Health & Care Review

Health & Care Review

March 5, 2018

Keeping up with all the latest developments in health and care policy could almost be a full time job and PSNC regularly receives questions from LPCs and pharmacy contractors about what is going on in the wider health and care landscape beyond community pharmacy. To help answer some of these questions and to help contractors and LPCs stay up to date, PSNC provides this update service outlining the latest information in an easily digestible format. Weekly updates are published on our website and contractors can ensure they do not miss them by signing up to PSNC’s email newsletter service here.

The reviews extend the work we have been doing for some time to help LPCs stay informed about the NHS changes, and they inform the more detailed PSNC briefings which we continue to publish on this topic; these can be accessed in the Healthcare Landscape section of the website.

Public satisfaction with GP services

The findings of the British Social Attitudes survey by the National Centre for Social Research have been analysed by the King’s Fund and the Nuffield Trust.

Since 1983, the survey has asked members of the public about their views on, and feelings towards, the NHS and health and care issues generally. The latest survey was carried out between July and October 2017 and asked a nationally representative sample of 3,004 adults in England, Scotland and Wales about their satisfaction with the NHS overall, and 1,002 people about their satisfaction with individual NHS and social care services

Key findings include:

  • Public satisfaction with the NHS overall was 57% in 2017 – a 6% drop from the previous year. At the same time, dissatisfaction with the NHS overall increased by 7% to 29% – its highest level since 2007;
  • older people were more satisfied than younger people: 64% of those aged 65 and over were satisfied with the NHS in 2017 compared to 55% of those aged 18 to 64. Between 2016 and 2017, satisfaction fell among all age groups;
  • the four main reasons people gave for being satisfied with the NHS overall were: the quality of care, the fact that the NHS is free at the point of use, the attitudes and behaviour of NHS staff, and the range of services and treatments available; and
  • the four main reasons that people gave for being dissatisfied with the NHS overall were: staff shortages, long waiting times, lack of funding, and government reforms.

Research reveals levels of inappropriate prescriptions in England

Public Health England (PHE) has resourced a paper which looks at inappropriate antibiotic prescribing and poor diagnostic coding in English primary care. The research found that at least 20% of all antibiotics prescribed are inappropriate and implies that antibiotic prescribing nationally should be reduced by 10% by 2020, in accordance with the national ambition to cut levels of inappropriate prescribing in half.

According to expert opinion, for most conditions higher proportions of GP consultations resulted in prescriptions for antibiotics than appropriate.

The research identified that better diagnostic coding, more precise prescribing guidelines, and a deeper understanding of appropriate long-term uses of antibiotics would allow identification of further reduction potentials.

Health Matters: Community-centred approaches for health and wellbeing

PHE’s latest edition of Health Matters focusses on community-centred approaches for health and wellbeing.

The article discusses why communities matter, how being connected is important for health and building social capital with community-centred approaches.

New technology supports new mums to breastfeed

PHE has made available, via its Start4Life programme, the Breastfeeding Friend to encourage parents to adopt healthy behaviours and encourage breastfeeding. Evidence shows the right support helps mothers to breastfeed for longer. The Breastfeeding Friend is available for free on a range of platforms such as Facebook Messenger, and will now also be available as a skill for Amazon Alexa’s voice services.

Mothers can ask Alexa a variety of questions about breastfeeding and the answers will be provided tailored to the age of the baby.

A survey commissioned by PHE of 1,000 mothers of young children showed that:

  • 31% of mothers felt embarrassed about asking for help with breastfeeding from healthcare professionals;
  • 64% felt that access to 24 hours a day, seven days a week breastfeeding support would make new mothers:
    • more likely to have a positive experience of breastfeeding;
    • more likely to decide to try breastfeeding; and
    • breastfeed for longer.

Deaths associated with neurological conditions

PHE has published new resources relating to deaths associated with neurological conditions in England during the period of 2001 to 2014.

They are written for those commissioning or providing end of life care to help them make sure local services meet the needs of people dying with neurological conditions. Conditions covered include epilepsy, multiple sclerosis and parkinsonism.

The resources contain information on:

  • the numbers and rates of deaths associated with neurological conditions and their recent trends;
  • the demographic characteristics of people dying with neurological conditions;
  • the underlying cause of death and association with the broad disease groups; and
  • the place of death.

Public health transformation five years on

The Local Government Association (LGA) has published its annual report to showcase the wide range of ways in which public health is transforming how it operates. The report notes that we are seeing significant changes in the understanding of public health teams of the potential breadth and depth of their reach in tackling the social determinants of health.

The report features eight case studies with a number of themes and messages such as tackling national priorities, prevention, digital technology and the recommissioning of services.

A matter of justice: Local government’s role in tackling health inequalities

The LGA has published a new report which focuses on how social and economic factors lead to long term ill health and premature death for the most deprived.

Key messages in the report include:

  • health inequalities exist both between and within local authority (LA) areas, with almost 20 extra years of healthy life enjoyed by those in the longest-lived areas compared with those in the shortest-lived areas;
  • health inequalities are not just caused by individuals’ lifestyle choices: the choices available to people and the choices they make are affected by broader social factors – the ‘causes of the causes’ of ill health;
  • tackling the causes of the causes is both about reducing deprivation and disadvantage and also about breaking the links between deprivation and ill health;
  • people’s life chances and their likelihood of living a long and healthy life are determined in their very early years but are affected at all stages throughout their life. Therefore, LAs need to take a ‘lifecourse’ approach to reducing health inequalities, influencing for the better the conditions in which people are born, grow, live, work and age;
  • within local government, public health is not just part of the remit of the public health team: almost every local government function has an impact on health, including
    early years services, education, housing, employment and welfare, social care, leisure and public amenities, environmental health and trading standards and partnerships with the voluntary and community sectors, business and other employers and the NHS; and
  • at a time of major cuts in local authority services, councils need to take a strategic, targeted approach, understanding the health impact of all their activities and making a commitment to ‘health in all policies’. Reducing health inequalities makes sense at a pragmatic as well as a moral level because it can prevent people becoming and remaining ill and reduce the associated costs to local government, the NHS and the rest of the Government.

The reports helps readers understand health inequalities, who experiences them, and local government’s strategic role and how it can be maximised.

Adding extra years to life and extra life to those years: local government guide to healthy ageing

A new report has been published by the LGA which highlights the issues faced by the health and care system as a result of increased life expectancy and poor health.

The report touches on healthy behaviours relating to biological, behavioural and psychosocial processes through a life course approach, and features eight case studies on how LAs have tackled various issues relating to ageing.

Operational update from the NHS National Emergency Pressures Panel

NHS England has published an update from the meeting of the National Emergency Pressures Panel.

The panel noted after stabilising A&E performance in January the NHS has been confronted with persistently high flu hospitalisations, a renewed spike in norovirus and prolonged cold weather which drives up hospital admissions.

The panel formally recorded their thanks for the hard work of all colleagues and noted the winter plans were having an impact in the face of the most challenging circumstances for several years.

As a result of the increased pressures, the panel is urging the public to use the NHS responsibly and access the services most appropriate to their needs.

Tackling multiple unhealthy risk factors: emerging lessons from practice

A new report on unhealthy behaviours has been published by the King’s Fund on using innovative ways to address multiple unhealthy risk factors in populations. It contains eight case studies from LAs and the NHS on examples where behaviour change services address multiple unhealthy behaviours together to reflect the reality of people’s lives.

The report makes recommendations on how services can develop and share evidence, and for how the Department of Health and Social Care and Public Health England can support further innovation in such services.

Key lessons have been drawn for services that want to focus on tackling multiple unhealthy behaviours:

  • target individuals who may have a particular risk of multiple risk factors using evidence that is available on who those people might be in a local area;
  • approaches to behaviour change should ensure that the social factors behind accruing multiple risk factors are taken into account;
  • unhealthy behaviours do not respect organisational boundaries, and some of the best partnerships on addressing multiple risk factors occur when local authorities and the NHS set up formal referral routes between them; and
  • the academic evidence on how best to tackle multiple unhealthy behaviours remains weak.

Commissioner perspectives on working with the voluntary, community and social enterprise sector

The King’s Fund has conducted research that was commissioned by DHSC which explores how and why Clinical Commissioning Groups (CCGs) and LAs chose to engage with the voluntary, community and social enterprise (VCSE) sector.

The research sets out the methodology that was used and presents findings on factors that underpin the adoption of different approaches and how commissioners’ perceptions of their own strategic role, as well as their views on what role the VCSE sector plays in the local area, appear to exert a strong influence on commissioning decisions.

The report summaries the findings:

  • there is a wide variation in commissioning practice;
  • the primary drivers for choosing a commissioning approach were local, not national;
  • successful co-production takes skill, time, confidence and mature relationships built on trust; and
  • changes to the commissioning landscape may provide more challenges for successful co-production.

RCGP calls for an end to referral management centres that ‘prioritise cost-savings over patient care’

The Royal College of General Practitioners (RCGP) has published a new report, Quality patient referrals: Right service, right time, which considers the context in which referral management and support initiatives are set up, as well as the evidence for and against these models.

It is acknowledged in the report that referral management centres are judged to be successful by those involved in running and commissioning them, but the RCGP is concerned that some risk patients’ safety as clinical decisions are often made in the absence of the patient and without full clinical information.

RCGP recommend in the report that referral management centres must demonstrate that they are safe for patients and cost effective to the whole NHS and suggest that systems of “referral support” have been demonstrated to be more effective in improving the quality and appropriateness of GP referrals.

Report on geographical inequalities in breast cancer

The All-Party Parliamentary Group on Breast Cancer has published the final report of its inquiry into geographical inequalities in breast cancer diagnosis, treatment and care across England.

The report found that whilst overall outcomes for breast cancer patients are good and have improved over recent years breast cancer treatment, care and support varies across the country. Furthermore, based on where they live in England, a woman with breast cancer may be:

  • more than twice as likely to die from breast cancer under the age of 75 than a woman treated in a different area; and
  • a third less likely to have attended breast cancer screening in the last three years compared to a woman living in another part of the country.

The key recommendations from the report outline that:

  1.  national and local workforce planning is essential;
  2. new NHS structures need to improve the consistency, transparency and accountability of cancer services; and
  3. effective collection and use of data will drive service improvement.

Reducing emergency admissions

The National Audit Office (NAO) has published a report which examines progress made by DHSC, NHS England, NHS Improvement and other stakeholders in reducing the impact of emergency admissions on acute hospitals.

The report sets out trends in emergency admissions, explains NHS England’s and partners’ responses to increasing emergency admissions and associated challenges.

Key findings include:

  • overall emergency admissions continue to increase each year. Emergency admissions have grown 9.3% from 2013/14;
  • older people make up more than half of the growth in emergency admissions between 2013/14 and 2016/17; and
  • the number of bed days used by people admitted in an emergency admission has increased from 32.41 million in 2013-14 to 33.59 million in 2016/17.

The NAO also makes several recommendations in the report aimed at specific organisations but states that all organisations need to work together more effectively.

The report concludes that the NHS still has too many avoidable admissions and too much unexplained variation and that the challenge of managing emergency admissions is far from being under control.

Media monitoring

On Monday 26th February 2018, the following stories were published:

  • NHS services for children are substandard in every region of England owing to nurse shortages and safeguarding failures, the Times also reports.
  • UK millennials are on track to be the most overweight generation since records began, says Cancer Research UK. This was covered by the BBC, the Guardian, the Independent, the Times and the Sun.
  • There is also some coverage of Eating Disorders Week, with the BBC and iNews reporting that many adults are unaware of symptoms.
  • A diet rich in fruit, veg and whole grains could help people to avoid depression, iNews, the Telegraph and the Mail report.

On Tuesday 27th February 2018, the following story was published:

  • The Government has launched a report and consultation on how it makes decisions about which vaccines to fund, the BBC and iNews report.
  • GPs are being offered cash payments not to refer patients to hospital as part of CCG ‘profit-sharing’ arrangements in place in some areas. This was a originally a Pulse investigation, but it has been reported on by the GuardianIndependent, iNewsTelegraph and Times.
  • The Brexit Health Alliance have put out a briefing paper warning that children could be excluded from lifesaving clinical trials for cancer treatments when the UK leaves the EU. The briefing is reported on by iNews.

On Thursday 1st March 2018, the following stories were published:

  • The Independent has a report about hospitals and GP practices cancelling non-urgent appointments and operations as staff struggle to make it in through the snow.
  • The Care Quality Commission (CQC) has published a review showing that patients with serious mental health problems are often treated far from their homes, leaving them isolated and less likely to recover. This is reported by the Guardian, Independent and iNews.
  • Taking a daily fish oil capsule during pregnancy and the first few months of breastfeeding may reduce a baby’s risk of food allergy, the BBC, Independent, Telegraph and the Times report.

On Friday 2nd March 2018, the following stories were published:

  • The London Ambulance Service has warned that it may no longer be able to answer all 999 calls quickly enough because its control rooms are chronically short of call handlers, the Guardian reports.
  • The Chief Medical Officer has said the NHS must take a lead on tackling a ”cocktail of pollutants” which are contributing to chronic sickness across the country. This is reported by the Independent, BBC and Telegraph.
  • A plan to pay host families to take in NHS patients recovering from surgery has been revived, as Cambridgeshire county council now says it is considering a trial of the “innovative” scheme, report the Times.
  • Scandinavian scientists have suggested that people with diabetes could be classified into five distinct groups, with treatment tailored to their group. This is reported by the BBC, Telegraph and Times.

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