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2018 Q2 April-June 2018

Health and Wellbeing Policy Update: April-June 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.

29 June 2018

Seeing the same doctor over time reduces death rates, according to a meta-analysis of 22 studies in 9 countries, published in BMJ Open.  The results related to specialist doctors as well as GPs and over different cultures and health systems.

Poorer areas have more fast food outlets, according to data from PHE.  The poorest tenth of England has 17% of fast food outlets while the richest decile has 3%.  The data was obtained from the Food Standards Agency which inspects all food premises.


25 June 2018

More public sector contracts will have to take account of social value, as the government proposes to extend the application of the Social Value Act, also making it easier for small businesses, charities, co-operatives and social enterprises to bid for government contracts.

NHS performance is mixed compared to other countries, with much more equal access to healthcare but a poorer record in preventing common causes of death according to a report by the Nuffield Trust, Health Foundation, King’s Fund and the Institute for Fiscal Studies.  It found that the UK has fewer doctors, nurses, hospital beds and CT and MRI scanners than 18 comparable countries.


24 June 2018

The government’s childhood obesity strategy has been updated, with a target of halving childhood obesity by 2030.  Specific proposals include banning sweets at supermarket checkouts, restricting junk food advertising on tv and online,  mandatory calorie labelling on restaurant menus and banning the sale of high caffeine energy drinks to children.  It encourages schools to institute the ‘daily mile’ or equivalent.  The Chief Executive of Channel 4 told MPs that banning tv advertising could backfire as advertisers would move to digital platforms where they could target children more effectively.
(25/06/18) Comment:
News release:
(25/06/18) The proposals:


18 June 2018

People with severe degenerative conditions will not need to be tested so often to prove eligibility for disability benefits, the government has said.  There is likely to be a light touch assessment every ten years for people with conditions such as Parkinsons and multiple sclerosis, rather than as often as every two years.


17 June 2018

NHS England’s budget is to increase by 3.4% a year on average for the next five years, rising by £20bn from £114bn to £135bn by 2023 after allowing for inflation, Theresa May has announced.  She said funding will come from various sources including a Brexit dividend, though that has been widely disputed.  This is lower than the amount being sought, to maintain services and pay for improvement and modernisation, and is less than the average 3.7% increase per year over the 70 year life of the NHS.  It applies only to direct spending by NHS England rather than other DHSC support such as for education, or spending on public health and social care in local authorities.  The head of the NAO, Sir Amyas Morse, said more money was needed.
(25/06/18) Commentary and analysis:


14 June 2018

Immigration rules restricting the number of doctors from outside the EU allowed entry have been relaxed, the Government has announced.  They are now to be excluded from the government’s cap on skilled migration.


13 June 2018

A ‘Care Crisis Review’ has been published, looking at the rise in numbers of children being taken into care, which is now at the highest level since 1985.  The review was funded by the Nuffield Foundation and the Family Rights Group charity.


11 June 2018

Medical examiners will examine patient deaths in the NHS as part of measures to allow doctors to admit to and learn from mistakes, Health Secretary Jeremy Hunt has announced.  The change is one of a number of recommendations made in a review chaired by Professor Sir Norman Willams following the case of Hadiza Bawa-Garba who was struck off for gross negligence manslaughter.  The medical examiners are to look at all deaths which are not referred to a coroner to consider whether they were ‘unnatural’ or required further investigation.


07 June 2018

Over 1.5m people, including 350,000 children, experienced destitution last year, meaning they went without adequate food, clothing, toiletries or shelter, according to research from Heriot-Watt University for the Joseph Rowntree Foundation.  A range of factors was blamed, including benefit cuts, delays and sanctions, harsh debt-recovery and high housing costs.  Overall levels of destitution are lower than the last equivalent study in 2016.


06 June 2018

Work stress increased early death for men with diabetes, heart disease or had previously suffered a stroke with a 68% greater risk of premature mortality, in a study tracking 100,000 people from Finland, France, Sweden and the UK.  The same effect was not seen for women.  Stress was defined as having high demands but little control or an effort-reward imbalance.  The results are published in The Lancet Diabetes and Endocrinology.


01 June 2018

The number of patients readmitted to hospital within 30 days rose by 19% in six years, from 1.16m in 2010-11 to 1.38m in 2016-17, according to analysis by the Nuffield Trust and the Health Foundation.  There is some concern that patients are being discharged too early because of a lack of beds and that conditions are being missed because staff are over-stretched.  About 1% of readmissions were judged to be preventable, affecting 185,000 people.  Emergency admissions amount to 8% of hospital stayes, up from 7.5% seven years ago.


31 May 2018

39% of GPs say they are likely to leave direct patient care by 2022 according to a survey of 2,195 of them undertaken in late 2017, as part of the government funded GP worklife survey.

NHS trusts’ financial deficit was twice the planned level in the last financial year, at £960m, NHS Improvement has reported.  This was largely due to overspending in acute hospitals because of excess demand, while ambulance, mental health and other trusts had collectively underspent.  The underlying deficit is bigger, if one-off and emergency funding is taken into account.


28 May 2018

A million smokers in France quit within a year, with the rate of 18-75 year olds smoking falling from 29.4% in 2016 to 26.9% in 2017.  It is thought that a range of measures such as neutral packaging, reimbursement for use of tobacco substitutes, higher cigarette prices and campaigns made a difference.


23 May 2018

The UK ranks 23rd out of 195 countries for its healthcare outcomes, according to a study published in the Lancet.  In 1990 it ws 20th.  The top countries for quality and accessibility of healthcare are Iceland, Norway, the Netherlands, Luxembourg, Finland and Australia.  The ranking was based on data from the 2016 Global Burden of Diseases study, looking at 32 causes of death which should not happen with good healthcare.


22 May 2018

Benefit sanctions are ineffective in helping jobless people back into work and are more likely to contribute towards poverty, ill-health and ‘survival crime’, according to a five year ESRC funded study by six universities involving repeat interviews over two years with 481 welfare service users, as well as interviews with 57 policy experts and 27 focus groups.  The study concludes that ““Benefit sanctions do little to enhance people’s motivation to prepare for, seek or enter paid work. They routinely trigger profoundly negative personal, financial, health and behavioural outcomes,”  Where people did move into work, it was personalised job support that made most difference, not sanctions.

A target of 5% less sugar in foods has not been met by the sugar industry, the PHE has said in a report.  The PHE had called for a 5% cut in the first year of a voluntary scheme to reduce sugar content in food by 20% by 2020.  In fact the reduction has been 2% in the first year.  Only three of eight food groups measured managed a 5% cut.


18 May 2018

Risk of depression at age 14 is more common in brighter girls and girls from poorer backgrounds, while the same is not true of boys, according to government funded research based on 9,533 questionnaires from 14 year olds in the Millennium Cohort Study.


17 May 2018

Capita’s primary care administration contract put patients at risk, the NAO says, in a report on the outsourcing.  Among the problems have been: 87 women being wrongly told they were no longer part of the certival screening programme; a failure to update the official list of qualified GPs, dentists and opticians; problems with that list meaning about 1,000 GPs, dentists and opticians were unable to work; a backlog of 500,000 patient registration letters; medical supplies not delivered; and patient medical records being lost.  No actual harm to patients has been identified.  The 7 year, £330m contract began in August 2015.  The National Audit Office report says NHS England should consider whether to retain the contract or take the services back in-house.


16 May 2018

Dementia decline is not halted by rigorous exercise, and the decline was actually greater in those taking the exercise, according to research in which 329 people with dementia were assigned to an exercise regime with 165 assigned to usual care.  The results were published in the British Medical Journal.  Despite the findings in relation to dementia, the exercise did help physical fitness.  It is also recommended that people with dementia should not stop moderate exercise such as going for a walk.  It is still thought that exercise can help prevent people getting dementia.


14 May 2018

Three quarters of Britons have been so stressed in the last year that they felt unable to cope, according to a representative survey of 4,169 adults, commissioned by the Mental Health Foundation from YouGov.  32% of respondents said that stress had made them have suicidal thoughts.  There was greater stress amongst women and amongst young adults.

The use of temporary nurses costs the NHS £560m a year, compared to filling the positions with permanent staff, according to a report from the Open University.  Overall the NHS is spending £1.46bn a year on temporary nursing staff.


09 May 2018

The Government’s green paper plans for children’s mental health have been criticised by two House of Commons committees; Education and Health and Social Care, which described the proposals as unambitious.  They were concerned about the timescales, only rolling out the plans to a fifth or quarter of the country by 2022-23.  They also fear that the health and education workforce may not have the necessary capacity to meet the demand, which in any case they say the government has underestimated.  They also suggest there is insufficient attention to early intervention, stresses from social media and exams and attention to groups at greater risk of mental ill health such as children in care.


08 May 2018

Perinatal mental health services are to be made available across England by April 2019, NHS England has announced.  It estimates that only 3% of areas had good acces to mental health services for pregnant women and new mothers in 2014 and this is now to be extended to 100% of areas with £23m of funding, part of £365m promised overall..


05 May 2018

The UK has amongst the lowest number of doctors, nurses and hospital beds of OECD countries, according to analysis by the King’s Fund of OECD data on 21 countries.  Out of the 21 countries, the UK has the third lowest number of doctors, the sixth lowest number of nurses and the fourth lowest number of hospital beds.


03 May 2018

The mortality rate of children under 5 is 50% higher in England than Sweden, according to research from the UCL Great Ormond Street Institute of Child Health, published in the Lancet.  The research looked at health and mortality data on children up to their fifth birthday between 2003 and 2012, including 3.9m English births and 11,392 deaths and over a million Swedish births and 1,927 deaths.  Between two days and four years old, the child mortality rate was 29 deaths per 100,000 children in England but 19 in Sweden.  If England had Sweden’s rate, there would have been 607 fewer child deaths per year.  It is suggested that greater inequality and differences in welfare provision are responsible for much of the difference.


01 May 2018

An inquiry into the Mental Health Act has found that some people have suffered discrimination and neglect when detained for treatment under the Act.  The Inquiry, chaired by Prof Sir Simon Wessely, was commissioned by prime minister Theresa May.  The interim report says that black people are disproportionately sectioned under the Act and have a particularly poor experience.  About half of the people interviewed for the reivew said being sectioned was very beneficial and even saved their lives, but about a half said it had not been the right thing for them.

Scotland’s minimum unit pricing for alcohol comes into force on 1st May.  Alcoholic drinks must not now be sold for less than 50p per unit.  This is not a tax, and any extra revenue is retained by the retailer.


27 April 2018

The Government has reversed its policy of refusing benefits to kinship carers who breach the two child limit, when they go on to have a child of their own.  They are already exempt from the limit if they have their own child first.  The climb down


26 April 2018

The NHS will need an extra £50bn a year by 2030, according to a report by Lord Darzi and others, supported by the IPPR.  The report also involved Conservative and Lib-Dem politicians Lord Prior and Norman Lamb.  The £50bn increase, taking the budget to £173bn was needed to match the traditional 4% increase in health spending since the second world war, but this would require significant improvements in productivity, without which the budget should increase to £200bn.  It said social care funding should also increase by £10bn a year.

Mental health counselling for primary school children could save money longer term, with a return of £6.20 for every £1 invested, according to a study by Pro Bono Economics based on the mental health improvements of 4,548 pupils from 251 primary schools who had received one-to-one counselling from the charity Place2Be.  The potential benefit per child was £5,500 made up of £3,568 from higher lifetime earnings and £2,050 from lower government spending on things like health and criminal justice.

44 gene variants that raise the risk of depression have been identified, including 30 that had not been connected to the condition before.  More than 200 researchers combined data from seven datasets from the UK, the US, Iceland and Denmark involving genetic information on 135,000 people who reported having depression and 345,000 mentally healthy people.  The results were published in Nature Genetics.  It is hoped that the research will indicate biological mechanisms that the next generation of anti-depressant drugs could target.


25 April 2018

More nurses and midwives from Europe are leaving than coming, with 3,692 from the European Economic Area (EEA) having left the Nursing and Midwifery Council (NMC) register in 2017-18 and 805 having joined the register.  In the previous year, 2016-17, there were 3,081 leavers and 6,382 joiners.  Only 1,311 left the register in 2013-14.  Of the 227 nurses and midwives who responded to a NMC survey of leavers, 47% agreed that Brexit had encouraged them to consider working outside the UK.  There are now  just over 35,000 EEA nurses or midwives on the register, (5% of the total), which is nearly 3,000 fewer than 2016-17.

Exercising for 20 minutes a day cuts the risk of depression in later life by a third, according to an analysis of 49 studies involving 266,939 people, published in the American Journal of Psychiatry.  The difference was independent of factors such as age, smoking and body mass index and applied across every continent.

All NHS trusts will have to implement NEWS-2 by March 2019, NHS Improvement has said in a patient safety alert.  The updated National Early Warning Score system is designed to spot deterioration in patients which in some cases could lead to death, such as from sepsis.  About a third of care providers currently use versions of NEWS.


23 April 2018

A judicial review into Accountable Care Organisation regulations is being held.


20 April 2018

Funding for continuing health care varies widely across the country, according to analysis from Which, from 8.8 patients per 50,000 population in South Reading CCG to 220.4 in Salford.  Which is reported as saying that the variations can’t be explained by demographic differences between the areas.  There are also unexplained differences within regions.

Small ‘nudges’ redirected patients to hospitals with shorter waiting lists, in pilot work by the Behavioural Insights Team working with NHS England and NHS Digital.  On the e-referrals system, the top three local clinics offering a quicker service were highlighted in green, and if a service with a longer waiting list was chosen a pop up box with a red, ‘Limited Capacity’ flag appeared (although the doctor and patient could still go on to select it if they wished).  In one evaluation, using a phone app, there was a 20% reduction in referrals to the red, limited capacity services and a 14% increase in referrals where there was a green alert.


19 April 2018

There is no specialist perinatal mental health care in a quarter of areas of the UK, although provision has been improving in recent years, according to research by the Maternal Mental Health Alliance (MMHA) and the Royal College of Psychiatrists.  There was no provision in 62 of the 235 (26%) NHS health boards or CCGs.  That is an improvement on the 97 areas offering no support at the time of the last survey in 2015.  The number offering a full range of help has risen from 55 to 109.  It is estimated that up to 20% of women who give birth every year suffer from mental health problems related to the pregnancy or child birth.

Multimorbidity is increasing worldwide, but not enough is known about it, according to a report from the Academy of Medical Sciences produced by a working group of 17 international health experts.  Current services tend to treat individual illnesses rather than the whole person and it is suggested there could be a bigger role for GPs.


16 April 2018

At least 19 NHS trusts have set up wholly owned subsidiaries, according to responses to freedom of information requests to Unison.   Fifteen trusts have already spent £3.2m setting up the subsidiaries.  While staff transferred would be on the same terms and conditions, new joiners need not be, which the union says could leave them worse off.  NHS Providers says the companies are wholly owned subsidiaries so this is not privatisation, and that they are often set up to avoid outsourcing.


14 April 2018

Disabled people lost legal aid for 99% of benefits cases between 2011-12 and 2016-17, a fall from 29,801 to 308 cases, according to figures released in a parliamentary answer.


13 April 2018

1,429 hospital beds were empty as at September 2017, compared to 502 four years earlier, according to figures obtained by Labour.  Dr Nick Scriven, president of the Society for Acute Medicine, is quoted as saying that hospitals were having to close beds because of staff shortages and the NHS budget squeeze.

Having 10-15 drinks a week could shorten life by 1-2 years, according to research based on 600,000 drinkers in 19 countries in 83 studies, published in the Lancet.  More than 18 drinks a week could shorten life by 5-6 years.  Having 5-10 drinks a week reduced life by about six months.  The paper suggests that five 175ml glasses of wine, or 12.5 units, a week, is the upper safe limit.  It is suggested that above two units a day, the risk of death steadily rises.


12 April 2018

61% of people would support higher taxes to pay for health services, according to a survey by the British Social Attitudes research centre, undertaken at the end of 2017, with some questions sponsored by the King’s Fund.  This was an increase from 41% in 2014.  Nearly 9 in 10 thought there is a funding crisis.

Only 76.4% of patients were seen within four hours in A&Es in hospitals in March according to the latest performance figures. This was the lowest proportion since records began in 2010.   Including all walk in and urgent care centres, the figure was 84.6%.  The proportion receiving planned care within 18 weeks fell to 87.9% in February, its worst ever level.  A&E figures for the whole year were also at their worst ever, at 88.4% including all types of emergency centre and 82.4% for just major hospital A&Es.


10 April 2018

Loneliness is more likely to affect young adults than older people, according to a study by the ONS.  Almost 10% of 16-24 year olds were ‘always’ or ‘often’ lonely, the highest proportion of any age group.  Others particularly likely to be lonely included: older widows living alone; people who were single, middle-aged, living alone and in poor health; and people with few connections to their local community.


06 April 2018

The levy on sugary drinks comes into force. As well as the potential impact on obesity, Public Health England emphasised its possible role in reducing teeth decay.

Personal health budgets could be extended to five new patient groups, under a government consultation.  The groups are: people with ongoing social care needs; certain mental health service users; those leaving the armed forces; people with a learning disability and/or autism; and wheelchair users whose posture and mobility impact on their wider health and social care needs.  It is currently only those receiving continuing healthcare funding who can access personal budgets as of right.  Those eligible could receive the money as a direct payment, have it managed by a third party (such as parent or carer) or leave it with the NHS to control.
(09/04/18) (£)
Background document:


05 April 2018

Up to 1,000 Sure Start children’s centres may have closed since 2010, much higher than the official estimate of 500, according to a report by the Sutton Trust.  In addition to the closure of centres, many of those remaining have had to reduce the level of services provided and target them towards families in particular need, rather than providing the universal service originally intended.  Six local authorities have each shut more than 70% of their centres: Camden, West Berkshire, Oxfordshire, Staffordshire, Stockport and Bromley.  More closures are planned in a number of areas.

Young people’s wellbeing has fallen over the last year, according to a survey by the Prince’s Trust, which recorded the lowest levels of wellbeing since the annual survey started in 2009. The Trust surveyed 2,194 young people aged 16-25, with the results weighted so as to be representative of that age group across the UK.  It found that half had experienced a mental health problem, with six out of ten saying they regularly felt stressed because of concerns over jobs and money.


04 April 2018

Taxes on sugary drinks, alcohol and tobacco are effective and do not unduly penalise poorer people, according to research published in the Lancet.  The paper is one of five produced by the Lancet taskforce on non-communicable diseases and economics.  They say that there is a vicious cycle of non-communicable diseases (NCDs) leading to poverty and poverty leading to NCDs.  Looking at taxes on sugary drinks, alcohol and tobacco in 13 countries they found that wealthier families paid a higher proportion of the tax but there was a bigger impact on the smaller budgets of poorer families so they ended up buying less which was good for their health.

Obesity related admissions to hospital have doubled in four years according to a range of statistics released by NHS Digital.  The increase was from 292,000 in 2012-13 to 617,000 in 2016-17.  This includes cases where obesity was a secondary as well as a primary diagnosis.  In the last year, there was an 18% increase in admissions to hospital directly for obesity or for conditions caused or complicated by obesity, such as in heart disease or pregnancy.  The most common problem caused or worsened by obesity was wear and tear of the knee joints.


03 April 2018

Ten pilot cancer diagnosis one-stop-shops are being set up by NHS England with Macmillan and Cancer Research UK.  The aim is to allow quicker diagnosis by having all the necessary tests in one place.  The approach was pioneered in Denmark.

The government reply to the accountable care organisation consultation on changes to regulations has been published. In light of a separate NHSE consultation and investigation by the Health Select Committee, they will delay making any changes to the regulations.
Comment.  (£)