2017 Q3 July-September
Health and Wellbeing Policy Update: July-September 2017
This is a list of key policy items relating to health and wellbeing (mainly in England), updated every week or so. It is in reverse chronological order (most recent at the top). It is grouped in three month blocks: click here for other quarters.
29 September 2017
The number of NHS hospital beds has halved in three decades, having fallen from 299,000 in 1987/88 to 142,000 in 2016/17, according to a report from the King’s Fund. According to OECD data quoted in the report, Britain is 29th out of 35 leading countries for the proportion of beds. It has 2.6 beds per 1,000 people compared to 13.2 in Japan, 8.1 in Germany and 6.1 in France.
22 September 2017
The economic cost of loneliness is £6,000 over ten years, according to an analysis by the LSE, which says that there are £3 in savings for every £1 spent preventing loneliness. The Campaign to end Loneliness said that 76% of over 65s said they would find it hard to admit to being lonely because of not wanting to be a burden, in a survey by Censuswide of 2240 people including 504 people over 65.
Link to pdf press release: https://www.campaigntoendloneliness.org/press-releases/
Link to web page with the publication: https://www.campaigntoendloneliness.org/resources/
Link to report, Docx format: https://campaigntoendloneliness-rspmbr9ezvmofjn.netdna-ssl.com/wp-content/uploads/CTEL-summary-doc-final-15.9.17.docx
21 September 2017
54% of primary school teachers did not feel adequately trained to help pupils with mental health problems, according to a survey of 330 primary school teachers by YouGov for the Anna Freud National Centre for Children and Families. Only one in ten felt they had the necessary training to feel confident about what action to take. About four in ten were not confident about which organisation to approach for help. However over 7 in 10 felt their school was doing a good job at promoting their pupils’ wellbeing.
Nine in ten GP surgeries have been rated ‘good’ or ‘outstanding’ by the CQC, with the vast majority, over 80% scoring ‘good’. One in seven surgeries, covering about 7m people, had severe safety problems. 7,365 surgeries have been inspected in the last three years.
20 September 2017
A quarter (24%) of 14 year old girls have signs of depression, while for boys the figure is 9% according to a survey of 10,000 young people from the Millennium cohort. This is different from the assessment by parents according to which 18% of girls had depression. By ethnicity, rates of depression amongst 14 year old girls included: mixed race-28.6%; white-25.2%; Bangladeshi-15.4%; black African-9.7%. Based on family income, those on the second lowest quintile were most likely to be depressed, at 29.4% while the least likely were those on the highest quintile at 19.8%. Critics (seem Mental Elf blog) point out that ‘symptoms of depression’ is not the same as the mental disorder of depression.
Guardian editorial: https://www.theguardian.com/commentisfree/2017/sep/20/the-guardian-view-on-childrens-mental-health-not-an-optional-extra
(29/09/17) Mental Elf blog: https://www.nationalelfservice.net/mental-health/depression/is-mental-malaise-the-psychological-equivalent-of-obesity/
Success rates for quitting smoking have reached a record high, at 20% for the first six months of 2017, compared to an average of 15.7% over the last decade, according to research from University College London. It is thought that the availability of e-cigarettes has played a part together with restrictions on smoking in public places and elsewhere, the ‘plain packaging’ regulations and an increasingly strong anti-smoking culture.
15 September 2017
42% of families moving to universal credit said it had led to rent arrears for the first time, and a quarter of new claimants had to wait more than 42 days for a first payment, according to a government study. Half of new claimants needed a DWP loan to help pay for living expenses while they waited for a first payment.
14 September 2017
The Health Service Safety Investigations Bill has been published by the Department of Health. It would set up the Health Service Safety Investigations Body (HSSIB). It would allow the HSSIB to conduct investigations using ‘safe space’, legal powers that prevent it disclosing the information it gathers during an investigation.
13 September 2017
Local welfare assistance schemes have been closed or cut back by nearly two thirds of councils, a study by the Centre for Responsible Credit (CfRC) has found, based on information from 110 out of 155 English councils [I thought there were 152 ST and CCs?]. 26 councils had scrapped their schemes completely. The £300m a year social fund was transferred to councils four years ago but with a £120m annual funding cut and no ring fencing, which meant it was susceptible to cuts by councils struggling to maintain core services. National funding has continued to fall.
10 September 2017
Michael Marmot calls for an enquiry into stalled life expectancy growth in the UK, after an analysis of Eurostat figures showed life expectancy at birth as the lowest in Europe for females and the second lowest for males. While life expectancy growth has slowed in all countries since the financial recession it has been particularly pronounced in the UK and Sir Michael has written to the health secretary, suggesting that austerity is a possible reason for the change and he has asked for an enquiry to be set up.
Link to pdf: www.instituteofhealthequity.org/resources-reports/marmot-indicators-2017-institute-of-health-equity-briefing/marmot-indicators-briefing-2017-updated.pdfhttp://www.instituteofhealthequity.org/resources-reports/marmot-indicators-2017-institute-of-health-equity-briefing/marmot-indicators-briefing-2017-updated.pdf
The UK government is flouting its duty to protect its citzens from illegal levels of air pollution, according to the UN special rapporteur on human rights related to toxic waste, following a visit to Britain in January.
07 September 2017
Treatment for ‘health anxiety’ is effective and could save the NHS £420m a year, according to an NIHR funded study involving 444 patients with health anxiety, half of whom were given a form of CBT. The team estimated that 1 in 5 people attending hospital outpatient appointments suffered from health anxiety. Many have already suffered a serious illness and fear it could happen again.
The suicide rate in Britain fell last year, particularly in England according to the ONS. They suggested the fall in England was due to suicide prevention work. The fall in Britain was from 10.6 per 100,000 in 2015 to 10.1 in 2016. This was a fall of 202, or 3.4%, to 5,688. The fall in England over that period was from 10.1 per 100,000 to 9.5. In Scotland it rose from 14.0 to 15.0 although the ONS said that different arrangements their make comparisons inappropriate.
Plans to sell off NHS Professionals have been dropped by the Government. Ministers announced plans to sell the wholly publicly owned employment agency last year, to much criticism. In a written statement, health minister Philip Dunne said the policy had changed because not enough had been offered for the 75% stake that was on sale. The company’s pre-tax profit rose by 44% in 2016-17 compared to the previous year.
31 August 2017
The underlying overspend by NHS providers was £3.7bn in 2016-17, according to analysis by the Nuffield Trust. The officially reported deficit was £791m, but there was an input of £1.8bn from the sustainability and transformation fund, there were £300m of ‘accountancy changes’. Although the underlying deficit was £3.7bn at the start of 2017-18, the spending gap will actually be £5.9bn this year because of NHS inflation at 2.9% and an increase in the national tariff of only 0.3%. Even with a further £1.8bn in sustainability and transformation funding, providers will have to save £3.6bn, or 4.3% of operating costs.
The Scottish smoking strategy has had a positive impact, according to research by the University of Edinburgh and NHS Health Scotland. However more needs to be done to reduce inequalities in smoking rates.
NHS England is recruiting more GPs from abroad, with a £100m payment to recruitment agencies. It is suggested that half the additional 5,000 GPs promised by 2020 could come from overseas, up from the original target of about 500.
The UK government is failing to uphold disabled people’s rights across a range of areas, the UN committee on the Rights of Persons with Disabilities has said. It says the UK has not done enough to ensure the convention on disabled people’s rights, to which it is a signatory, is reflected in UK law and policy. Among the issues raised are increasing numbers of disabled children educated in special schools, high levels of poverty for disabled people and their families and the failure of the UK government to recognise the rights of disabled people to live independently in the community.
One in three sick notes were for mental health conditions, the most common reason for issuing them, according to figures from NHS Digital. There was a 14% rise in notes for anxiety and stress between 2015-16 and 2016-17. Sick (or fit) notes for psychiatric problems covered longer periods than those for other conditions.
Press release: https://digital.nhs.uk/article/7584/Mental-health-and-behavioural-conditions-account-for-nearly-one-in-three-known-fit-notes-
30 August 2017
Firms that have built NHS hospitals under PFI made £831m profit in the last six years and are predicted to make almost £1bn over the next five, according to a study by the Centre for Health and the Public Interest. It says that if the NHS had not paid those pre-tax profits, hospital deficits would have been reduced by a quarter. Expected payments in the next five years constitute 22% of the extra money the government has promised the NHS between 2016-17 and 2020-21. The research is based on figures from the Treasury and the accounts of PFI companies held at Companies House. The Department of Health said that less than 3% of the NHS budget was spent on PFI.
Young people with a low sense of belonging to their school were nearly 7 times more likely to self-harm than those feeling attached to it, according to research by the University of Hertfordshire. The university, with the WHO, surveyed 5,335 11-15 year olds in England. Nearly three quarters of boys and girls said that PSHE lessons helped them look after their own health.
Resources on mental health have been produced by Public Health England, includng guidance on commissioning and tools identifying the cost effectiveness of various interventions. A concordat signed by a wide range of bodies was also published.
Press release and link to the publications: https://www.gov.uk/government/news/phe-highlights-8-ways-for-local-areas-to-prevent-mental-ill-health
The concordat: https://www.gov.uk/government/publications/prevention-concordat-for-better-mental-health-consensus-statement/prevention-concordat-for-better-mental-health
29 August 2017
Young people who try e-cigarettes are not more likely to take up smoking, according to a study based on five separate surveys undertaken between 2015-17. The research is by a collaboration including PHE and is published in the International Journal of Environmental Research and Public Health. Between a tenth and a fifth of 11-16 year olds had tried e-cigarettes, but only 3% or less used them regularly and they were mostly already tobacco smokers.
24 August 2017
Lessons for health reform from Canterbury, New Zealand, are set out in a report published by the King’s Fund. Work has been going on for the last decade and has led to a shift in the balance of acute to community services.
23 August 2017
Reports of child neglect have risen by 61% in the last five years, from 12,110 instances mentioning it in calls to the NSPCC in 2011-12 to 19,448 in 2016-17.
18 August 2017
The British Retail Consortium says the government must move beyond voluntary agreements to tackle obesity. In response to the recent announcement by PHE suggesting voluntary reduction of calories in foods, the BRC says such approaches only go so far and that mandatory targets may be needed. They say it is always the same 80% of responsible companies that respond and there is a need to engage the whole food sector.
16 August 2017
The amount of time that social care is needed has doubled in the last 20 years, according to research from Newcastle University, published in the Lancet. While life expectancy rose by 4 years between 1991 and 2011, the number of those years with substantial care needs rose by 1.1 for men and 1.6 for women to a total of 2.4 and 3 years respectively. They estimate that by 2025 there will be another 350,000 people with high care needs.
Commentary, challenging whether the extra need has to be met by care homes: https://www.theguardian.com/social-care-network/2017/aug/16/old-age-care-home-beds-shortages-ageing-population
14 August 2017
People are happier if they experience emotions they desire, according to research by an international team of researchers, studying 2,300 university students from the United States, Brazil, China, Germany, Ghana, Israel, Poland and Singapore. They study found that 10% of people wanted to feel negative emotions such as hatred and anger (these were the only negative emotions studied) and had greater life satisfaction if they were able to do so.
12 August 2017
Health inequality is growing, according to figures in the Department of Health’s annual report. Inequalities have widened in all 15 indicators reported in the document including those on life expectancy, healthy life expectancy (there are a number of indicators for each), premature mortality from cardiovascular disease, premature mortality from cancer, emergency admissions to hospital and access to GP services. A separate study (referred to in the King’s Fund blog by David Buck) suggests the Labour government’s previous policies reduced inequalities in the 2000’s.
11 August 2017
£120m is being held back from CCGs to provide a ‘risk reserve’ for the NHS as a whole, NHSE has said, in a letter seen by the HSJ. The £120m would normally have been paid to CCGs to reflect lower prices for generic drugs
10 August 2017
The latest NHS performance figures show more than 4m people were waiting for surgery at the end of June, the highest level since August 2017. There has been an upward trend in the figures since around 2009-10. A number of other targets were also missed, leading Danny Mortimer, deputy chief executive of the NHS Confederation to say that ‘the current system is unsustainable. There has also been an increase in demand in that time.
09 August 2017
75% of councils overspent their children’s social care budgets by a total of £605m in 2015-16, according to analysis by the LGA. There is a particular problem with early intervention with cuts of £500m since 2013 and further cuts to come of £183m by 2020 [is this cuts to general funding or specifically for early intervention?]. They say that children services will face a £2bn funding gap by 2020. The LGA says that 365 children’s centres and 603 youth centres have closed since 2012. The Government says that spending on children’s social care has gone up by £530m since 2010-11.
500 more medical training places for next year have been announced by the Government, in addition to the 1500 promised last October.
04 August 2017
Prof Tim Briggs says the NHS shouldn’t get any money until it puts its own house in order, and makes available efficiency savings. He is leading a review of efficiency in healthcare.
31 July 2017
A recruitment plan for more mental health staff has been published by the government. The aim is to recruit enough staff to treat 1m more patients by 2020-21. There are plans for 2,000 more staff for CAMHS, 2,900 for adult talking therapies and 4,800 for crisis care. Funding is to come from £1bn already promised for mental health, out of the £1.3bn already identified for transforming care. Critics said there was insufficient detail in the plans and more new cash was needed.
26 July 2017
About 20 CCGs have been asked to resubmit their financial plans with more challenging savings targets, according to the HSJ. CCGs have to make efficiency savings of 3.8% in 2017-18, according to an NHSE report. In 2016-17 there were plans for savings of 3.2% but only 2.6% was achieved.
24 July 2017
Happiness is increased more by time than material goods, according to a study by researchers from Canada, the US and the Netherlands which included a survey of 6,000 adults from four countries and an experiment where 60 working adults in Vancouver were asked over one week to spend £30 ($40) on things that would save them time and the next week on material goods. The results were published in the Proceedings of the National Academy of Sciences.
21 July 2017
A dashboard on STP performance has been published by NHS England. This is designed to give a baseline view of STPs’ work, so as to show progress over time. It tracks 17 performance indicators across nine priority areas within three themes of: hospital performance; patient focussed change; and transformation.
Ending funding for homeopathy and other low value treatments is being proposed in consultation published by NHS England.
19 July 2017
£325m of capital funding for the strongest STPs has been announced. Among the larger payments are £100m to Dorset for a reconfiguration of acute services, £80m for Greater Manchester to consolidate emergency surgery and build a new trauma centre, and £105m to West, North and East Cumbria for a new cancer centre and equipment.
18 July 2017
People on jobseeker’s allowance with mental health problems or who are homeless are to be eligible for immediate hardship payments rather than being immediately subject to sanctions, the DWP have said. Sanctioned claimants would otherwise have to wait for two weeks. The changes are to come into effect in October 2017 and should help 10,000 job seekers over the next four years.
A new Tobacco Control Plan has been published by the Government. It has a target of reducing smoking rates from the current 15.5% to 12% by 2022. It also wants to cut the rate of 15 year olds who regularly smoke from 8% to 3% or less, and the number of women smoking in pregnancy from 10.7% to 6% or less.
Life expectancy increases have stalled since austerity started according to Michael Marmot. Although he is not suggesting a link can be proved, he says the plateauxing is not inevitable and notes it coincides with cuts introduced from 2010.
13 July 2017
Ambulance target response times are to be revised with fewer 999 calls classed as life threatening, following a pilot in 3 of the 10 regions in England over the last 18 months. It will result in about 8% of calls requiring the quickest response. Call handlers will be given four minutes, rather than the current one minute, to assess what is required. The average fesponse time for the most serious cases will now be 7 minutes with a maximum of 15 minutes for 90% of patients. Some patients, including those who have suffered a stroke could now have to wait 40 minutes. Average waits for emergencies will be recorded to avoid less effort being put in if a target has already been missed. The changes are to be rolled out by the autumn. [If the aim is to avoid perverse incentives, will changing the targets achieve that? Isn’t there a risk it will just create new ones?]
(14/07/17) Comment: https://www.theguardian.com/healthcare-network/2017/jul/14/ambulance-response-system-overhaul-deliver-improvements
11 July 2017
‘Smarter people live longer’, or, an inverse correlation between childhood IQ tests and premature mortallity has been found which cannot be totally explained by confounders such as smoking. The research was based on IQ test results on all 11 year olds in Scotland in 1936, comprising 33,536 men and 32,229 women, followed up 68 years later. There were particularly strong correlations between lower intelligence and respiratory diseases, heart diseases and strokes. It is suggested this provides evidence to support the ‘system integrity hypothesis’, that people with higher intelligence are innately healthier.
06 July 2017
32% of nursing homes have been judged ‘inadequate’ or ‘requires improvement’ by the CQC, which has now inspected all adult social care services. It said that social care was in a ‘precarious’ state. 37% of nursing homes failed on safety. Of all 24,000 adult social care services in England, 21% have been judged ‘inadequate’ or ‘requires improvement’.
05 July 2017
The number of individual funding requests increased by 47% in three years, from 50,188 in 2013-14 to 73,927 in 2016-17 according to an investigation by the BMJ based on foi requests to the 207 CCGs, of which 192 responded. It is argued that this is because treatments that were previously routinely available are now being restricted, leading to calls of increased rationing. Requests for hip and knee surgery rose from 49 in 2013-14 to 899 last year while the number of requests for cataract surgery trebled to over 1,000 in the same period.
The latest legal challenge to the government’s air pollution plans has failed in the High Court. The case, brought by environmental lawyers ClientEarth failed on the basis that these were draft proposals and therefore subject to change. Ministers were instructed to publish their full proposals by the end of July.
04 July 2017
Millions of children in England are living vulnerable or high risk lives according to a report from the Children’s Commissioner for England. It finds half a million children ‘so vulnerable that the state has to step in’, 670,000 growing up in high risk family situations and 800,000 suffering from mental health difficulties.
03 July 2017
Measures to reduce delayed discharges from hospitals have been announced by Jeremy Hunt. They include councils setting their own targets for reducing social care related delayed transfers and a new performance dashboard. The CQC will also undertake targeted reviews to see how effectively health and care systems are working together.The NHS mandate for 2017-18 requires that DTOCs should account for no more than 3.5% of beds by September 2018. The figure at the end of 2017-18 was 5.6%.
(£) LGA withdraws support on BCF guidance: https://www.lgcplus.com/7019334.article
The dashboard: https://www.gov.uk/government/publications/local-area-performance-metrics-and-ambitions
More nurses and midwives left the profession than joined it in 2016-7, for the first time since 2008, according to registrations to the Nursing and Midwifery Council. The number on the register fell by 1,783 in 2016-17 with further drops since then. The majority of those leaving are UK nurses. The number leaving the register was 34,941 compared to 23,087 in 2012-13. There was also an increase in the number of EU nurses leaving the register.