2018 Q1 January-March 2018
Health and Wellbeing Policy Update: January-March 2018
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.
31 March 2018
Advanced paramedics are to be able to prescribe medicines under new laws coming into force on 1st April 2018. The change will apply to 700 advanced paramedics across the UK. The change comes from an amendment to the Human Medicines Regulations 2012. It is hoped that the change will reduce the number of people having to see their GP or go to hospital.
The statutory instrument amending the regulations: http://www.legislation.gov.uk/uksi/2018/199/made
29 March 2018
A policy to end housing benefit for 18-21 year olds has been reversed by the Government, because of concern it could increase homelessness amongst young people. The change means that this age group will now qualify for the housing element of universal credit. The policy to restrict the benefit was in the 2015 Conservative election manifesto and was introduced by Theresa May a year ago.
The prescription of many over-the-counter medicines is restricted from the beginning of April, following earlier consultations, NHS England has announced. The prescriptions include those for constipation, athlete’s foot, diarrhoea and earwax. The 35 treatments account for £570m of spending a year. The restrictions will apply where the problem is minor and short term. Individual doctors will still be able to use their clinical judgement to decide whether to prescribe or not.
28 March 2018
The Prime Minister has promised a multi-year funding plan for the NHS, speaking to the Commons Liaison Committee. The details of what this would involve are yet to be revealed. Jeremy Hunt has also promised £760m of capital funding, part of the £2.9bn already planned for 2017-23.
(27/03/18) (£) https://www.hsj.co.uk/finance-and-efficiency/government-promises-long-term-nhs-plan-this-year/7022050.article
A shared view of quality for general practice has been agreed by the 11 national organisations responsible for the regulation and oversight of general practice in England. The statement draws together elements from the frameworks of bodies such as the Royal College of GPs, the CQC, NICE, the General Medical Council and the General Pharmaceutical Council, which are summarised into an overarching set of principles. The aim is “to reduce the workload and duplication for health care providers in providing evidence of outcomes for quality assurance” which was a key aim in the General Practice Forward View. The 11 bodies operate through the Regulation of General Practice Programme Board.
Press release: http://www.cqc.org.uk/news/stories/national-bodies-agree-shared-view-quality-general-practice
27 March 2018
The NHS is in a perilous state financially, the Public Accounts Committee has said. The NHS is scraping by on emergency handouts and using funds intended for investment to prop up the system rather than plan ahead, the PAC chair, Meg Hillier said. Last minute funding for last year’s winter crisis, despite the predictability of the problems, was an example of the Government’s short term approach. The report says that “The NHS is still very much in survival mode, with budgets unable to keep pace with demand.” The Committee also said they had not heard from witnesses how integrated care systems will work in practice or how they will improve patient care.
The teenage pregnancy rate is at the lowest level since records began in 1969. There were 19 conceptions per 1,000 women aged 15-17 in 2016, compared to 47 in 1969. Possible reasons include programmes to reduce teenage pregnancies by success governments, better sex and relationship education, improved access to contraceptives and a change in aspirations of young women.
NHSE and NHSI are to work more closely together, they have announced, with plans for 7 integrated regional teams, subject to board approval. The degree to which functions are aligned or combined is yet to be finalised and will depend on legal requirements.
Press release: https://improvement.nhs.uk/news-alerts/nhs-england-and-nhs-improvement-working-closer-together/
(03/04/18) (£) Interview with Baroness Dido Harding, Chair of NHSI, about the ‘joint venture’: https://www.hsj.co.uk/policy-and-regulation/harding-joint-venture-with-nhs-england-may-not-lead-to-redundancies/7022082.article
The Troubled Families Programme has eased pressure on children’s social care, according to the government’s annual evaluation of the programme. In 2017-18, 92,000 families (33%) were said to have made significant progress, compared to 44,000 (24%) in the year before.
26 March 2018
Statistics on children’s wellbeing and social relationships have been published by ONS.
25 March 2018
3,000 more midwife training places are to be made available over the next four years, an increase of 25%, the Department for Health and Social Care has indicated. There are to be 650 more places next year and 1,000 in each of the subsequent three years. However, making places available does not mean they will necessarily be filled and there will also need to be enough funding to allow them to be employed once qualified. Over the last five years, there were 7,700 new midwives but 8,900 left the profession. There was an increase in numbers over that period, by 1,500 to 22,500 due to recruitment from overseas.
24 March 2018
Four in ten online GP firms are not safe, according to CQC inspections. Of 35 companies identified in the last 18 months, 5 stopped trading and 13 were in breach of safety standards. This is nevertheless an improvement on a year ago, when 86% were not meeting required standards.
TB rates in England have fallen by a third (38%) in six years and are at their lowest level in 35 years according to PHE data released to coincide with World TB day. However, England still has one of the highest rates in Western Europe, with just under 5,200 people affected in 2017.
A requirement for every inpatient to be assessed twice a day by a senior doctor cannot be met within current resources, according to hospitals and NHS Providers. The request came in a letter from NHS England and NHS Improvement to hospital chief executives and medical directors, with a view to cutting the number of beds used unnecessarily.
22 March 2018
Guidance on physical activity and the environment has been published by NICE. Amongst other things, it calls on councils to encourage people to be more physically active by improving facilities and routes for pedestrians, cyclists and others.
Press release: https://www.nice.org.uk/news/article/local-councils-should-improve-the-quality-of-footpaths-so-more-people-can-be-active-says-nice
The guidance: https://www.nice.org.uk/guidance/ng90/chapter/Recommendationsstrategies-policies-and-plans-to-increase-physical-activity-in-the-local-environment
21 March 2018
The NHS mandate continues to put key performance targets on hold, with no specific objective for the 18 week referral to treatment target or that for waiting 4 hours in emergency departments. The mandate for 2019-20 says that on the 4 hour target, ‘aggregate A&E performance’ should be above 90% in September 2018 with the majority of trusts hitting 95% by March 2019 and aggregate performance at 95% in the course of 2019. Indicative figures show NHSE’s administration budget is to be cut by a quarter in 2019-20.
(23/03/18) Reaction from patients’ groups: https://www.theguardian.com/society/2018/mar/23/patient-groups-criticise-hunt-ditching-nhs-waiting-time-targets
Mental health screening for everyone with a long term physical health condition or medically unexplained symptoms is to be introduced in 2018-19, NHS England has said in new pathway guidance. It is estimated that two thirds of people with a long term health problem will also have mental health difficulties. The guidance suggests that IAPT services should be co-located in physical healthcare settings. In pilot areas it is estimated that integrating IAPT and long term condition pathways reduced the cost per patient from £5,670 to £3,910 a year.
19 March 2018
A short guide to the social determinants of health has been published by the Health Foundation. Its title is “What Makes Us Healthy?”
Linkk to the publication: https://www.health.org.uk/publication/what-makes-us-healthy
18 March 2018
NHS whistleblowers will be protected when applying for other jobs under draft regulations published by the government. Discriminating against whistleblowers applying for jobs will be unlawful.
15 March 2018
The number of babies dying within a year of birth has risen for the second year in a row, from 3.7 to 3.8 deaths per 1,000 live births between 2015 and 2016. Another report by the Nuffield Trust and Royal College of Paediatrics and Child Health found that Britain had the fourth highest child mortality among 15 OECD countries.
An international comparison of health outcomes for babies and young children has been published by the Nuffield Trust. The report looks at a range of indicators across 14 comparable countries. It finds the UK doing well in many areas but poorly in obesity and breastfeeding, with progress on a number of other indicators stalled.
13 March 2018
Over 27% of patients have multiple, long-term health problems, according to an analysis of the records of a random sample of 400,000 people registered with a GP in England, published in the British Journal of General Practice. That represents 14 million people with multimorbidity. They account for 53% of GP consultations, 79% of prescriptions and 56% of hospital admissions.
07 March 2018
Lonely older people do not use GP services more, despite frequent claims to the contrary, according to a meta-analysis of 126 studies covering 226,678 people in 19 countries. There was evidence of increased rates of re-admission to hospital but not of increased use of ambulatory care services.
06 March 2018
PHE is calling on food sellers and manufacturers to reduce the calories in their products by 20% by 2024, or face being named and shamed. It is asking for action on 13 food categories, that could include reformulating products, promoting healthy options or reducing portion sizes. PHE is to produce guidance for specific categories of products for the food industry to follow, by 2019. They will advise the government if progress isn’t made, which might lead to ‘other levers’ being used. PHE is also extending it’s ‘One You’ campaign which urges individuals to make healthy lifestyle choices, with guidance to consume no more than 400 calories for breakfast and 600 each for lunch and dinner.
Press release: https://www.gov.uk/government/news/plans-to-cut-excess-calorie-consumption-unveiled
The report: https://www.gov.uk/government/publications/calorie-reduction-the-scope-and-ambition-for-action
27 February 2018
A fifth of antibiotics prescribed by GPs are unnecessary, according to research published by Public Health England. A panel of experts said that 6.3m of the 32.5m antibiotics prescribed every year, or 20%, are unnecessary. The results are published in a series of five articles in the Journal of Antimicrobial Chemotherapy.
26 February 2018
Alcoholic drinks in Scotland are to cost at least 50p a unit from May, the Scottish health secretary, Shona Robison, has confirmed.
21 February 2018
Anti-depressants do work, according to a meta-analysis based on 522 trials involving 116,477 people and published in the Lancet. The study also showed differences in how effective each drug is on average, varying from a third more to twice as effective as a placebo.
Mental health trusts’ income was lower in real terms in 2016-17 than in 2011-12, according to analysis by the Royal College of Psychiatrists. However NHS England said this neglected the fact that many trusts provide other services and the responsibility for funding some mental health services has transferred from health to local government. The RCPsych says that 34 out of 55 mental health trusts (62%) reported lower income in 2016-17 than 2011-12.
15 February 2018
1,200 learning disabled people could be dying prematurely because of a lack of training for professionals according to Mencap. A survey by Mencap of 506 heatlhcare professionals found that 23% had never received any training on meeting the needs of patients with a learning disability.
The life expectancy gap between the richest and poorest neighbourhoods has widened since 2001, according to an analysis of ONS figures by the Longevity Science Panel, which was set up by the insurance provider Legal and General. The gap for boys born in the most and least affluent areas is 8.4 years, up from 7.2 in 2001. The gap for girls born in the top and bottom fifth wealthiest areas has increased from 5 to 5.8 years. Death rates for all 60-89 year olds has increased but with most gains for the better off. That means that those in that age group in the poorest fifth of areas are 80% more likely to die in any given year than those in the most well off fifth. In 2001 the figures were 52% for men and 41% for women.
14 February 2018
17% of post-surgery infections were resistant to antibiotics in wealthy countries, with 36% resistant in poorer countries, according to research from Edinburgh, Warwick and Birmingham Universities, tracking over 13,000 patients in 66 countries. It was published in the Lancet Infectious Diseases. It tracked patients who had had common gastrointestinal conditions
09 February 2018
Hip fracture patients have a 15 day wait for rehabilitation on average when they return home from hospital, according to a survey of 6,000 people by the Chartered Society of Physiotherapy. Early physiotherapy is recommended to avoid becoming sedentary, losing independence and developing other conditions. Only one in five start physiotherapy within a week and some have to wait as long as 80 days.
07 February 2018
Dementia patients’ quality of life can be improved by just one hour’s social interaction a week, a randomised controlled cluster trial involving 553 people (out of 847 initially randomised) in 69 UK nursing homes has found [N.B. Mental Elf blog says 16 nursing homes]. The research was led by the University of Exeter (lead author Clive Ballard), King’s College London and Oxford Health NHS Foundation Trust. It was funded by the NIHR and published in PLoS Medicine. The intervention involved training all staff in patient-centred care with ongoing delivery by care staff champions. There were small but statistically significant improvements in assessments for quality of life, agitation and neuropsychiatric symptoms. The intervention reduced costs compared with usual care.
A report describing how best to help people change their lives has been published by Nesta and social impact lab OSCA. Using a range of examples it suggests that ‘good help’ is about helping people find a sense of purpose, develop their confidence and create a positive cycle of action. It identifies seven characteristics of ‘good help’: power sharing; enabling conversations; tailoring; scaffolding; role modelling and peer support; opportunity making; and transparency. It is suggested that, although more cost effective, such approaches are often not used in public services because of the constraints of time and money.
People with positive age beliefs were less likely to develop dementia in a study of 4,765 people over 60 (average age 72) followed over four years, published in the journal PLoS One. Overall, those with positive beliefs about ageing at baseline had a 2.60% risk of developing dementia compared with a 4.61% risk for those with negative beliefs. For those with a gene predisposing them to dementia (APOE ε4) the respective figures were 2.7% and 6.14%.
05 February 2018
The annual charge for visitors to use the health service is to double from £200 to £400 a year. The charge applies to those from outside the European Economic Area who are staying for six months or more. The charge for students is to rise from £150 to £300. Ministers said the change should raise £220m a year.
29 January 2018
All 1.6m PIP claimants are to have their claims reviewed, the Government has said, following a court ruling that said that the rules blatantly discriminated against people with mental illness and were a breach of their human rights. It is expected that around 220,000 people will receive more money with a total cost of possibly £3.7bn by 2023.
25 January 2018
Giving alcohol to teenagers may create more problems later according to research from the University of New South Wales published in The Lancet Public Health, based on information on 1,900 parents and secondary school children over six years from the age of 12. Earlier access to alcohol led to more binge drinking and alcohol related harms.
23 January 2018
Self-harm by nursery and primary school pupils has increased, with a 27% increase in the five years to 2017 in hospital admissions for children aged 3-9, and a 13% increase just between 2016-17, according to figures from NHS Digital obtained by the Guardian.
Progress since the Francis report is being put at risk by financial and regulatory pressures, according to research by the Alliance Manchester Business School, Birmingham University and the Nuffield Trust based on a survey of 381 board level directors, funded by the NIHR. Asked about important challenges, patients safety rated higher than finances which was higher than patient experience. On significant barriers to improving board leadership, 73% said financial pressures, 68% meeting the demands of the regulators and 41% said poor relationships in their local health economy.
There was underspending on NHS Technology of £256m in 2016-17, according to figures obtained by the HSJ using freedom of information requests. These was nearly a third of that allocated for technology improvements, with a £4.2bn fund having been announced by Jeremy Hunt in February 2016. The unspent money will now be available “to offset pressures in other parts of the system”.
The first ACOs are to be delayed, with a consultation before legislation allowing their creation, Jeremy Hunt has said. This is in response to concerns by the Health Select Committee and a pending judical review. NHS England is to hold a consultation on the proposed contract for accountable care organisations in the coming months.
18 January 2018
An association between playing sports and reduced mental illness following childhood trauma has been found in a study by Public Health Wales and Bangor University based on face to face interviews with 2,005 18-69 year olds. It found that among those with four or more ‘adverse childhood experiences’ the adjusted proportion of those with current mental illness fell from 25% of those who did not participate in sports to 19% who did. The study could not demonstrate causation: it is possible that those with greater resilience were more likely to play sports.
(19/01/18) PHW news release: http://www.wales.nhs.uk/sitesplus/888/news/47341
16 January 2018
A minister to tackle loneliness issues has been appointed, as recommended by the Jo Cox Commission. Prime Minister Theresa May has appointed Tracey Crouch, minister for sport and civil society, to the role. The Government also said it would develop a wider strategy on the issue, also as recommended by the Commission. The ONS is to devise a method of measuring loneliness.
12 January 2018
A third of NHS 111 queries could be handled by algorithms online by 2020, according to a leaked report obtained by the HSJ. The estimate was based on experience in Australia. Pilots were conducted in 4 UK areas in 2017, with systems from Babylon Health, Sensely, NHS Digital’s NHS Pathways and Expert 24. Only 6% of those in the pilot areas switched to the online tool, and they were predominantly younger people. The evaluation of the pilots concluded that all four were safe, provided a cheaper and faster service than a phone call and did not seem to lead to an increase in demand.
08 January 2018
Income levels above which happiness does not increase have been identified for different countries in research published in Nature. The research uses data from the Gallup World Poll on life-satisfaction which surveyed over 1 million people. The ‘satiation level’ varies by country and region, with Australia and New Zealand having the highest levels and Latin America the lowest. The research takes account of household size. However, the income levels were self-reported.
02 January 2018
Teenagers who tried e-cigarettes were 2.5 times more likely to start smoking cigarettes in the following year, according to research from the University of California based on a natioanl survey of 10,384 teenagers who reported never having smoked a conventional cigarette. They were interviewed in 2013 or 2014 and then again the following year. The research was published in JAMA Pediatrics.