2017 Q4 October-December 2017
Health and Wellbeing Policy Update: September-December 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.
20 December 2017
Ending prescriptions for over-the-counter medicines is proposed in a consultation by NHS England. This would include items such as eye drops, indigestion tablets, cough mixtures, cold sore cream, and treatment for haemhorroids and minor pain. The consultation runs until 14th March 2018.
Press release: https://www.england.nhs.uk/2017/12/nhs-england-consults-on-freeing-up-136-million-to-boost-frontline-nhs-care-by-curbing-prescription-costs/
The consultation: https://www.engage.england.nhs.uk/consultation/over-the-counter-items-not-routinely-prescribed/
19 December 2017
Council tax rises of up to 5.99% are to be allowed next year, made up of 2.99% for general services and 3% for social care, before a referendum has to be held. Ten areas are to pilot 100% retention of business rates.
Transcript of oral statement to the House: https://www.gov.uk/government/speeches/provisional-local-government-finance-settlement-2018-to-2019-statement
14 December 2017
More US teenagers have tried vaping than have smoked, leading to fears that it is not just being used to replace cigarettes but as a new drug delivery vehicle. 36% of students in their final year of high school had tried vaping compared to 27% who had tried smoking according to the nationally representative survey of about 50,000 students in the annual Monitoring the Future survey.
An association between healthy eating and happiness was found in an observational study of 7,675 children aged 2-9 from eight European countries, by the University of Gothenburg, published in BMC Public Health. The association held independently of the child’s socioeconomic position or their body weight. No cause and effect could be demonstrated by the study.
Press release: https://sahlgrenska.gu.se/english/research/news-events/news-article/healthy-eating-linked-to-kids–happiness.cid1535571
The Jo Cox Commission on Loneliness has reported, with a series of recommendations. They include a government strategy to tackle loneliness; a nominated lead minister; new policy to be assessed against a family and relationships test; improved measurement and evidence; a new innovation fund to catalyse action; and action by leaders and the community more widely.
(Page with link to the report): https://www.jocoxloneliness.org/
(The report – pdf): https://www.jocoxloneliness.org/pdf/a_call_to_action.pdf
13 December 2017
The first NHS staffing strategy in 25 years has been produced by Health Education England. It says there is a shortage of 42,000 nurses, midwives and therapists. The number of GPs has fallen by 1% in the last five years, despite the promise to increase numbers by 5,000 by 2020. Although there are 40,000 more clinical staff than in 2012, the increase hasn’t kept pace with rising demand. It says that staff are leaving because of pressure of work, lack of flexible working, inadequate pay and lack of career development.
(14/12/17) (Not directly linked to the strategy, but an example of a doctor quitting because of the pressure and inflexible conditions) https://www.theguardian.com/healthcare-network/2017/dec/14/faced-burnout-doctor-struggling-nhs-quit
08 December 2017
Stephen Hawking has joined legal action against Accountable Care Organisations. Hawking joins four others seeking a judicial review to stop ACOs being brought in without public consultation and parliamentary scrutiny.
(15/12/17) Comment and analysis: https://www.theguardian.com/healthcare-network/2017/dec/15/under-radar-nhs-reforms-fuelling-public-anxiety
07 December 2017
Labour demand a debate and vote on Accountable Care Organisations, which they fear will open the way for more privatisation of the health service. They say that ACOs are being introduced without proper parliamentary scrutiny. The Department of Health is to amend 10 sets of regulations to pave the way legally for the eight new ACOs due to start in April 2018.
The £72,000 cap on social care costs is not to be implemented, the Government has confirmed. The cap was recommended by the 2011 Dilnot Commission, agreed by the government and included in an Act of Parliament but the implementation was then delayed until 2020. Now, health minister Jackie Doyle-Price has said the government will not be taking forward the previous government’s plans to implement the cap on care costs.
06 December 2017
A project to double the number of volunteers in hospitals by 2021 is being piloted by a non-profit community interest company, Helpforce, involving 12 trusts, including 5 in the pilot. It is being led by philanthropist Sir Tom Hughes-Hallett.
05 December 2017
Type 2 diabetes went into remission in 46% of people who lost weight after following a low calorie liquid diet, according to research from Newcastle and Glasgow universities published in the Lancet. The trial involved 298 people who had a low calorie diet (825-853 kcal per day) for 3-5 months followed by gradual food reintroduction and structured support for long-term weight loss maintenance. After a year, 24% of those following the diet had lost at least 15kg (none in the control group had). Of those who lost at least 15kg, 86% put their diabetes into remission. Only 4% of the control group went into remission.
03 December 2017
Access to CAMHS within 4 weeks has been promised, in a Green paper, along with a teacher in every school to co-ordinate support for children and young people with mental health issues. The improvements are to start from 2019, with £300m of what is said to be new money. About £215 is for the creation of mental health support teams in schools, to be piloted first, with the aim of having them in a fifth of the country by 2022-23. Lib Dem MP Norman Lamb noted that there were already plans, including better linking of schools and mental health services, in the Future in Mind report from 2015, but that had not been implemented. Labour say the initiative is inadequate.
30 November 2017
The current care home regime is unsustainable, with a £1bn a year funding gap as a result of councils not paying enough for places, which has to be met by people paying for their own care, according to a report from the Competition and Markets Authority. The CMA is taking action against homes charging large up-front fees and charging for periods after someone’s death. Other problems identified included an inadequate complaints system and families and friends being unfairly banned from visiting. The CMA is also calling for an independent body to be in charge of care home planning in England and Northern Ireland.
Homeopathic and herbal remedies are no longer to be provided on the NHS, NHSE has said. However, the thyroid drug, liothyronine is to remain available. There is to be a further consultation on whether over-the-counter medicines such as suncream, cough and cold remedies and indigestion tablets should be available on prescription.
The NHS will not be able to meet its constitutional waiting time targets with the money that has been allocated to it, the NHS Board has said. However, Health Secretary Jeremy Hunt said it has to stick to the targets. In his budget last week, Philip Hammond made it clear than an extra £1.6bn of funding was to be used to improve waiting times.
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28 November 2017
Unexplained harm to, or deaths of, new born babies are to be reviewed by the new Healthcare Safety Investigations Branch, Jeremy Hunt has said. About 80% of stillbirths and baby deaths during childbirth could be prevented by better staffing and care according to a report by MBBRACE-UK, a coalition of experts.
23 November 2017
GP e-consultation systems could improve access for some patients but are not an immediate solution for efficiency savings according to research from Bristol University based on 36 GP practices in Bristol, North Somerset and South Gloucestershire and published in BMJ Open and BJGP. Use of the system was low, with only 2 e-consultations a month per 1,000 patients on average. The contact via the website led to a face to face consultation in 38% of cases and a phone call from a GP in a further 32% of cases. A face to face consultation was more likely for a new than for a pre-existing condition.
Press release: http://bristol.ac.uk/news/2017/november/gp-online-consultations.html
22 November 2017
An extra £2.8b for the NHS was promised in the November 2017 budget. This was made up of £335m to help cope with winter pressures during the current year and £2.5bn spread over the following two years. It was described as being ‘exceptionally’ provided, suggesting these are to be one-off payments rather than being added to the recurrent budget. There will be an additional £1.6bn for 2018-19 and £900m for 2019-20. £3.5bn is to be provided for capital spending. More money is also to be set aside for a pay rise for NHS staff but conditional on unions agreeing reforms. The increases were generally welcome but regarded as insufficient to meet the NHS’s problems. NHSE Chairman Sir Malcolm Grant said the country could “no longer avoid the difficult debate” about what the health service could deliver for patients. Labour says real per person funding will fall between 2018-19 and 2019-20, contravening a Conservative manifesto promise.
21 November 2017
The number of GPs has fallen by 1,193 in the last year, according to figures from NHS Digital, despite the Government’s promise to have 5,000 more GPs by 2020.
17 November 2017
Poorer people have suffered more than richer families from governments’ tax, benefit and public spending changes since 2010, according to a report from the Equality and Human Rights Commission, which modelled the effect of the changes. While the poorest tenth of households will lose 10% of their income by 2022, the richest tenth will lose 1%. Other big losers are disabled people, single parents, women and ethnic minority households. There is a consistent negative gradient, with those having more disabilities losing out more. According to the EHRC, the Government has refused to carry out a cumulative impact assessment of all its policies, preferring instead to assess the impact of individual policies.
16 November 2017
120,000 excess deaths between 2010-17 have been linked to cuts in health and social care budgets, by researchers from Oxford and Cambridge universities and University College London. The computer modelling compares deaths in 2000-2010 to 2010-17. It cannot prove a link with cuts: other reasons for the change could include the ageing population, unhealthy lifestyles and deprivation. One of the study authors is quoted as describing this as ‘economic murder’.
BMJ blog: http://blogs.bmj.com/bmjopen/2017/11/15/health-and-social-care-spending-cuts-linked-to-120000-excess-deaths-in-england/
The article (not open access): http://www.bmj.com/content/359/bmj.j5332
15 November 2017
Scotland’s minimum alcohol pricing legislation can go ahead, the UK Supreme Court has ruled. The relevant legislation was passed by the Scottish Parliament five years ago but had been challenged in court by the Scotch Whisky Association. A minimum price of 50p per unit had been proposed. The change is not a new tax or duty, but a minimum price retailers must charge (so they take any extra income). The Act needs to be renewed after six years or else it will automatically lapse.
Reaction including campaigners urge similar action in England: https://www.theguardian.com/society/2017/nov/15/campaigners-urge-minimum-alcohol-price-in-england-after-scottish-ruling
13 November 2017
Trusts are to be assessed on inappropriate mental health placements out of area, as out of area placements is added to the single oversight framework. This means trusts could face regulatory action for not reducing the amount of time spent in mental health inpatient facilities long distances from home.
07 November 2017
Wellbeing rose in the year following the EU referendum, according to the latest ONS statistics. There were increases in life satisfaction, happiness and the extent to which people felt the things they do in their life were worthwhile, for the year to June 2017 compared to the year to June 2016. The increases were in England rather than the other UK nations (although the UK average went up as a result). The results were based on interviews with 100,000 adult UK residents.
06 November 2017
Funding for supported housing is likely to be less secure and could be cut, contrary to the impression given by the recent Government u-turn on payment of housing benefit in such cases. While the cap is no longer to be applied on housing benefit for those in supported housing requiring it for over two years (e.g. for some older people and disabled people), for those requiring it for shorter periods (such as homeless people and victims of domestic violence) payments are to be replaced by block grants to local authorities. While housing benefit is a statutory entitlement, if the new grants are discretionary it will make longer term planning by providers difficult. Also, on the basis of previous experience, a requirement on local authorities to secure value for money could mean grants reduced in future.
Comment piece: https://www.theguardian.com/housing-network/2017/nov/06/supported-housing-desperate-danger-u-turn
30 October 2017
NHS England’s workforce planning is not fit for purpose, according to a report by the Health Foundation. Although the NHS workforce overall rose by 2% in the year to April, there was a fall in the number of nurses and GPs. The report questions the ability of the government to meet its target of an additional 5,000 GPs and 21,000 new mental health posts by 2020.
Climate change is already affecting health globally, particularly through heatwaves, pollution and disease, according to a Lancet report. It says that climate change is the biggest threat to global health in the 21st century. There has been an increase in the number of older people exposed to extreme heat. Air pollution kills about 40,000 people a year in the UK.
27 October 2017
Children’s mental health services vary widely in quality, with children in some areas having to wait as long as 16 months for services, according to a CQC report which reviewed 100 inspections. It found that 39% of the services were rated as ‘Requiring improvement’ and 2% ‘Inadequate’. NHS England said progress was now being made with a 15% increase in spending in child mental health services.
Press release: http://www.cqc.org.uk/news/releases/cqc-completes-initial-review-mental-health-services-children-young-people
The report: http://www.cqc.org.uk/publications/themed-work/review-children-young-peoples-mental-health-services-phase-one-report
Although adult social care spending rose last year for the first time since 2010, higher costs meant it did not increase service activity, according to data from NHS Digital. The total spent by local authorities plus client contributions rose by £556m to £17.5bn in 2016-17, largely due to the specific adult social care precept, but the report found there had been minimal change in activity possibly because of increased costs.
26 October 2017
Poor mental health at work costs the economy £99bn a year, with a £42bn cost to employers, according to a Government commissioned report, Thriving at Work written by Paul Farmer and Dennis Stevenson. It says that up to 300,000 people with long term mental health conditions have to leave their jobs each year. The report makes 40 recommendations for employers and the government and they are asking employers to commit to six core standards: create a mental health at work plan; build awareness; encourage open conversations; provide good working conditions; promote effective people management; and routinely monitor employee mental health. The Prime Minister said the report’s recommendations would be implemented in the civil service and the NHS, which together employ 2 million people.
Press release: https://www.gov.uk/government/news/millions-to-benefit-from-groundbreaking-mental-health-support
The report: https://www.gov.uk/government/publications/thriving-at-work-a-review-of-mental-health-and-employers
25 October 2017
The Government has reversed plans to cap housing benefit for social housing and supported accommodation, the Prime Minister has announced. The proposals had been blamed for reducing the number of homes being built for vulnerable people such as war veterans, disabled people and domestic violence victims.
CCG caps on continuing healthcare could breach the human rights of disabled people, the Equalities and Human Rights Commission has warned. The Independent reports that the EHRC has written to 44 CCGs asking them to explain the caps they have imposed, giving them 21 days to respond. It is suggested that the funding caps may fail to take into account a person’s specific circumstances and so may put them in breach of the European Convention of Human Rights and the UN Convention on the Rights of Persons with Disabilities.
23 October 2017
Hospitals must charge those not eligible for free treatment up front from today in a bid to stop so-called ‘health tourism’. The changes apply to planned, non-urgent care but not to A&E, maternity, general practice or infectious diseases. According to the results of freedom of information requests reported in the Mail, a number of trusts do not have enough overseas visitor managers to implement the new requirements.
19 October 2017
50,000 deaths are linked to pollution in the UK, according to research reported in the Lancet on the impact of pollution worldwide. That represents 8% of UK deaths. Worldwide, pollution was linked to 9 million deaths in 2015, most of those in low or middle income countries. The UK was 55th out of the 188 countries measured, behind the U.S. and many European countries.
18 October 2017
Self-harm rose by 68% in three years amongst 13-16 year old girls, according to research published in the BMJ based on data from 679 GP practices across the UK relating to 10-19 year olds. This rise was not matched in boys or girls of other ages. Self-harm was more common in deprived areas where the youngsters were also less likely to be referred to mental health services within 12 months of their first incident. The youngsters who self-harmed were 17 times more likely to die from suicide and 9 times more likely to die an unnatural death.
10 October 2017
The UK is the most obese country in Western Europe, according to the OECD’s annual ‘Health at a Glance’ report. It has the sixth highest obesity rate of OECD countries, below the US, Mexico, New Zealand, Hungary and Australia. All OECD countries have seen life expectancy at birth increase by at least 10 years since 1970. Health spending per capita has grown at 1.4% annually since 2009 compared to 3.6% in the six years before then. While there has been success in a number of areas, such as smoking, there has been little progress in tackling obesity, alcohol consumption and air pollution.