of 18-21, according to information obtained by freedom of information requests to the Department for Education.

Four million people are at risk of falling below the povery line because of increasing food and fuel prices, according to a report by the Joseph Rowntree Foundation.  The price of a minimum basket of goods had risen by 27-30% since 2008, but average earnings had only increased by half that amount.  Around 30% of the population, 19m people, are living below the minimum income standard, an income required for decent living standards, calculated by Loughborough University’s Centre for Research in Social Policy.

The increase in business rates for 1,249 hospitals should be stopped, politicians are urging the government.  Revaluation will mean their costs increase by £322m or 21% over the next five years.  Some private providers get an 80% discount because they are charities.

Vitamin D supplements could stop 3m people in the UK getting colds or flu each year, according to an analysis, led from Queen Mary University of London, pooling data on 11,321 people from 25 trials, published in the British Medical Journal.  The study found that one person in 33 would be spared a respiratory tract infection, which is more effective than flu vaccinations which require 40 injections to prevent one case.  However, some experts said the evidence was not definitive and Public Health England said the data was not conclusive.  Too much, as well as too little, vitamin D can cause problems.

Sex and relationship education should be made compulsory in secondary schools to avoid major problems later, the LGA has said, describing the situation as a ‘ticking sexual health time bomb’.  Sex education is compulsory in local authority maintained schools but not free schools and academies which now make up 65% of secondaries.

The number of abortion pills bought illegally online that have been seized has increased from 5 in 2013 to 375 in 2016, with the pills addressed to places in England, Wales and Scotland according to data from the Medicines and Healthcare products Regulatory Agency (MHRA) obtained by the BBC’s Victoria Derbyshire programme .  Taking the pills while pregnant is illegal in the UK, with a possible maximum sentence of life imprisonment.

A manifesto to support the children of alcoholic parents has been launched by an all party parliamentary group on children of alcoholics.  The manifesto makes ten demands on government, including more education for children and professionals, better support for families and action on availability and promotion of alcohol.

People who are overweight in their 20’s and become obese in later life have an increased cancer risk, and are three times more likely to develop oesophagael or stomach cancer, which, although less common than other types linked to obesity such as bowel, breast and liver, has a lower survival rate.  About 5,600 people are diagnosed with one of those two cancers in the UK each year.  The U.S. research, based on data on about 400,000 people, was published in the British Journal of Cancer.

A report on obesity in secure mental health settings has been published by Public Health England, looking at the evidence on the extent of the problem and possible interventions to address it.


14 February 2017

STPs will require £9.5bn of capital investment upfront, the BMA has said, based on 37 responses to freedom of information requests sent to the 44 STP areas.  The BMA says that the money is unlikely to be available, with the annual capital allocation of £4.8bn granted to the DH for 2016-17 to 2020-21 being drawn on to cover revenue deficits, as well as other demands on the money.
Press release:
List of required funding area by area:

Post natal support is an area of major concern, according to a survey by the NCT and the National Federation of Women’s Institutes of 2,500 women who gave birth between 2014 and 2016 in England and Wales.  Overall, 18% of respondents said they didn’t have access to a midwife and 29% of those, or 37,000 of the 700,000 who had given birth, went to a GP, A&E or walk-in centre instead.  The situation had not improved since the previous survey 4 years ago.  The main concerns were the baby not feeding properly (64%), their own emotional or mental wellbeing (50%) and the healing of stiches or sutures (35%).

Air pollution was eight times worse for tube than car commuters in London, according to research by the University of Surrey published in the journal Environment International.  However, the types of pollutants given out by cars are more harmful than those given out by the tube.  Pollutants were higher when the tube windows were open.  The exposure to the pollutant PM10 was an average of 8.2mg for car drivers, 38mg for bus commuters and 68mg for those commuting by tube.  There was no systematic relationship between income distribution and pollution exposure.  The research didn’t test exposure of commuters cycling or on foot.


13 February 2017

The Home Office is blamed for abandoning vulnerable children and lying about the causes of the problem, blaming it on local authorities when they have not properly explored potential solutions to accepting child refugees.  The accusation is made in a Guardian article by the chief executive of the Adolescent and Children’s Trust.

The STPs have implausible assumptions and lack credible implementation measures, according to a report reviewing them, from the Centre for Health and the Public Interest.  It also says that planned reductions in hospital services implies rationing and risks the collapse of some services.

Councils will not be able to boycott particular countries or companies through their procurement policies, unless that is in line with national government’s foreign or other policies, under revised Best Value guidance, out for consultation until 27th March 2017.  This is particularly to stop the boycott of goods from Israel.
Press release:
The revised guidance:

Very premature babies are at greater risk of developing mental health problems, according to an analysis of findings from 41 published studies over 26 years involving data on 13,000 children, of whom 2,712 were premature, in 12 countries, published in the journal Psychological Bulletin.  Those born extremely early and weighing less than 1Kg were four times as likely to have ADHD and significant emotional problems.


12 February 2017

Six out of seven trainee anaesthetists are at risk of burnout, according to a survey to which 2,300 responded, by the Royal College of Anaesthetists.  Two thirds of respondents said their physical or mental health were affected by the pressures at work.

Surgeons have been left ‘kicking their heels’ as operations are cancelled because of a lack of beds, according to the president of the Royal College of Surgeons, Clare Max and the chief executive of NHS Providers, Chris Hopson, in a letter to the Times.  They said that bed occupancy was routinely at 89% against a standard of 85%.  NHS England said cancellations remained low, at 1%.  According to the latest figures, 82,730 operations were cancelled last year.


11 February 2017

The NHS could save £300m a year if all locums charged within the agency price cap, according to NHS Improvement.  It said that the 20 most expensive locums cost £7.5m a year while around 260 agency doctors were each charging more than £240k a year (a total of about £62m).


10 February 2017

Local councils’ finances cannot continue as they, according to three quarters of councils who said they had no confidence in the sustainability of local government finances, in a survey by the Local Government Information Unit, which had 163 responses from individuals, from 131 councils in England and Wales, of which 71 had social care responsibilities.  More than a tenth thought they were in danger of not meeting their legal obligations.  More than 40% said they were likely to make cuts in frontline services, visible to the public, with that figure being 71% for authorities with social care responsibilities.  94% of authorities are planning to increase council tax with 6% saying they will freeze it.  Half of the councils thought they would lose out from the retention of business rates.

Sir Robert Francis says that a care scandal equivalent to Mid Staffs is inevitable, given the financial pressures on the NHS and high levels of demand.  In an interview with the Health Service Journal, he said there was a disconnect between what is being said nationally and what is being felt on the ground, with the health service manifestly failing to keep pace with demand.  He then made similar comments on the BBC’s Andrew Marr show.

Jeremy Hunt has acknowledged that the NHS in England is facing ‘completely unacceptable’ problems, in an interview with the BBC, following a week of special coverage on the health service.  He said the key was to treat more people at home and in the community.  However, he said these problems were not unique to the NHS and other health systems were grappling with similar problems because of an ageing population.  He said it was not all about money, with France and Germany spending more than the UK but still facing problems.  He said that tackling social care problems was on the Government’s agenda.

Brexit could lead to delays in getting new drugs approved, if Britain withdraws from the European Medicines Agency (EMA), according to former UK regulator Sir Alasdair Breckenridge and others.  It is argued that as the UK only constitutes 3% of the world market, it would move towards the back of the queue for approvals after the likes of the US, Europe and Japan.  Similar comments were made by Prof Paul Workman, president of the Institute of Cancer Research.  The Government is minded to quit the EMA because it is subject to the European Court of Justice.

Professor Eileen Munro has withdrawn her support for the proposals to allow the government to exempt councils from children’s legislation in the Children and Social Work Bill.  The change of heart is a blow for the Government which has cited Prof Munro’s support in aid of their proposals.

There were 314 ‘never events’ in nine months between April and December 2016, according to figures from NHS Improvement.  These are preventable events which are so serious it is deemed they should never happen.  It includes operating on the wrong body part, leaving foreign bodies inside patients after surgery and serious mistakes with medicines.

64% of people recently diagnosed with cancer have experienced mental health problems such as anxiety and depression, according to a report, ‘Warning Signs’, from Macmillan Cancer Support.  It reports on the dangers of increasing delays in people accessing treatment.  It also sets out the challenges in transforming cancer services given the pressures faced in areas such as workforce.


09 February 2017

Simon Stevens says STPs are to get ‘decision rights’ on reorganisations, including a right to recommend that member trusts and commissioners reorganise if the veto power or intertia of individual organisations is getting in the way of big strategic change.  He also said that STPs are here to stay.  He was speaking at an NHS England board meeting.  A formal appointment process is being set up for STP leads.  [It is not clear how ‘decision rights’ would happen without primary legislation and if not, how this is different from recommendations anyone could make.  It is also counter to other suggestions that there will be no more top down reorganisation.]

The NHS had its worst performing month in 13 years in December and possibly also in January, according to official figures for December and leaked information about January from NHS Improvement reported by the BBC.  For January, it found that only 82% of patients met the four hour A&E standard, compared to the target of 95%.  There was also a record number of people (780) waiting more than 12 hours for a hospital bed after being seen in A&E.  Scotland’s figures were better than England’s, while Wales’ and Northern Ireland’s were worse.  The DH is quoted as saying they did not recognise the figures and said it was irresponsible to publish unverified data and said it did a disservice to NHS staff.  The official figures for December show 86.2% meeting the 4 hour target in England.  61,000 people were stuck on a trolley for more than 4 hours.  A record number of people needed to be admitted as an emergency.  For ambulance Red 1 calls, only 66.4% met the eight minute standard against a target of 75%.  Targets were also missed for referral to treatment in 18 weeks and urgent cancer treatment within 62 days.

New standards for hospitals providing congenital heart disease services have been published for consultation by NHS England.  It says surgeons should do a minimum of 125 cases per year, there should be a minimum of three surgeons in the team to provide 24 hour cover, rising to 4 by April 2021.  The consultation runs until 5th June 2017.

A proposal to publish the private earnings of hospital consultants has been dropped by NHS England.  The proposal, made in September 2016, was for outside earnings to be listed in three bands: less than £50k, £50k-£100k and over £100k.  The proposal was to have come into effect in April.  NHS England said that the proposal had not been popular with consultants.  NHS England has published new guidelines on conflicts of interest.  It says it should be standard practice for NHS commitments to take precedence over private practice, for non-clinical as well as clinical staff, to declare outside employment but not earnings ‘at this stage’.

While LGBT people tend to have worse mental health than others, this is not because of their sexual or gender orientation, but because of social circumstances such as bullying, discrimination and lack of social support, according to research by the Australian National University based on interviews over eight years with 5,000 young and middle aged adults of homosexual, bi-sexual and heterosexual orientation.

The turnover of social workers has increased in adult social care in England, at 16% in 2016 compared to 13% the previous year, according to figures from NHS Digital.  The total number employed remained broadly the same.  The move from council employment to the independent sector continued, with the proportion of the adult social care workforce employed in local authorities falling by 6% and 78% now working in the independent sector.  However, 86% of social worker jobs were in local authorities.

A report on the impact of fathers on children’s mental health has been published by the Centre for Mental Health.

Financial incentives increased the use of dangerous x-rays by dentists according to research by the Centre for Health Economics at York University based on panel data of 1.3m treatment claims by Scottish NHS dentists between 1998 and 2007.  They found significant increases in x-rays when the dentists received a fee per service rather than a salary and when patients were exempt from payment.

Six high impact ways of promoting person and community-centred care have been set out in a publication from National Voices as part of the delivery of chapter two of the Five Year Forward View.  Recommendations include: making it part of normal business; make a commitment to developing new outcome measures; support a small number of demonstrator sites; clarify key success factors for social prescribing; revive and champion the inclusion health agenda; and commission a pool of preferred VCSE partners to support person-centred, community-focussed interventions in defined geographical areas.

Training and working standards in social care need to be improved in order to attract UK workers and avoid labour shortages post-Brexit, according to a report from the IPPR.  A boost in funding is also needed.


08 February 2017

The Better Care Fund has not achieved its targets, according to a report from the National Audit Office.  Instead of meeting the target of reducing emergency admissions by 106,000, they actually increased by 87,000.  Rather than making a saving of £511m, an extra £311m was spent.  Delayed discharges rose by 185,000 against a target of a reduction of 293,000.  The Fund had helped improve co-ordination between different bodies, though. [N.B. the NAO only says the scheme hasn’t achieved its plans – which may have been too ambitious.  However it is possible it still made things better than they would otherwise have been.]  The report notes that despite general agreement that there should be place-based planning, local government was generally not involved in the development of STPs.  It says that while DH and DCLG have identified barriers to integration such as finance, workforce and information sharing, they are not systematically addressing them.  It also said the ambition to save £900m through new care models may be optimistic.
[N.B. misleading headline – the BCF is not just about OAPs.  It is also not just about treating people at home.]
(10/02/17) Feature and comment:|SCSC|SCDDB-20170208

The number of delayed transfers of care could be three times as high as the official figures suggest, according to a briefing from the Nuffield Trust on what lies behind them.  It is based on research in three small and medium sized NHS hospitals and a study of 7,500 bed days in a larger number of bigger hospitals.  It suggests there are still operational improvements that could improve the situation both within hospitals and in their relations with outside bodies, but this may be hard with current levels of demand.

The mental health of young people in the UK was the second worst of 20 countries, in a survey of 20,000 15-21 year olds commissioned by the Varkey Foundation, an educational charity, from the polling firm Populus.  The survey, “What the World’s Young People Think and Feel” also asked opinions about a wide range of issues.  Amongst the countries included were France, Germany, the US, China, India, Japan, South Korea and Nigeria.  Overall, more of the young people were pessimistic (37%) about the world’s future than optimistic (20%).

About 2,000 senior NHS doctors are asking the Prime Minister to increase spending on health and social care. [I think this is the same letter as reported on 31/1/17 – it was then said to be printed in the BMJ but now being sent to the Prime Minister].  The letter was organised by consultants in Brighton.

Pregnant women and new mothers should be given more support for their mental health, NICE is recommending, in draft indicators for general practice published for consultation.

Children’s social workers are to face accreditation tests, with 8,000 to be assessed by December 2018 as the first phase of a national roll out, subject to the results of a consultation currently underway.  The Government wants all children’s social workers to be accredited by 2020.

Some breakfast cereals contain as much sugar as in 1992, with it making up 35% of the weight of some products, although salt content has reduced by 50% over the past 10 years, according to research by ‘Action on Sugar’ and ‘Consensus Action on Salt and Health’, published in the journal, Public Health Nutrition.  Campaigners called for a national sugar reduction programme, similar to that which had been successful for salt.
Press release:

Being creative and ‘open’ boosts wellbeing in later life, according to a report by Age UK, based on data from 15,000 people aged 60 and over and using a wellbeing index developed by Age UK and the University of Southampton.

Three Bournemouth GPs have set up a private clinic within their surgery, though they cannot see NHS patients already registered with them.  A 10 minute phone consultation costs £40 while a  20 minute face to face appointment with the GP would cost £80.  It is open 8am to 8pm Monday to Friday and also on Saturdays.  The NHS surgey is only open 8:30am to 6:30pm Monday to Friday and is closed for an hour at lunch.

Who gets social care and who pays for it. Not a news item, but a helpful summary of the position in social care.


07 February 2017

A housing white paper has been published by the Government.  The Communities and Local Government Secretary, Sajid Javid said home ownership was a ‘distant dream’ for young families and said the answer lay in building more houses.

Delays in paying universal credit are forcing thousands of people into debt, rent arrears and eviction with one estimate that 80% of social housing tenants moving onto the benefit are going into, or increasing, rent arrears.  There is a built-in delay of 42 days before the first payment, on the logic that claimants will have a month’s salary to tide them over, but many people do not have enough money to manage and often have to turn to food banks.  There is some evidence that landlords are becoming less willing to let properties to recipients of universal credit.  Former welfare minister Lord Freud, speaking to the work and pensions select committee said the situation was not as bad as claimed by councils and housing associations, but admitted that universal credit was adversely affecting about a quarter of people.

Surrey County Council has called off its planned referendum on a 15% council tax rise. Council leader David Hodge initially said he believed the Government had listened and understood the problems and he was prepared to “take a risk that a solution will soon be found to the issues that all councils face.”  Then at prime minister’s questions, Jeremy Corbyn produced tweets (accidentally sent to the wrong person) suggesting some sort of deal had been done for the council to call off the referendum.  Ministers later admitted that the council was to take part in a trial to retain local business rates to fund social care from 2018, but said this did not amount to a special deal as other councils could also apply to be in the pilot.

A third of midwives in England are in their 50’s suggesting there may be a looming recruitment problem, according to the annual ‘State of Maternity Services’ report from the Royal College of Midwives. There are more older midwives in other parts of the UK, with the highest level in Scotland at 41%.   It says there is a shortage of around 3,500 midwives with the current workforce at about 21,600.  In England, 1,300 come from other parts of the EU and their future status is currently unclear.  Health minister Philip Dunne is quoted as saying that there are 2,100 more midwives since 2010 with 6,300 more in training and that projected retirement rates are taken into account when modelling training places.

E-cigarettes produced fewer carcinogens than smoking according to research funded by Cancer Research UK, led by UCL and involving two other US institutions.  It was published in the Annals of Internal Medicine.  The research was based on 181 participants who were smokers or non-smokers.  It found significantly lower levels of toxic chemicals and carcinogens in former smokers who had been using e-cigarettes or nicotine replacement therapy for at least six months, than current smokers.  Those who used both cigarettes and vaporisers still had high levels of toxins and carcinogens.

A new GP contract for 2017-18 has been agreed by NHS England, the government and the BMA.  It includes incentives for practices not to close for half a day a week and to work with other practices to increase access.

Hospitals are ‘gaming’ cleanliness inspections, with the proportion of patients reporting excellent cleanliness rising by 2.5-11 percentage points in the two months before inspections.  There was only such an association in hospitals that had outsourced their cleaning services.  [It appears that this relates to PLACE assessment – Patient Led Assessments of the Care Environment – rather than CQC inspections].  It is suggested that hospitals are being given substantial notice of the inspections rather than the 48 hours which they are supposed to have.  The research used data from 205 NHS hospitals between 2011-14 and was published in the journal Health Affairs.

Ten minute GP consultations are crazy, the president of the Royal College of GPs, Dr Helen Stokes-Lampard has said.  She also expressed concern that demand would be increased as STPs (sustainability and transformation plans) pushed care out of acute hospitals and into the community.  GPs’ ten minute consultations are thought to be the shortest in the developed world.
(10/02/17) Comparison with consultation times in some other countries:

Alcohol related deaths have increased in Scotland, Wales and Northern Ireland but dropped slightly in England, according to figures from the ONS.  The alcohol related death rate for women fell in the South East and the East of England but rose in other regions, particularly the North East.  Overall there was a slight rise in the rate of deaths for women and a fall for those of men, but the rate for men remained much higher, at 19.2 per 100,000 people compared to 9.7 for women.


06 February 2017

A sixth of A&E departments could be closed or downgraded according to an analysis of STP plans and existing proposals, by the Health Service Journal.  Proposals have already been drawn up in relation to 7 casualty departments, but 26 more are now being considered for change.  The HSJ says that 24 of the 33 hospitals under consideration are likely to lose full A&E services.  An NHS spokesman said he did not expect significant numbers of A&E changes in the years ahead.

Bed occupancy has been over 85% at 137 out of 152 hospital trusts since the start of December, according to analysis by the BBC.  The analysis which looked at week day occupancy from 1st December to 22nd January found 60 trusts with occupancy above 95%, where 85% is generally considered the maximum safe level.

Hospitals are to be required by law to check patients’ eligibility for free health care from April, the health secretary, Jeremy Hunt, has said.  Patients from overseas will be billed in advance for non-urgent care.  Nobody is to be denied emergency treatment, whether they can pay or not.  Doctors expressed concern that vulnerable people might avoid seeking health care.  Health tourism is estimated to make up 0.3% of the annual NHS budget.
Evaluation of cost recovery programme:
(11/02/17) Feature by regular Mail Online contributor:

The number of unexpected mental health patient deaths has risen by almost 50% in three years according to freedom of information responses received by BBC’s Panarama programme from 33 of a total of 57 mental health trusts in England.  That showed an increase in unexpected deaths from 2,067 to 3,160 between 2012-13 and 2015-16.  DH said the increase was expected because of the way such deaths are recorded and investigated.  They also said there had been a 30% fall in the suicide rate among people in mental health services since 2004.  According to research commissioned by Panarama from the Health Foundation, funding for mental health trusts has been cut by £150m in the past four years.  DH said the latest figures showed that spending by CCGs on mental health has gone up by £342m this year.

Calls to Childline for mental health and depressive disorders increased by 36% over four years with an 8% increase in those calling about a serious mental health problem, according to figures from the NSPCC.  There were 9,474 counselling sessions for mental health and depressive disorders in 2011-12 and 12,867 in 2015-16.  In total, there were 50,819 counselling sessions, 29,636 for girls, 4,358 for boys and 16,825 where the gender was not known.

Almost two thirds of 10 and 11 year olds say they worry ‘all the time’, according to a survey of 700 children in the final year of primary school, in 20 schools, by charity Place2Be.  The top concerns were family wellbeing (54%), well-being of friends (48%) and school work (41%).  The most common coping strategies were talking to family members (72%) or friends (65%), with 65% of boys saying they played computer games to calm themselves (compared to 39% of girls).

Robots and computers could replace almost 250,000 public sector workers over the next 15 years according to a report from the Reform think tank.  Websites and artificially intelligent ‘chat bots’ could replace 130,000 Whitehall administrators, 90,000 NHS administrative posts and 24,000 GP receptionists.  There is also scope for using computers for diagnosis and robots for surgery.  The report, “Work in progress. Towards a leaner, smarter public-sector workforce”, evaluates governments’ approaches to workforce design in health and other parts of the public sector and suggests ways in which it might be ‘improved’ in future such as by the use of technology, using the ‘gig economy’ and recruiting less educated workers.
Blog and summary of the report:
The report:

Families who had their tax credits cut by HMRC contractor Concentrix are to have their cases reviewed, the government has said.  Both HMRC and Concentrix were heavily criticised in a Work and Pensions select committee report in December and by the NAO in January.  Of 36,000 claimants who lodged an appeal, 87% were successful.  The remaining 23,000 claimants are now to have their cases reviewed.  HMRC has now taken the work back in-house.

E-cigarettes harmed fewer genes than smoking in research which involved exposing cells in the laboratory.  It used cultured human airway cells and found that cigarette smoke damaged 123 genes while vaporisers affected two.  The research was published in Applied In Vitro Toxicology.

Chocolate bars are to be reduced in size to comply with new guidelines on reducing sugar, it is reported.  Big companies such as Mars, Cadbury and Nestle are reported to have agreed to reduce the size of their bars after a meeting with Public Health England.

Sedentary behaviour was not linked with the onset of diabetes, though there was a link to sitting in front of the television, according to research from the University of Sydney, based on data from a 1998 long term health study of London workers.  Blood glucose levels were examined up to the end of 2011 to identify new cases of diabetes, of which there were 402.  The researchers said the findings did not exonerate sitting, but suggested there may be a number of risk factors to be considered.  They suggested that the health risks attributed to sitting in front of the tv may be due to factors such as snacking, exposure to adverts for unhealthy foods and poorer mental health.

An historical perspective on health inequalities is given in a paper published by the Centre for Health Economics at the University of York.  It looks at key milestones in health inequality policy in England and how government policy and the academic literature have evolved over time.


05 February 2017

The number of people waiting over 18 weeks for a non-urgent operation has increased by 163% in England over the last four years, according to the latest figures which are for November.  There are now 3.7m on a waiting list, which is a 44% increase on 2012.

The Government is accused of shifting blame for spending cuts to local councils by Labour’s shadow local government minister Jim McMahon, who says parliament is being bypassed.  The local government finance bill would abolish the annual local government finance settlement which is approved by parliament, as councils retain 100% of business rates by 2020.  However the government still retains controls over local spending and there is predicted to be a £5.8bn shortfall in funding by 2020, of which £2.6bn is for social care services.  McMahon said there would be a council tax bombshell with no consideration of people’s ability to pay.

GPs charging of domestic violence victims for proof of their abuse so they can get legal aid should be ended, 16 police and crime commissioners have urged Jeremy Hunt.  Some GPs do not charge but others do, up to £175 for a letter, which puts some people off applying for legal aid.  The PCCs say the ‘callous, insensitive and unjust practice’ should be ended either by making the letters funded by the NHS or removing the requirement for them.  The call was supported by Labour deputy leader Tom Watson and by the charity End Violence Against Women.


04 February 2017

Stroke services should be reorganised into fewer centres of excellence, according to the Stroke Association.  The charity’s chief executive, Juliet Bouverie, said that the number of hospitals routinely accepting stroke patients should be cut from the current 126 to between 75 and 100.  She said that such a concentration of specialisms had saved lives in London.  Fewer centres would help with the shortage of specialist doctors and nurses, concentrating them in fewer places and also allow for more specialist procedures to be used.   She also said that more needs to be done to support stroke victims after they have left hospital.

Crowdfunding for private cancer treatment has been increasing, according to figures from charitable giving website JustGiving.  It shows 2,348 cancer appeals set up in 2016 which is seven times that in 2015.  Over £4.5m was raised in 2016, compared to £530k in 2015.  Concern was expressed by experts that some of the treatments sought might not be effective.


03 February 2017

Cutting unemployment benefit for disabled people is unlikely to incentivise them to move into work, according to a report from the Work and Pensions select committee, which described any evidence for it as “ambiguous at best”.    The Government is intending to cut the Employment Support Allowance (ESA) for those in the work related activity group (WRAG), (who have been found unfit to work but able to prepare for moving into work), by £29 a week from April.  The committee said there was a risk that the cut would affect disabled people’s quality of life and likelihood of moving into work.  They said that this group often faced higher costs than non-disabled claimants and called on the DWP to set out a clear plan for identifying such costs and how they would be met.  They also said ministers should revise practice on the use of sanctions.

Private ambulances are increasingly being used for 999 calls, the Guardian reports, quoting information from each of the ten ambulance trusts.

Cancer rates are forecast to rise more amongst women than men, because several types of cancer where obesity is a risk factor only affect women (e.g. cervical and ovarian) and because widespread adoption of smoking happened later amongst women than men and is now starting to have an effect.  The report, by Cancer Research UK, found that rates for women could increase by six times those for men over the next 20 years; 3% for women and 0.5% for men.

Four million people have been left without an out of hours GP at some point last year according to responses to freedom of information requests by Pulse magazine received from 104 commissioners.  Ten providers covering about 4 million people had shifts unfilled by GPs at some point last year.


02 February 2017

377 Sure Start children’s centres have closed since 2010, while only 8 have opened, according to a parliamentary answer obtained by Labour MP Dan Jarvis.  Spending on the centres was 47% less in 2015-16 than 2010, with £600m less spent in real terms and £60m more cuts planned for this year.
(07/02/17) Letters:
(10/02/17) More letters:

Local health systems in England owe the Department of Health £2bn, according to an analysis by the HSJ.  The loans were introduced in 2014-15, replacing what were effectively non-repayable bail outs.  While the debts can be large for individual trusts – in two cases representing over 30% of their annual income – if spread across a whole STP they are typically only around 4%. NHS England wants them to move towards such ‘control totals’, balancing finances across the STP.  39 of the 44 STPs had some level of debt.  Paying off the debt is factored into the STP plans, although it is possible it might be written off eventually.

West Kent CCG has banned non-urgent operations until the end of March to save money.  Clare Marx, president of the Royal College of Surgeons criticised the move as unfair and said that patients’ health could worsen in the meantime and end up costing the NHS more.  The Department of Health is quoted as saying “Blanket restrictions on treatment are unacceptable.”  The CCG said that no-one will have their already planned operations cancelled.

The number of destitute and vulnerable refugees and asylum seekers helped by the Red Cross has increased by 10% in the last year.  They helped 14,909 people without adequate access to food, housing or healthcare last year.  They helped 13,660 in 2015 and 11,268 people in 2014.  At least 21% of those helped had refugee status and 46% were asylum seekers waiting for a decision on their application.  People were seen most frequently in Leicester, London and Cardiff.


01 February 2017

NHS Digital was put under pressure by the Home Office to release data on immigrants, despite concerns about the legality of doing so, its former head Kingsley Manning has said in an interview with the Health Service Journal.  He said he was challenged for daring to ask if there was a legal basis for handing over confidential patient data.  He said this had been going on since at least 2005.  An agreement for transferring such data was agreed last month, which he said maximised the Home Office’s powers to the absolute limit, with no provision for transparency, oversight or scrutiny or role for the National Data Guardian.  He has commissioned an external review but this has not yet been published.

Applications for nursing courses have fallen by 23% by 9,990 to 33,810 in the last year, according to UCAS, following the abolition of the bursary.  This may not lead to a decline in trainees as in the past there have been fewer places than applicants, with 28,890 being accepted onto nursing-related courses last year.

The ‘chaotic’ systems for charging overseas patients must be improved by the Department of Health, the Public Accounts Committee says.  However, caution is needed before a pilot scheme in Peterborough, where two forms of identification have to be provided, is rolled out more widely because of the risk that eligible people may be deterred from seeking treatment.  The report noted that a passport and utility bill do not necessarily demonstrate entitlement to free NHS care, and in any case, some eligible patients would not be able to provide such documents.  It suggests more should be done to extend the use of NHS numbers and electronic patient records.  It says action is also needed by NHS England, NHS Improvement  and CCGs.

The NHS will not be opened up to competition from US healthcare providers, Liam Fox has said, ahead of initial discussions on a trade agreement with the American administration.  There has been concern that ‘non-tariff barriers’ could reduce the ability of the British government to regulate the health sector.  David Cameron’s former special adviser for health, Nick Seddon, has been appointed Executive Vice-President of US private healthcare firm Optum.

Older patients seeing the same GP each time had 12% fewer admissions to hospital for conditions that could be treated in doctors’ surgeries, such as flu, pneumonia, diabetes, asthma and urinary tract infections, according to research by the Health Foundation published in the BMJ.  Hospital admission for such conditions cost £1.42bn in 2009-10.  The research was based on data on 230,000 people in England, at 200 GP practices, aged between 62 and 82.  The study was observational and did not prove cause and effect.
Health Foundation briefing:

38% of people with mental health problems had been negatively treated as a result of their problems, according to an independent poll of 2,000 people with mental health problems commissioned by Time to Change [it is not clear how representative the survey was].  Of those who said they had suffered stigma and discrimination, 19% had lost their job, 54% had lost contact with a loved one and 55% had stopped socialising or going out.
Press release:

A call for £1bn more to be spent on adult social care services in 2017-18 has been made by the Association of Directors of Adult Social Services.


31 January 2017

The NHS is still not doing enough to learn from its mistakes according to a report from the Public Administration and Constitutional Affairs Committee.  It suggests there is ‘precious little evidence’ of the NHS moving away from a culture where fear of blame inhibits open investigations and towards more open minded learning.  It said that while there were initiatives to to improve the investigative culture, there was also a lack of co-ordination and accountability for how they might coalesce.  The committee also expressed concern that the new Healthcare Safety Investigation Branch is beginning operations without the necessary legislation to secure its independence.

2,000 NHS doctors have written to Theresa May warning that safety is at risk because of an unacceptable lack of money.  The open letter, published in the BMJ, said that doctors are constantly having to apologise to patients about the poor standard of care.

Falling living standards for poor people risk the biggest rise in inequality since Margaret Thatcher was in power, according to a report by the Resolution Foundation.  It said that this parliament would be the worst for living standards of the poorest half of the population since comparable records began in the 1960s.  Income inequality has been largely flat since a large increase in the 1980s, but is now forecast to rise by 2020.  Amongst the causes of falling incomes for the poorer part of the population are sluggish wage growth, welfare cuts and rising inflation.

The number of nurses from the rest of the EU registering to work in the UK has fallen since the Brexit referendum, according to figures released by the Royal College of Nursing.  1,304 nurses from elsewhere in the EU registered to work in Britain in July 2016 and 101 in December, a fall of 92%.  The average monthly registration was 204 in 2016, a fall from 820 in 2015, though the RCN said it was not possible to definitely link the change with Brexit.

People should be responsible for looking after their parents, a minister has said, just as they are responsible for looking after their children.  David Mowat, Parliamentary Under Secretary of State at the Department of Health, was speaking to the House of Commons select committee on communities and local government.  He also said the Government had no final answer on how it was going to deal with the rising costs of social care but that this country was unusual in not having a social insurance system or long-term savings scheme, though they would only help in the very long term.  Over 1 million over 65’s have never had children and for others their children are not available to help.  It is also suggested that 92% of all informal care is already provided by the family.
(05/02/17) Letters:

A single route for doctors to be licensed to practise in the UK is being proposed in a GMC consultation.  Currently each of the 32 Medical Schools has their own system and there is no UK-wide common standard to pass.  Depending on the terms of exit from the EU, the same process could be used in future for applicants from the European Economic Area.
Press release:

Over 65’s should be asked how often they have fallen in the last year, by health and care professionals, to help assess whether they could benefit from support, such as from a falls prevention clinic, according to an updated NICE Quality Standard.  About 255,000 people are admitted to hospital each year because of falls.  Falls are estimated to cost the NHS £2.3bn a year.

The West Midlands Combined authority has published a mental health action plan called ‘Thrive West Midlands’.  The plan is the result of more than a year’s work by a mental health commission chaired by Norman Lamb.
Press release:
Link to the document:


30 January 2017

Underfunding of social care means local authorities may not be able to meet their duties under the Care Act, the Local Government Association has said.  In its submission to the Treasury ahead of the spring budget, the LGA says that in the absence of any ‘genuinely new government funding’ for adult social care there is a risk of providers pulling out of the care market or going bust, growing unmet needs such as help getting washed and dressed, shorter care visits, greater strain on carers, more workforce turnover, greater pressure on GPs and hospitals and more people stranded in hospitals unable to leave.  If councils fail to meet their duties under the Care Act, they could be challenged in the courts.

Smoking costs local authorities £760m in social care costs in addition to £630m paid by individuals, according to research by Action on Smoking and Health (ASH) for the All Party Parliamentary Group on Smoking and Health.  The report says the situation could get worse as funding for stop smoking services is cut.  A government strategy on smoking is now a year overdue.

Heart attack patients are 40% more likely to receive rapid treatment than a decade ago, with 89% receiving cutting edge treatment within 90 minutes of arriving at hospital in 2014-15, compared to 52% in 2004-5, according to an audit by University College London using data from 217 hospitals in England, Wales and Northern Ireland.  It is thought that the improvement is largely down to the creation of specialist 24/7 heart units.  However the most common reason why treatment is delayed is people not calling 999 quickly enough.

The number of patients in mixed sex wards rose by almost 70% last year, from 4,248 in 2015 to 7,163 in 2016 accoding to statistics from NHS England.  Hospitals have been fined £250 for each instance since April 2011

A comparison of healthcare performance across 35 European Countries has been published. The annual Euro Health Consumer Index has been published by Health Consumer Powerhouse. It assesses healthcare on the basis of 48 indicators covering  such areas as patient rights, access to care, treatment outcomes, range and reach of services, prevention and use of pharmaceuticals.  It suggests that healthcare could be improved across these countries by learning from the best.


29 January 2017

Unemployed people are more likely to be underweight than employed people, those who were full time parents or in full time education, according to research from the University of Essex’s Institute for Social and Economic Research, published in the journal Preventive Medicine.  It is based on data on 10,737 working age adults between 2010 and 2012.  The proportion of unemployed people who were underweight was 4% compared to 0.7% of those who were employed, parents or in full time education.  People who were unemployed were more likely to be obese if they were also non-smokers.  The proportions classified as overweight were 29% for the unemployed and 40% for those in work.!/content/playContent/1-s2.0-S0091743516304492?

Warnings that intensive care is ‘at its limits’ have been made to the Guardian by senior doctors, including those from the Faculty of Intensive Care Medicine and the Royal College of Anaesthetists.  Problems include a lack of available beds and staff shortages.  A third of the 220 Intensive Care Units across the UK have at least one consultant vacancy.

A fixed cap on legal costs for medical negligence cases is being proposed in a Government consultation.  It is expected that the cap could save the NHS up to £45m a year.  The annual cost of compensation and legal fees is £1.5bn.  The NHS paid former patients’ lawyers £418m last year.

The private health group, Spire, is setting up a network of GPs at its hospitals and clinics, initially trialling it at 4 of its 38 hospitals.  A number of other private providers already provide GP services in their hospitals.  A director of Spire is quoted as saying, “The old free-at-the-point-of-use model is breaking down and I suspect the next stage is GP primary care,”


28 January 2017

Hospital bed occupancy was dangerously high during the recent crisis period according to the King’s Fund.  NHS trusts were told by NHS Improvement to keep occupancy below 85% between 19 December and 16 January, but it only fell below 90% on four days and below 85% on the three days of 23-15 December when as many people as possible were discharged for Christmas.  It is suggested that this level of strain on capacity makes the NHS in England vulnerable to epidemics of flu or norovirus or extreme snowy weather.

Leaving the European Medicines Agency could delay access to drugs by up to a year for people in the UK compared to the rest of Europe, according to the Association of British Pharmaceutical Industry.  Jeremy Hunt told MPs last week that he did not expect the UK to remain a member of the EMA once it left the EU.  If the UK set up its own regulatory system it would add time and cost to the process.  It would also be less of a priority for pharmaceutical companies as it would represent as little as 3% of the world market, compared to the EU’s 25%.

The NHS is losing hundreds of millions of pounds by price rises of out-of-patent cancer medicines according to researchers from the University of Liverpool and London School of Hygiene and Tropical Medicine presenting to the European Cancer Congress in Amsterdam.  The research looked at 89 cancer medicines and found that 21 had risen in price between 2011-16, of which 17 were generic.  The prices of 14 of those had increased by between 100% and nearly 1,000%.  The cost of all sorts of generic drugs (not just those for cancer) prescribed by GPs and pharmacists had increased by £380m in the five years to 2015.  The cost to hospitals was not known, but it was suggested the total cost to the NHS could be as high as £1bn.  The British Generic Manufacturers Association said hospitals would usually pay less than the list price.

The NHS could save £50m a year on the cost of basic painkillers according to a report commissioned by the WHO, which looked at the average price paid by the NHS for a range of painkillers such as aspirin and paracetemol, and how much they cost from supermarkets.

NHS spending will fall in real terms per head in 2018-19 in England, ministers have confirmed in a written parliamentary answer.  The amount increases by 3.2% in 2016-17, by 0.9% in 2017-18, then falls by 0.6% in 2018-19 then increases by 0.2% and 0.9% in the following two years.


27 January 2017

A record number of urgent operations were cancelled in England in 2016, according to figures from NHS England.  At 4,093 it was an 8% increase over the previous year and a 27% increase on 2014.  There were also 38,129 non-urgent elective operations cancelled in the six months from April to October, another record, with 2,204 (6%) of those not rescheduled within the required 28 days.

Knee and hip replacements are being rationed by 3 CCGs to save money. The operations would only be available to those patients whose pain and disability is “sufficiently severe that it interferes with their daily life and/or ability to sleep” in the three West Midlands CCGs of Redditch and Bromsgrove, South Worcestershire and Wyre Forest.  This should reduce the number of hip replacements by 12% and knee replacements by 19%.

Unlimited refills of sugary drinks have been banned in France in restaurants and public eateries, including school canteens.
Text of the law (in French):


26 January 2017

Ambulance service performance is struggling in the light of rising demand, according to a report by the National Audit Office.  Last year, 58% of ambulances met the target of transferring their patient within 15 minutes and 65% met the target of leaving at least a quarter of an hour later which was the equivalent of losing 41,000 ambulance shifts of 12 hours each.  All but one of the 10 regional ambulance trusts are breaching the 999 call response targets.  Funding has not kept pace with the increase in demand and there is a shortage of paramedics, with a 10% vacancy rate.  The report said that much of ambulance services’ ability to work better depends on other parts of the health system and CCGs need to see them as integral to that system.  A trial is going on in three ambulance services to relax the eight minute target for Red 2 calls (which include heart attacks) with the aim of doing what is needed rather than just meeting targets.

Most patients with mental health problems attending hospital for physical problems receive poor care, with only 46% being well looked after, according to a report by the independent National Confidential Enquiry into Patient Outcome and Death.  It was  based on an analysis of the medical records of 552 patients with both mental and physical conditions who had sought help from an acute or general hospital, usually through an emergency department.  Poor care led to many repeatedly returning to A&E.  Amongst the report’s recommendations are that liaison psychiatry services should be fully integrated into general hospitals, all hospital staff who have interaction with patients should receive training in mental health conditions, and patients with known mental health conditions presenting at hospital should have them assessed and documented along with any other clinical conditions.
Link to report and to summary:
(30/01/17) (Subscriber only)

Disabled children with severe behavioural and complex mental health issues are being hidden from society according to a review by the Council for Disabled Children, commissioned by the Department of Health.  It says that such children should not be put into institutions at an early age, and said there was no clear vision for how they should be treated.  The review also criticised the lack of suitable provision in some areas.

The ADCS says schools should pay for home to school transport rather than local authorities, because of ‘the current financial climate’ and to reflect current ‘living arrangements’.  The ADCS (Association of Directors of Children’s Services) estimates that providing the service costs £1bn a year.  They said responsibility for special needs students should stay with authorities.
(27/01/17) (£)

Suicides in prison reached a record 119 people in England and Wales in 2016, an increase of 32% (29 people) over the previous year.  Prison suicides were 8.6 times the rate of the general population.

An association between depression and increased risk of death from cancer has been found, although it is not clear what, if any, causal relationships there may be.  A meta-analysis of data from 16 surveys, involving 163,000 people aged over 16, measured mental health at a point in time and compared this with deaths from any type of cancer 10 years later.  The research was published in the BMJ.  It found that those who had had the highest level of mental distress were 32% more likely to have died from any kind of cancer.  The figures were adjusted for confounders such as age, sex, BMI, education, smoking and alcohol consumption.  Factors not taken into account included propensity to seek help or go for treatment, diet or physical health.  A possible biological link would be increased inflammation resulting from psychological stress.  It is also possible that undiagnosed cancers affected mood.

Mandatory standards for better hospital food have not been met by almost half of hospitals, according to a Department of Health study.  It found that 48% of hospitals were not meeting standards related to the quality, nutritional value and ethical sourcing of food and 55% had not fully complied with a toolkit from the British Dietetic Association on nutrition and hydration.  The DH said that “over 90% of hospitals are compliant or actively working towards compliance with food standards.”

A £1.5m mental health centre designed with the input of people who have experience mental illness has been opened in Swansea.  The not-for-profit Gellinudd Recovery Centre was developed by charity Hafal and part-funded by the Big Lottery and the Welsh Government.  It is said to take a more rounded and fulsome approach to treatment, taking account of physical health and social lives.

A review of the evidence of what outcomes can be expected from drug misuse treatment has been published by Public Health England (158pp).  It compares outcomes in England to the evidence and to other drug treatment systems.  It looks at the impact of housing problems, unemployment, and social deprivation on treatment outcomes.  It provides advice on future policy including how drug treatment will need to be configured to meet future needs.
Press release:


25 January 2017

The UK has stark inequalities in child health and is falling behind many other European countries, according to a report by the Royal College of Paediatrics and Child Health.  It looks at 25 health indicators such as on specific conditions like asthma and diabetes and risk factors such as breastfeeding and obesity.  The UK has the fifth highest mortality rate for children under one, of 19 European countries.  Infant mortality is more than twice as high in the lowest compared to the highest socio-economic group.  In 2015-16, 40% of children in England’s most deprived areas were overweight or obese compared with 27% in the most affluent areas.  Recommendations include developing child health and wellbeing strategies, restricting advertising of unhealthy foods and extending the ban on smoking in public places to schools, playgrounds and hospitals.

The number of rough sleepers increased last year for the sixth year in a row, to reach 4,134 in 2016.  That was an increase of 16% on the previous year and double the figure in 2010.  The numbers are based on either a snapshot count on a single night or an estimate based on intelligence from charities, police and homeless outreach teams.  They are not regarded as robust by the UK Statistics authority and considered an underestimate by some campaigners.  They include people sleeping in places not designed for habitation such as doorways, bus shelters, cars or sheds.  The number of people homeless, including those in hostels and temporary accommodation is estimated at 250,000.

Private care home residents are filling a funding gap of £1.3bn a year, according to research by LaingBuisson.  They calculated that the average fee per resident paid by councils is more than £100 a week less than the real cost of the service.  They said that the care sector is being kept afloat through cross-subsidies from the 40% of residents who pay privately.

The number of GPs fell slightly last year by 96 to 34,495 full time equivalents in the year to September 2016, according to figures from NHS Digital.  Doctors’ leaders say this shows the crisis in general practice getting worse and indicates the challenge the Government faces in fulfilling its promise of 5,000 more GPs by 2020.
RCGP response:

Payment to GPs for non-NHS, out of hours work is being considered in some areas. Oxfordshire LMC (GPs’ Local Management Committee) is quoted as saying that other LMCs are considering charging for such things as minor operations, like vasectomies or mole removal, out of hours.  The patients would pay a third party company which would deal with the transactions.  GPs already charge for such things as writing letters in relation to insurance claims.

Help for GPs with mental health issues is being supported by £20m from NHS England to extend the Practitioner Health Programme to a wider group of GPs.  It is to be trialled initially in 13 areas, with a view to rolling it out across England.  The GP Health Service is described as the first support system of its kind in the world.  It launches on 30th January 2017.

An enquiry into prison suicides has been launched by the Ministry of Justice as the latest statistics are expected to show a record high in 2016.

Simple hygiene techniques such as good hand washing should be taught to children and young people to help curb the spread of infections, NICE has said, as part of its guidelines on Antimicrobial stewardship.  The guidelines also suggest that university students should be taught how to care for themselves if they catch a self-limiting illness such as cold or flu.  There are also recommendations related to the storage and cooking of food.
PHE press release
NICE press release:
The guidelines:

Guidance on preventing falls and fractures has been published by Public Health England.  It is aimed at local commissioning and strategic leads.


24 January 2017

NHS Trusts’ capital budgets are £1bn more than resources and they have been asked by NHS Improvement to defer any non-urgent spending to next year, the HSJ reports.

Attendances at cervical cancer screening are the lowest in 19 years according to research by charity Jo’s Cervical Cancer Trust, based on freedom of information requests sent to all local authorities in England.  A third of women aged 25-29 have been found not to attend invitations for a smear test, although cervical cancer is most common in women under 35.

The number of patient records handed by the NHS to the Home Office to track immigration offenders has increased threefold since 2014 according to the latest figures.  There were 725 requests for patient non-clinical details in the first three months of 2014 and 2,244 requests in September-November last year, of which only 69 were refused.  A memorandum of understanding has just been published making clear that NHS Digital must by law hand over non-clinical patient details such as last known address, date of birth and information about the GP.
The memorandum of understanding:

People with both learning disabilities and dementia need to have their needs better addressed, according to a report from a partnership of voluntary organisations.  People with learning disabilities are five times more likely than the general population to develop dementia.

Banks should accommodate people with mental health problems by adapting their procedures, the Money and Mental Health Policy Institute argues in a report based on an analysis of peer-reviewed research.  It shows how periods of poor mental health can affect people’s ability to manage everyday financial tasks.  For instance, people with depression, OCD or PTSD are likely to struggle with short term memory, making it harder to remember pin numbers.  People with bipolar disorder or ADHD often struggle to control impulses so may go on dramatic spending sprees.  Serious anxiety can make people less likely to open post and so keep track of bills.  Methods to deal with such problems are already availble, such as limited delegation to manage finances available to wealthy people, controls on use of corporate credit cards and setting communication preferences available to people with visual or hearing impairments.  The British Bankers’ Association says it is committed to working with mental health initiatives.
Press release:
Link to the report:

People with mental health problems should be involved in preventing their violent behaviour including having a debrief after any incident that involved them being restrained or sedated, according to a NICE draft quality standard out for consultation until 20th February.  Patients who have been violent should be involved in identifying trigger points and de-escalation techniques that work for them.

A partnership between Cadbury’s and the Premier League to promote healthy lifestyles has been criticised by campaigners including Action on Sugar and the National Obesity Forum which called it ‘little more than a marketing ploy’.

Guidance on reducing blood pressure has been published by Public Health England.  The advice is for commissioners and providers on how to reduced blood pressure throughout the population, which is estimated to cost the NHS £2.1bn a year.  There could be 5.5m adults in England with undiagnosed high blood pressure.
Press release:
The guidance:


23 January 2017

Patients do not want seven day access to GP surgeries and a better understanding of the needs and preferences of different types of patients is required, according to an evaluation by Nottinghamshire University of pilot schemes in Nottinghamshire and Southern Derbyshire.  It said that the most efficient weekend hub model offered a mix of routine and urgent care appointments.

Early deaths from obesity save the taxpayer £3.6bn a year according to the right wing Institute of Economic Affairs, based on estimated costs of pensions, healthcare and benefits if the 35,820 people who died in England and Wales in 2014 had lived for another 12 years.  Because of this, it says the net cost of obesity is £2.5bn a year, which is less than half of the most commonly cited estimates.  It criticises “the ‘burden-on-the-taxpayer’ narrative, propagated by public health campaigners” which it says incites resentment of a vulnerable group.  It notes that the age group whose deaths are worth most to the Treasury are the 65-74 year olds at £166,000 per head.

41% of junior doctors have fallen asleep at the wheel driving home from a night shift, according to a 1,100 of them for the BBC Inside Out South programme.

Over-browned toast and potatoes should be avoided because of the cancer risk according to the Food Standards Agency.  The risk comes from a build up of acrylamide when starchy foods are roasted, grilled or fried for too long at high temperatures.  However the advice was soon challenged on the basis that evidence comes from animal rather than human studies and you would need extremely high consumption to have a significant effect, with one estimate, that you would need to eat 320 slices of toast a day.  However some researchers noted that there is a dose-response effect meaning that there is some, albeit small, effect at all levels of consumption, rather than a cut-off point below which there is no effect.

Cervical cancer rates are higher than previously thought, according to US research, since the official figures include women who have had a hysterectomy and exclude women over 65.  After taking out those who have had a hysterectomy the rate per 100,000 of deaths from cervical cancer for women over 20 rose from 5.7 to 10.1 for black women and from 3.2 to 4.7 for white women.  Black women are more likely to have hysterectomies because they are more susceptible to fibroids.  The research is published in the journal Cancer.

Data packs on mental health for CCGs have been published by NHS RightCare.  They allow local areas to compare their performance with their ten most similar CCGs.
Press release:
Link to the packs:


21 January 2017

Cuts to housing support services will lead to extra costs in homelessness, health, social care and criminal justice, charities are warning as councils identify cuts as they finalise their budgets for next year.

Older people who break their hip are 2.78 times more likely to die in the following year, according to an analysis of eight studies of over 122,000 people from Europe and the US published in the Journal of Internal Medicine.  It is thought that part of the problem may be issues such as pneumonia, blood clots or heart problems after surgery, and also greater frailty following the operation.  Even after eight years, people who had broken their hip were over double the risk of dying.

A paper on the lessons of integrating care, in practice, has been published by the Institute of Public Care at Oxford Brookes University.  It draws on their experience of working with local authorities and health organisations.  It suggests that “There has been a shift of focus from co-location and organisational structures towards working with teams to clarify and consolidate the professional roles and relationships which will make integration work in practice.”
Press release:
The publication:


20 January 2017

The NHS has experienced the busiest week in its history, with 68 hospital trusts declaring an alert between 8th and 15th January, and with a bed occupancy rate across England of 95.8%.  Also in that week, 52 trusts had to divert ambulances elsewhere, which was up from 39 the previous week and compared to 27 in the second week of January last year.
Link to spreadsheet with the data, including by individual trust:

Overweight or obese patients are less likely to die in hospital after a heart operation, according to research funded by the British Heart Foundation, using data on 400,000 adults in the UK and Ireland who had cardiac surgery between 2002 and 2013.  Of those included, 11,511 died in hospital, including 4.4% who were of healthy weight, 2.8% overweight (BMI 25-30), 2.7% obese (BMI 30-35) and 8.5% who were underweight.  The research was published in the journal Circulation.  It is suggested that this challenges the advice that people should lose weight before surgery and any restrictions on access to surgery for overweight people.

NHS sick days are estimated to cost £1.1bn a year, excluding doctors, according to an analysis based on official figures by recruitment website Totaljobs.  The biggest proportion of the cost was from nurses, midwives and health visitors at £442m, with healthcare assistants and other support staff costing £319m and admin staff £198m.  The greatest number of sick days was from ambulance staff, but in total this accounted for just £28m of the cost.

Case studies on child obesity have been published by the DH, showing 8 examples of action being taken by local authorities, businesses, families and schools.


19 January 2017

Hospitals had fewer nurses on duty than they considered safe in 96% of trusts in England, in day shifts in October and 85% did not have the desired number working at night according to analysis of official data by the Health Service Journal.  Almost half of hospitals were employing more healthcare assistants than they originally planned, leading to the fear that lower qualified staff were being used to make up for a shortage of nurses.  The Royal College of Nursing estimates that there are 24,000 nurse vacancies across the UK.  The figures are the worst since hospitals had to start publishing staffing levels in 2014 in the wake of the Mid Staffs scandal.  DH said there are 11,200 more nurses than in 2010.

Surrey County Council plans to increase council tax by 15%, which requires it to hold a referendum.  The Council leader, David Hodge, who is also the leader of the Conservative Group on the LGA, said the increase was needed because of the rising demand for adult social care, learning disabilities and children’s services.  Critics have suggested this is just a smokescreen for cuts, as it is unlikely the referendum will be passed.  The leader of the local authority covering the Prime Minister’s constituency, Windsor and Maidenhead, said that others may follow Surrey.
(20/01/17) Feature article:
(24/01/17) Feature; support for David Hodge from Polly Toynbee:
(26/01/17) Letters:

Drugs which cost over £20m a year will only be made available at the discretion of NHS England, even though approved by NICE.  [The consultation on this was announced on 13/10/16.]  It is thought this could apply to a fifth of new medicines.  For drugs costing a total of more than £20m, NHS England will be able to extend the 90 days deadline for introducing them to enter into talks with the pharmaceutical company to try and reduce the cost.

Financial control totals have not yet been agreed by about a quarter of NHS trusts with NHS Improvement, (60 out of 238), according to the HSJ.  NHS providers will in total have to find savings of around 4% in 2017-18.  There are concerns about whether this will be achievable.  The proportion refusing to agree their control total is about the same as at this time last year.

Prostate cancer can be detected more accurately with MRI scans, with 93% of aggressive cancers picked up by the MRI compared to 48% from a biopsy, according to research based on 570 men, published in the Lancet.  Using the scans could avoid 27% of patients having to have a biopsy.  The MRI could also be used to guide the biopsy which could lead to up to 18% more clinically significant cancers being detected.  The test could reduce the over-diagnosis of harmless cancers by 5%.   The introduction of the scan into practice is already underway but it will need more scanners and training for radiologists.  47,000 men are diagnosed with prostate cancer in the UK each year, and 11,300 die of the disease.
NICE’s position:

When diagnosed with dementia, people would like more information about services and support, according to feedback received from Healthwatch England and local healthwatch organisations.  The research also found that services like memory cafes are not always accessible to those who need them, the quality of services is inconsistent and more needs to be done to make public spaces more dementia friendly.
Press release:
The report:

A report on designing healthcare systems for patients with complex needs has been published by the New York based Commonwealth Fund.  The report was produced through an International Experts Working Group, set up in 2014 through a grant to the London School of Economics.  The top 10 recommendations include: make care co-ordination a high priority; identify patients in greatest need of proactive, coordinated care; train more primary care physicians and geriatricians rather than specialists; facilitate communication between providers—for example, through clinical record integration; engage patients in decisions about their care; and provide better support for caregivers.


18 January 2017

The pay of midwives, social workers and others will fall by £3,000 in real terms by 2020, if the Government continues to limit public sector pay increases to 1% a year, the TUC has said.  The TUC general secretary Frances O’Grady said that the government would struggle to fill public sector jobs if they maintained the cap, particularly given the growing strains on such workers.  The TUC said that the average public sector salary is already £1,000 lower in real terms than 2010.

The push to increase adoption has punished low-income women and hasn’t reduced the number of children in care, according to research by the legal service and campaign group, Legal Action for Women.  The research found that between 2001 and 2016, the number of children from care living with adopted parents or special guardians, rose by 65% from 87,090 to 143,440.  Over the last five years, adoptions rose by 40% but the number of children in care rose by 7.5%.  The report says the number of looked after children is at its highest since 1985 and one in five children under five are referred to children’s services.  More than 90% of adoptions are done without the consent of the family.
(24/01/17) Letters in response:
(30/01/17) Further letters:

‘Disconnected communities’ could be costing the UK £32bn a year, according to a report commissioned by the Eden Project’s Big Lunch initiative from consultancy, the Centre for Economics and Business Research.  The study found that neighbourliness produces economic benefits for the UK equal to an annual saving of £23.8bn, based on a survey of 122,000 people on the Big Lunch database and a review of previous research.  The cost of disconnected communities includes £5.2bn demand on health services, £205m on policing and £12bn in lost productivity.  The study estimates that if more people got involved in their communities it could create a net gain to the economy of £18.1bn.
Feature article:
Press release, with link to the report:

Noisy and confusing hospitals can accelerate the course of dementia according to research led by UCL and the University of Cambridge based on a study of 987 elderly people in Britain and Finland over the last 10 years of their lives and an analysis of their brains after death.  It was published in JAMA Psychiatry.  They found that people who had suffered an episode of delerium (confusion) were eight times more likely to be diagnosed with dementia within the next three years.  Those who already had dementia were three times more likely to have their condition worsen after an episode of delerium.
(19/01/17) (Rgn)

Working in a stressful job for 15 years increases the risk of contracting five forms of cancer according to research from Quebec University involving over 3,000 adults who had been diagnosed with cancer.  It was published in the journal Preventative Medicine.  It is thought the link may be that people under stress may start smoking, overeating or drinking alcohol.  However, the researchers said this was a summary assessment of specific jobs, that nothing was yet proven and more research was needed.

Women who sat for more than 10 hours a day had a biological age  up to eight years older than those who spent eight or less hours a day sitting, based on an analysis of their cells, in research based on 1,481 women over the age of 64 (average age 79), led by the the University of California, San Diego and published in the American Journal of Epidemiology.  The women were tracked for a week using accelerometers and their blood was then analysed for signs of changes to telomeres that indicate cell ageing.  There was no association with telomere length for those who did at least half an hour’s moderate exercise a day.  However, NHS Choices notes a number of limitations of the research and suggests it doesn’t add much to what we already know, in that sitting is bad and activity good for you.

A code of practice on the use of video should not yet apply to the NHS the Home Office has said, in response to a request from the Surveillance Camera Commissioner.  The Commissioner, Tony Porter, asked to monitor the use of CCTV and body-worn video cameras in hospitals, with the NHS to be added to the list of public bodies required to comply with a code of practice, but the Home Office refused on the grounds that the possibilities of increasing voluntary compliance had not yet been exhausted.  NHS Protect, the body responsible for hospital security, has twice rejected recommending that trusts voluntarily adopt the code of practice, as it is not mandatory for them.

A report on the statutory assessments of people who care for someone with a mental health problem has been published by the Centre for Mental Health.  The report, ‘Supporting Carers’ looks at the challenges faced by the 1.5m mental health carers in accessing the assessments to which they are entitled under the 2014 Care Act.  Those include: people not identifying themselves as carers; data protection laws which limit the sharing of information; limits to the support available once an assessment has taken place; and the varying quality of carers’ support in different places.  87% of carers feel that the caring undermines their own mental health.

A report on the state of public-service commissioning has been published by the Reform think tank.  ‘Faulty by Design’ is based on interviews with 29 experts, a literature review and evaluation of publicly available data.  It focuses on complex human services where there is a purchaser-provider split, in health, social care, criminal justice, housing and homelessness and criminal justice.  It finds that commissioning bodies are not delivering value for money in three areas: (1) failing to focus on outcomes that matter to service users, (2) fragmentation of commissioning bodies that stand in the way of integrated services, and (3) a lack of devolution of commissioning to local areas.
Blog with detailed summary:
Summary with link to the publication:


17 January 2017

Half of women in labour are experiencing at least one ‘red flag’ incident, such as not getting timely access to pain relief, according to a survey by the National Childbirth Trust and the National Federation of Women’s Institutes, of 2,500 women who have given birth since 2014.  There had been little progress since a similar report four years ago.  Some women said they felt like cattle with one saying it was like being on a conveyor belt.  Amongst the red flag incidents were a third (31%) of women experiencing a delay of 30 minutes or more in receiving pain relief and 17% not getting one-to-one care from a midwife in established labour.  After giving birth, 18% said they did not see a midwife as often as they needed to.
Press release:

HMRC  has been strongly criticised by the NAO for continuing payments to outsourcing firm Concentrix despite evidence of failure, in an investigation into the affair.  The report said that out of 108,000 cases of change to payments,  35,000 people had had payments wrongly stopped, in some cases leading to ongoing debt.  The firm was contracted to review and correct personal tax credit payments, but despite performance management arrangements designed to protect customer service, it met only 104 of 242 monthly performance indicators between November 2014 and September 2015.  In October 2015 commission payments were increased from 3.9% to 11%.  The three year deal was supposed to have saved £1bn but actually saved £193m for which Concentrix was paid £32.5m.  Shadow minister Louise Haigh described HMRC’s actions as not incompetence but ‘neglect by design’.  [The Work and Pensions select committee reported on this case on 1/12/16.]

The NHS budget in England will have to increase by 2% a year, the Office for Budget Responsibility has said, taking it from £140bn in 2020-21 to £228bn in 2066-67, at today’s prices.  As a proportion of GDP it would rise from 6.9% to 12.6%.  The increase is necessary to take account of the ageing population, new technologies, new drugs and the number of people with chronic, long-term conditions.

The BMA has criticised the Government for downplaying the NHS crisis and scapegoating GPs, in an open letter to the Prime Minister.  In the letter the BMA Chairman Dr Mark Porter suggests the Government appears “to be seeking deliberately to distract from what is really happening in the NHS.”  The letter ends by requesting an urgent meeting to talk about the issues so they can be part of the solution to the challenges facing the NHS.
The letter:

45 former directors of social services warn the government about the underfunding of social care in a letter published in the Guardian.

A report on ‘The State of Rural Services 2016’ has been published by Rural England.  It covers nine service areas including: public health, older people’s services, mental health,  and welfare.


16 January 2017

The world’s eight richest men have as much wealth as the poorest half of the world’s population according to figures from Oxfam.  The report was published to coincide with the World Economic Forum (WEF) meeting in Davos.  The WEF said last week that rising inequality and social polarisation were two of the biggest risks facing the global economy in 2017.  New information shows that people in China and India have even less assets than previously thought which is why the figure for the number of people owning half the world’s wealth has fallen from 62 last year to 8 this.

There could be a fall in the number of NHS staff employed as a result of the STP process, if an analysis by the HSJ of a quarter (11 out of 44) of the plans, is representative.  It found that between 2016-17 and 2020-21, there is planned to be a fall of 1.6% in whole time equivalent staff and a fall of 2.3% in registered nursing posts.  NHS England suggested that the fall in the number of nurses might be mitigated by more working in GP surgeries, although that is not shown in the STPs.  The biggest proportionate cut, of 5.2%, would be to ‘infrastructure support’.  The only staff groups likely to see significant growth are GPs and those supporting them, reflecting the aim of a shift towards primary care.  The plans also project a fall in emergency admissions of 4.1% over that period.  There would be bigger growth in spending on community heatlh services (26%) and core general practice (22%) than mental health (12%) or accute care (2%)

The Department of Health is cutting 538 jobs as part of its plans to reduce costs by 30% up to 2020, under measures announced after the spending review.  The jobs will go under voluntary redundancy.  The number of non-senior jobs will fall from 1800 to 1300 with the number of deputy Director posts falling 116 to 80.  The Department is also centralising its offices in Victoria Street, London.

Artificial intelligence has been used to predict when people with a heart disorder will die, more accurately than doctors.  Based on blood tests and scans of beating hearts, it could accurately predict which of the patients with pulmonary hypertension would still be alive in one year’s time 80% of the time, compared to 60% for doctors’ predictions.  This test was based on 256 patients and is now to be tested on other patients in other hospitals.  The predictions help doctors prescribe the best treatments under the circumstances.

Referral centres, which review GP referrals to hospital, cause dangerous delays, the BMA has said.  Responses to a BBC freedom of information request from 197 of 209 CCGs found that 61 (31%) used some form of referral management centre [see also news item from 4/1/17].  There has been a ten fold increase in such centres since 2005.  There has been a rise in rejections for administrative reasons, from 28% in 2013-14 to 41% last year.

Children whose parents regard them as overweight are more likely to gain weight  in later childhood, and are more likely to diet, according to research by Liverpool and Florida State universities based on two longitudinal data samples.  The first was the Longitudinal Study of Australian Children tracking the weight of children in 4,983 families from the ages of 4-5 to 14-15.  One in five children were overweight or obese although 86% of parents thought they were normal.  The second data set was from the Growing Up in Ireland study, involving 8,568 families, which looked at children at the ages of 9 and 13.  This also found that those considered overweight at 9 had put on more weight at 13.  Both studies controlled for factors such as parents suffering depression or being overweight or obese themselves.

An NHS ‘efficiency map’ has been published by the Healthcare Financial Management Association.  This is an updated version of the map, produced by the HFMA and NHS Improvement.  The map highlights the successes NHS providers have had in delivering efficiency schemes and provides signposts to tools and reference materials.

A report on demographic trends and their implications for living standards has been published by the Resolution Foundation.  The report, ‘Live Long and Prosper?’, notes that for people born in the last 15 years, life expectancy is 93 and a third can expect to live to 100.  People are staying in education longer, having children later and working to older ages.  As the baby boomers start to enter retirement, the ratio of workers to non-workers is starting to fall  for the first time in many years.


15 January 2017

Sarah Wollaston has defended Simon Stevens over comments on the extent of Government funding for the NHS. The chair of the Health Select Committee told the Sophy Ridge on Sunday programme on Sky News that Stevens was correct that the Government hadn’t given the NHS in England more than it asked for, given cuts in other parts of the health budget and in social care.  She also said the Government should give him their unequivocal support in doing a very difficult job.  She also criticised the Government’s scapegoating of GPs, noting that they were extraordinarily stretched and that when surgeries are closed during the day GPs would be doing such things as home visits, administrative work and chasing test results.

Vision problems amongst British over 40’s are five times higher than in the 1960s, with 54% of 40-69 year olds suffering vision problems compared with 10% in the 1960s, according to research by UCL.  It is thought that part of the cause may be people spending less time outdoors in brighter sunshine.


14 January 2017

Hospitals are having to cancel cancer surgery, which was previously protected, because of the current crisis in the health service, the Observer reports.  Writing in the paper, Lord Kerslake, chair of King’s College Hospital and former head of the civil service, said the Government is not sufficiently in touch with the reality facing the NHS and the severity of the crisis.

Labour would take failing care homes into public ownership, Jeremy Corbyn has said in a wide ranging speech.  He said that cuts of £4.6bn over the course of the last parliament had created a “social crisis made in Downing Street.”  He accused Theresa May of using GPs as a scapegoat for the crisis.

More people trust the Conservatives to run the NHS than trust Labour according to a ComRes poll for the Independent and the Sunday Mirror.  43% said they would be more likely to trust Theresa May and the Conservatives, while 31% would trust Jeremy Corbyn and the Labour Party.  71% said the NHS provides a high standard of care, 13 percentage points higher than in 2013.  Satisfaction with Jeremy Hunt’s performance has fallen since 2013 with 53% now disagreeing that he is doing a good job.  43% agreed that they or a member of their family had struggled to get a GP appointment in the past 12 months but 54% disagreed.  30% of respondents agreed that those who could afford to should be required to pay for NHS services while 53% disagreed.

78% of people would be prepared to divert money from the foreign aid budget to support the NHS instead according to a poll for the Mail on Sunday of 1200 people by Survation.  According to the poll, 77% think free care should be reserved for UK citizens by requiring patients to show ID.  79% backed the idea of a £50 charge for people who end up in A&E because they are drunk.


13 January 2017

Theresa May has been accused of scapegoating GPs in attempting to deflect blame for the NHS crisis after Downing Street issued a statement saying “it is increasingly clear that a large number of surgeries are not providing access that patients need – and that patients are suffering as a result, because they are then forced to go to A&E to seek care.”  Extra funding for out of hours care, 8am to 8pm, seven days a week, is in future to be linked to evidence that it is being used to meet patient demand.  The BMA noted that GPs already provide care round the clock through out of hours schemes as well as many offering evening and wekend appointments, although some such schemes had been abandoned because of lack of demand.  The Royal College of GPs said the Government’s move was nonsensical and that routine GP surgery hours were not contributing to the pressures on A&E.  They said GPs were also struggling with increasing demand and insufficient staff and that general practice was ‘close to the precipice’.  It has been suggested that GPs are so angry with the Government’s stance that it could lead to mass resignations from the service.  The Nuffield Trust said that Mrs May’s call misinterpreted the nature of the crisis which was about people with serious health problems who could not be safely taken care of in general practice.  Ministers said they are providing £528m a year by 2020-21 to meet the seven day opening target.

There were major alerts at nearly half the hospitals in England in the first week of the year, in 66 out of 144 trusts, with 8 at the highest level, level 4, according to the latest figures.  There were 226 serious alerts issued between 3rd and 8th January.  Occupancy rates for hospital beds were 95%, up from 91% the week before (and against a standard of 85%).

The number of people waiting more than 18 weeks for surgery has risen dramatically, to 193,406 from 139,240 last year and 105,427 four years ago, according to analysis by the Royal College of Surgeons.

The doctors’ revalidation process is working well, except for locums, according to a review by the GMC.  The five yearly ‘MOTs’ have been in place since 2012.  The review found that hospitals were often unwilling to provide frank feedback on locums.  There was also concern that for all doctors, some patients might be put off providing honest feedback in case it affected their care.
GMC press release:


12 January 2017

The combined NHS performance figures for November show targets continuing not to be met, with increased pressure on the system.  Only 88.4% of people were seen at A&E within four hours.  90.5% of patients waited less than 18 weeks for an operation, against a target of 92%.  Seven out of eight cancer targets were met, though only 82.3% started treatment within 62 days of a referral by a GP against the target of 65%.

Depression causes 15% of heart attacks in men, compared to 21% caused by obesity and 8% by high blood pressure, according to research led by the University of Munich based on data on 3,428 male patients aged 45-74, followed for 10 years.  The research was published in the journal Artherosclerosis.
Press release:
Journal article:


11 January 2017

The Government does not know the cost of extending access to GPs at weekends and in the evenings or where the money for it will come from, the National Audit Office has said in a report, ‘Improving Patient Access’.  They estimated that while the cost per appointment in core hours was £154 per appointment hour for every 1,000 registered patients, it was £230 in the evenings and at weekends.  They said that promised increases in the workforce were at risk as GPs were leaving faster than they were being recruited.  In 2016-17, only 3,019 (93%) of a targetted 3,250 GP training places were filled.  The report also said that 46% of surgeries close at some point in the core hours of 8:00-18:30 with 18% shut from 3pm on at least one day a week.  It said that practices open for less than 45 hours a week have an 8% higher rate of A&E attendances.
Press release:
Links to the report:

The NHS will fail and patient care will suffer without urgent investment, the Royal College of Physicians has warned the Government.  They said that the NHS was ‘under-funded, under-doctored and over stretched’ and that hospitals are ‘too paralysed by spiralling demand to transform and modernise’.  The Academy of Medical Royal Colleges also warned about the pressures on the NHS.  Another group of 75 health organisations including Independent Age and the Royal College of Nursing have written an open letter to the Government warning of the impact on older, ill and disabled people if urgent action is not taken.

Simon Stevens has disputed the Prime Minister’s claim that the NHS is getting more funding than it asked for, saying that this was ‘stretching it’ and noting that the £8bn asked for was over five years, while the £10bn quoted by the Government is for six years.  He also noted the extreme pressure the NHS is under, reiterating that real terms spending per head will go down in 2018-19, pointedly noting that this is “10 years after Lehman Brothers and austerity began.”  He also held up a page from the Daily Mail showing that the NHS has fewer medics, beds and scanners than other countries in Europe. He said that an update of the Five Year Forward View is to be published in March.   It is also reported that key members of the Prime Minister’s team have described Stevens as unenthusiastic and unresponsive, although this is denied by Downing Street.  Stephen Dorrell, former Tory health secretary and chair of the NHS Confederation, said it was unfair of May to blame Stevens.  It is reported that Stevens intends to stay in post for at least the next two years, until 2019, despite differences with No. 10, and he will stick more closely to his remit rather than calling for more money for social care.

More than twenty hospitals have declared a black alert this week, (Monday to Wednesday) meaning they could not deliver comprehensive care and there is a risk of patient care and safety being compromised, the Guardian reports.

A call for a convention on long term funding of medical and social care has been made by a group of 20 MPs from all three major parties and including two former health secretaries.  Signatories include Norman Lamb, Sarah Wollaston, Dan Poulter, Alan Milburn and Stephen Dorrell.

Business rates for NHS hospitals will be £64m a year more in total from next year, a rise of 21% from £313m to £377m as a result of property revaluation.

More than 40,000 children and young people are having teeth extracted in hospital each year according to NHS figures obtained by the LGA.  There was a 10.7% rise in the number of extractions from 36,833 in 2012-13 to 40,800 in 2015-16.  The annual cost to the NHS is over £35m.
Press release:

On site ‘independent domestic violence advisers’ (IDVAs) should be available in every hospital, the charity SafeLives has said.  They say that such a team would cost a hospital about £100,000 a year, while domestic abuse costs the NHS £1.73bn annually.
Feature article.

The NHS Confederation has appointed Niall Dickson as its new chief executive. He was previously head of the General Medical Council.  He will take over from interim chief executive Stephen Dalton.

A study on how genetics and environment influence obesity claims there is no silver bullet to beating obesity. The study, led by the University of Exeter and also involving the universities of Bristol, Geneva and Lausanne, London and Emery, and published in the International Journal of Epidemiology, used data from 120,000 people from the UK biobank.  Amongst other things, it found that for people in the poorer half of the population, carrying 10 additional genetic risk factors was associated with 3.8kg extra weight for someone 1.73m tall, while for people in the richest half with those same characteristics it was 2.9kg extra.
Press release:

Advice on reducing health inequalities in the criminal justice system has been published by Public Health England.  PHE has worked with charity Revolving Doors to produce the guide, ‘Rebalancing Act’ (62pp).
Press release from PHE:
Press release from Revolving Doors:

A summary of patient experience scores for each NHS Trust has been made available on a website by NHS Improvement.  It shows the headline scores from a range of sources including: the friends and family test, ambulance survey, A&E survey, community mental health survey, maternity survey, PLACE and CQC inspection ratings.  Users can select one or a number of trusts to compare scores.
The tool:

A report on systems leadership in the STP process has been published by the Institute of Healthcare Management.  The report, ‘Swimming Together or Sinking Alone’ (20pp) is written by journalist Richard Vize and is based on interviews with leaders from health and local government.
(20/01/17) Feature by the author of the report:


10 January 2017

Nearly a quarter of A&E patients waited longer than four hours last week, according to NHS Improvement documents leaked to the BBC.  About one in five patients admitted for further treatment, or 18,000 people, had ‘trolley waits’ of four hours or more, with 485 of 12 hours or more.  Overall since the start of December hospitals have seen only 82.3% of patients within the four hour target, the worst performance since the target was introduced in 2004.  NHSI said the data were provisional and could be revised.

The power to exempt local authorities from certain children’s legislation has been reinstated into the Children and Social Work Bill by MPs after having previously been removed by the House of Lords.  An amended version of the proposals was approved by 10 votes to 5.

People with continuing care needs may be forced into residential care rather than being cared for at home, according to the policies in at least 37 CCGs, aiming to limit spending on NHS Continuing Healthcare.  The policies could affect over 13,000 people.  The information was obtained by campaigners Disability United, who sent freedom of information requests to all CCGs and received replies from 122.  Of those, most used the national framework and guidelines but 53 had their own policies, of which 37 set cost restrictions.  19 said they would not fund care in a person’s own home if the cost was more than 10% above an alternative option, usually residential care, 7 set caps at 20%, 25% or 40% above care homes and 11 said they would restrict the cost but hadn’t set a cap.  Several CCGs had actively considered whether their policies were legal and concluded that they were.
(23/01/17) (£)

The number of people attending emegency departments rose by 4.6% last year to reach 20,457,805 people in 2015-16, an increase of about 900,000 on the previous year, according to figures from NHS Digital.  The numbers attending in January-March was 12.2% above the same period in the previous year.  The number waiting for more than four hours rose from 1,638,058 to 2,090,200 in 2015-16 (an increase of 28%).  Most people were assessed quite quickly: median 11 minutes, mean 36 minutes with the median time to treatment 56 minutes and mean time 77 minutes.  The busiest months were June and July, with attendances of 57,100 and 56,400 a day respectively, with the least busy month being January at 48,800 attendances a day.
Press release:
Link to data:

A&E attendances by people with mental health problems have risen steeply in recent years, with the number with a psychiatric condition as the primary diagnosis having increased by 50% between 2011-12 and 2015-16 to reach 165,000, and with a doubling of those under 18 to reach 22,000 according to figures compiled for the BBC by NHS Digital.  These nevertheless constitute only just over 1% of A&E attendances, although there will be many others where there are also mental health problems.

Concerns that the Children and Social Work Bill could make court orders protecting vulnerable children unenforcable have been raised by the Magistrates’ Association.  Although the clauses of the bill that allow local authorities to be exempted from selected legislation were defeated in the Lords before Christmas, it is thought the Government may reintroduce them when the Bill returns to the Commons next week.  The MA said a local authority might be ordered to come before the court to account for a failure to adhere to legislation when it didn’t apply to them, making it hard to achieve consistency.
(09/01/17) Comment piece:

Half of eligible heart attack patients miss out on rehabilitation according to the National Audit of Cardiac Rehabilitation published in the journal Open Heart.  It found that 66,000 out of 132,000 eligible patients missed out on rehabilitation and 69% of NHS cardiac rehabilitation services in England, Wales and Northern Ireland did not meet all the minimum standards.

A ban on advertising alcohol in the UK has been called for by the Alcohol Health Alliance, a coalition of over 40 health bodies, including the Academy of Medical Royal Colleges.  The call comes alongside the publication of 14 articles on the subject in the journal Addiction, which suggest that much marketing appears to breach voluntary codes of practice, that young people are increasingly exposed to such advertising through social media and much marketing seems designed to appeal to young people.  It suggests there is a need for statutory regulation rather than self-regulation.
Press release:

People with learning disabilities should have an annual health check, to include mental health, NICE have said in a new quality target.  Mental health problems are more common amongst people with learning disabilities with a rate of 40% amongst adults and 36% in children at any one time.  Only a half of people with learning disabilities received a health check in 2011-12.  The standard also said that people with LD and a serious mental illness should have a key worker to co-ordinate their care.

Meeting exercise guidelines in two days reduces mortality by almost as much as spreading it over three or more days according to research involving pooled survey data from England and Scotland on 63,591 adults collected between 1994 and 2012 and analysed in 2016, by researchers from Loughborough University, the University of Sydney and Harvard, published in the journal JAMA Internal Medicine.  Compared with those who did not exercise at all, those completing the weekly recommended 150 minutes of moderate activity or 75 minutes of vigorous activity in one or two sessions (‘weekend warriors’) reduced their risk of dying from any cause by 30%, those meeting the guidelines on three or more days reduced their risks by 35%, while those exercising regularly but not meeting the guidelines reduced their risk by 34%.  One of the study authors said that no-one yet knew the best way of meeting the recommended weekly exercise total.

A report on ‘Tackling Wasteful Spending on Health’ has been published by the OECD.  It says that one in ten patients in OECD countries is unnecessarily harmed at the point of care and more than 10% of hospital expenditure is spent on correcting preventable medical mistakes of hospital acquired infections.  The market penetration of generic drugs ranges from 10% to 80% across OECD countries.


09 January 2017

The Prime Minister announces a focus on mental health as part of a ‘shared society’.  Initiatives include: every school to be offered mental health first aid training; trials to improve links between schools and NHS specialist staff; a review on improving support in the workplace; training for employers on supporting staff who need to take time off; and expanding online services.  She highlighted stigma as a key issue.  There is no new money to implement the plans (£15m was announced for creating ‘places of safety’ but this is to come from existing DH budgets).  Norman Lamb described it as a ‘puny response to a burning injustice’ and said measures on mental health in school were agreed during the coalition but that the government hasn’t ensured the necessary investment has got through.  Other critics pointed to rising rates of mental health problems and reductions in budgets.
Reaction and background information:
Press release:
The Prime Minister’s speech:

Jeremy Hunt denies the NHS is in a humanitarian crisis but hints that the 4 hour A&E target could be changed, while the Red Cross have repeated their use of the phrase.  Hunt acknowledged the pressures on the service but said that most hospitals are coping better this winter than last.  He also said that the situation, with many people waiting on trolleys, had eased over the weekend.  In an emergency statement to parliament, Hunt said that the situation was extermely fragile in a few trusts but said the four hour target was a “promise to sort out all urgent health problems” not all health problems.  He said that according to NHS England, 30% of people attending A&E didn’t need to be there.  The Royal College of Emergency Medicine said a substantial number of A&E departments were falling sufficiently far below the four hour standard to put patients safety at risk.  Mark Holland, President of the Society for Acute Medicine described Jeremy Hunt as out of touch.
Background information about the Red Cross’s role in the NHS:
Jeremy Hunt’s statement to Parliament:

There is to be no additional funding for A&E before the next election, the Department of Health has said, in comments to the Health Service Journal.  The HSJ had previously reported that the department was in talks with the Royal College of Emergency Medicine about an emergency care transformation fund.

The third annual suicide prevention strategy progress report has been published by the Department of Health.  As well as reporting progress, it indicates a number of updates to the strategy.

The Government’s response to the Five Year Forward View for Mental Health has been published, accepting all the recommendations of the Mental Health Taskforce.
Summary of the recommendations and responses:


08 January 2017

Thirst or starvation were the cause of death of 1,022 people in 2015 according to figures from ONS, reported in the Sun, although the BBC says the figure is 828.  Also, these are just where thirst or malnutrition might be a factor, but it could be a complication of another cause such as stomach cancer.


06 January 2017

The British Red Cross says a ‘humanitarian crisis’ faces the NHS as it provides support to help get people home from hospitals.  Two patients have died at the Worcestershire Royal Hospital after long waits on trolleys in hospital corridors.  There is also concern that a shortage of beds throughout the country may mean patients put on wards without the specialist staff relevant to their condition, potentially leading to more deaths.  NHS England rejected claims there was a humanitarian crisis, although they did say there was a level of pressure they had not seen before.  Jeremy Corbyn demanded that Theresa May come to the Commons on Monday to say how she would fix the ‘national scandal’ of the NHS.  Lib Dems have made similar demands.  Theresa May said (8th) that there wasn’t a ‘humanitarian crisis’, though she acknowledged the pressures on the service and reiterated the approach to dealing with it (essentially existing funding and spreading good practice).
(08/01/17) Examples of problems on the front line of A&E:

It is alleged that DH colluded with HEE in imposing the junior doctors’ contract after the Independent obtained emails through freedom of information requests, which showed communications between the two bodies prior to Health Education England writing to trusts emphasising the importance of consistent implementation of the new contract.  The secretary of state did not have the power to impose the contract, but HEE provides £3.65bn to 429 trusts and has power over who becomes a consultant, so it is argued that trusts were in practice unable to do other than impose the contract.  Various drafts of HEE’s letter were sent to DH and one email says that the Secretary of State wanted to see a draft by 15:00.  In response, HEE said the letter was discussed with DH as a ‘common courtesy’.

A third of hospitals had to issue alerts because of the pressure of patient numbers last month according to an analysis by the Nuffield Trust for the BBC.  There is a new system this year for measuring the pressure on trusts, known as Operational Pressures Escalation Levels (OPEL), replacing the previous red and black alerts.  There are four levels.  Level 1 is ‘meeting anticipated demand within available resources’, OPEL 2 is ‘starting to show signs of pressure’, level 3 is ‘major pressures compromising patient flows’ and OPEL 4 is where pressure leaves organisations ‘unable to deliver comprehensive care’.  Between 1-27 December, 50 of the 152 trusts submitting data to NHS England declared an OPEL 3 or 4, with 7 of them level 4’s.  Although the system is different from last year, it seems that pressures are higher this year.

The Prime Minister should tackle the challenge of funding health and social care, the chairs of three influential Commons committees have urged.  They are Sarah Wollaston for Health, Meg Hillier of the Public Accounts Committee and Clive Betts, chair of the communities and local government committee.  The chairs ask the prime minister to look for a cross-party consensus so that ‘agreement can be reflected in the next spending round’.  They say the review needs to look at both health and social care together.  There is concern that Brexit is pushing other, domestic issues off the agenda.

Delayed discharges have been rising faster in mental health than other acute trusts, with the increase between November 2015 and October 2016 being 56% in mental health trusts compared to 30% in acute trusts according to figures from NHS England.

Half a million over 60’s usually spend every day alone while another half a million typically do not speak to anyone for five or six days of the week according to a poll commissioned by Age UK of 2,241 UK residents aged over 60.  Of those, 498 (22%) said they spent seven days alone with 464 (21%) spending five or six days on their own.  The charity has been running a pilot programme in eight areas to identify lonely older people and offer them companionship.  It found that 88% of lonely older people participating in the trial experienced a reduction in loneliness.

London’s annual air pollution limits have been breached in five days, with Brixton Road in Lambeth exceeding the legal requirement for hourly levels of toxic nitrogen dioxide to be no more than 200 micrograms per cubic metre more than 18 times in the year.  Preliminary data suggests that 60% of the 97 air pollution monitoring sites in London exceeded the legal limits in 2016.  Across the whole of the UK, 169 (40%) of local authorities exceeded legal NO2 pollution limits in 2015.

Pregnant women living near busy roads have a greater risk of pre-eclampsia according to a study, published in the journal Epidemiology, of 72,745 pregnant women in Denmark which modelled the noise and air pollution at their addresses.  It found that both noise and air pollution appeared to have an impact on the condition.  It found that for every 10 decibel increase in noise, there was a 10% greater risk of pre-eclampsia and high blood pressure.  Each increase of 0.01 micrograms of nitric oxide per litre of air raised the risk of the condition by 7%.  Pre-eclampsia affects about 6% of births in the UK, affecting 42,000 women with about 500 babies a year dying from the condition.

Some newly qualified dentists are being prevented from treating NHS patients because of delays in the paperwork, with the time taken to provide the necessary ‘provider number’ having risen from about six weeks to seven months under new provider Capita who took over running some back office NHS services as ‘Primary Care Support England’, according to the British Dental Association.

The Prime Minister is to announce new government action on mental health in a speech on Monday (9th January).  It is expected that she will announce action to be taken on support for young people, reducing suicides and the role of employers.  It is not expected that any extra funding will be announced.


05 January 2017

A smartphone app providing triage diagnosis is to be tested in a pilot in North London, as part of the NHS 111 service.  The app is supplied by private company Babylon, which also provides access to private healthcare.  The six month trial is to start at the end of January.  It is to be tested in the five London boroughs of Barnet, Camden, Enfield, Haringey and Islington.  It is said that the app can decide in two minutes whether someone would be best served by a GP, hospital, a pharmacist or staying at home.  The results of the text chat on the app will be sent to the NHS for further action.

NHS screening for people at high risk of diabetes has little impact according to a study from Oxford University which looked at 49 studies of screening tests and 50 intervention trials. It was published in the BMJ.  It said that blood tests would give too many people an incorrect diagnosis and that lifestyle changes had a relatively low success rate.  However the NHS director of the programme has said its screening programme is based on robust evidence.


04 January 2017

Two thirds of asthma sufferers (3.6m people) in the UK still do not receive all elements of recommended care, according to a report from Asthma UK, based on its annual survey, with 4,650 responses from around the UK.  The basic recommended care includes an annual review, being on the right medication and knowing how to use it and having a written asthma action plan.  There have been some improvements in recent years, with the proportions receiving an asthma action plan being 24% in 2013, 36% in 2015 and 42% in 2016.  Seven out of ten people with asthma who end up in hospital are not given a follow up appointment with a doctor or nurse.  In 2015, 1,468 people died from asthma and according to the charity two thirds of such deaths are preventable with the right care.

People living near a busy road had a slightly higher risk of dementia according to research led by Public Health Ontario which was published in the Lancet.  The study tracked about 6.6m people for more than a decade from 2001 to 2012 using postcode data to determine how close they lived to major roads.   The biggest association was for those living within 50 metres of a major road in a big city who did not move house during the study period who had a 12% higher risk of developing dementia.  Factors such as wealth, education and other measures of health and socilal status were taken into account, but it is possible some confounding factors were missed.  No link was found with multiple sclerosis or Parkinson’s disease.

Another doctors’ trade union, other than the BMA, has been granted national recognition by NHS Employers, the first time there has been another such body since the NHS was founded in 1948.  The Hospital Consultants and Specialists Association, which was granted national collective bargaining rights on 22 December, was formed in 1948 and has more than 3,500 members.

The latest tobacco control plan should be published as soon as possible, a group of 1,000 senior health professionals have urged the Prime Minister in a letter which is being published in the British Medical Journal.  The last tobacco strategy expired a year ago and a new one was due to be published last summer but is said to have been delayed in part due to Brexit.  The signatories say the plan is necessary to reduce smoking rates which are higher amongst the less well off.

Over a third (39%) of CCGs use some form of ‘referral management centre’ to scruitinise GPs’ referrals to hospitals, research by the BMJ has found.  It received responses to freedom of information requests from 184 of 211 CCGs contacted of which 72 (39%) said they commissioned some sort of such scheme.  32% of schemes are provided by private companies, 29% in-house and 11% by local NHS trusts.  Of the responding CCGs, 69% provided operating costs, which amounted to £57m since 2013.  Most CCGs were unable to provide evidence that their scheme had saved money, although some said that this was not the purpose and it was rather to improve the quality of referrals.

GPs’ concerns about working in federations and at larger scale include loss of independence, time and money, according to a survey of 294 GPs by GPonline and the medical defence organisation Medical Protection.  Asked about their top three concerns, 64% included loss of independence, 56% lack of time and capacity to develop a network, 48% financial issues and 45% problems of governance or leadership.

The number of patients registered with each GP practice has increased by 7% since 2013, to 7,521, according to figures from NHS Digital.  Only 4 out of 209 CCGs have seen their average surgery list size fall in the last three years.  It is suggested that the increase is a result of practices closing or merging.


03 January 2017

Children consume half their recommended sugar allowance at breakfast and three times the full amount by the end of the day, according to information from Public Health England based on a survey of a representative sample of 1,000 people.  PHE is launching a campaign on the health risks of too much sugar.  It has also developed a ‘Be Food Smart’ app which can be used to scan barcodes and find out how much sugar, saturated fat and salt is in products.

Employers should help end the ‘cake culture’ at work to help tackle obesity and oral health problems, the Royal College of Surgeons faculty of dental surgery is urging.  They suggest that organisations should have fruit and nuts in meetings rather than biscuits, scrap sugary snacks from vending machines and encourage employees to have less cake for celebrations such as birthdays.


01 January 2017

A quarter of UK babies are not receiving mandatory health check ups from health visitors up to the age of two, according to the commission on social mobility.  A fifth of babies had not had the 12 month check they were supposed to by 15 months of age.

The feasibility of a seven day NHS within current resources has been questioned by professionals and politicians.  The chair of the Royal College of GPs, Dr Helen Stokes-Lampard, said that seven day GP opening with current resources is unrealistic.  The view was supported by MPs Norman Lamb and John Ashworth.  She said there was little demand for Sunday opening and that without additional resources weekday services would suffer.  Norman Lamb also said that a letter from Jeremy Hunt had failed to identify how many junior doctors would be trained and employed by the end of the parliament which therefore didn’t answer the question of how there would be adequate staffing throughout the week.