Health & Care Review

Health & Care Review

May 30, 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.

12 million people to benefit from better joined up NHS and social care work

NHS England has announced the second wave of Sustainability and Transformation Partnership (STP) sites selected to become Integrated Care Systems.

The new sites are:

  • Gloucestershire STP;
  • North Cumbria;
  • Suffolk and North East Essex; and
  • West Yorkshire and Harrogate.

The four sites received a vote of confidence in strong local leadership, partnership working and ambitious plans to strengthen primary care and integrate services for the benefit of local communities.

Health matters: preventing Type 2 diabetes

Public Health England (PHE) has published the latest edition of Health Matters, this time focussing on preventing Type 2 diabetes, specifically on the NHS Diabetes Prevention Programme. The resource highlights the scale of the problem, the national response to diabetes prevention, as well as lifestyle interventions and national policies.

£15 million boost for local mental health crisis services

New funding worth £15 million has been announced to create support services for people at risk of a mental health crisis.

The Beyond Places of Safety scheme will fund clinics, crisis cafes and other community services to prevent people from reaching crisis point and supporting those to do.

The funding will be allocated to 51 projects that will:

  • integrate health and care support with other services such as housing advice, addiction services and counselling;
  • improve links with local voluntary and community sector partners; and
  • provide safe and secure spaces in the community for those experiencing distress.

It is hoped that the support offered to those at risk of a mental health crisis will help to relieve pressures on hospitals by reducing unnecessary A&E visits. The projects will also include measures to strengthen the long-term support available to those at risk of a mental health crisis and relapse prevention.

Emergency admissions in the NHS increase by almost half in a decade due to rise in sicker patients, new research shows

The Health Foundation has published the findings of new research looking at trends in emergency admissions over the past decade and reviews some of the interventions aimed at reducing harm.

Key findings include:

  • one in three patients admitted to hospital in England as an emergency in 2015/16 had five or more health conditions, such as heart disease, stroke, type 2 diabetes, dehydration, hip fracture or dementia. This is up from one in ten in 2006/07;
  • the number of patients admitted urgently to hospital has increased by 42% over the past decade – that’s an average of 3.2% per year;
  • patients arriving at A&E are sicker than ever before, and more likely to need admission. This has grown for patients with multiple health conditions, as well as for older patients aged 85 or over, up by 58.9%; and
  • Hospitals are treating patients more quickly, with overnight stays for those with five or more conditions lasting 10.8 nights in 2015/16 compared with 15.8 days a decade previously. The number of these patients admitted to hospital but discharged on the same day have increased by 373% over the same period.

Parental alcohol and drug use: understanding the problem

PHE has published a toolkit for commissioners of drug and alcohol services, and children services to help identify problematic substance use and help commission appropriate services.

It has been developed to support local authorities to:

  • identify problematic parental alcohol and drug use as early as possible;
  • ensure that the services they commission have sufficient capacity and resources to support parents and children affected by problem parental alcohol and drug use;
  • identify and commission interventions to reduce harm and promote recovery for parents who misuse alcohol and drugs and also to reduce and prevent harm to their children; and
  • address the effects of adverse childhood experiences and to safeguard children.

Air pollution: a tool to estimate healthcare costs

PHE has published a new report and cost tool to estimate the health and social care costs of air pollution in England, as part of the wider Government strategy to reduce air pollution. The tool is intended to be used by local authorities to inform their policies to improve air quality.

Key facts highlighted include:

  • health and social care costs of air pollution in England could reach £5.3 billion by 2035 unless action is taken; The costs are for diseases where there is a strong association with air pollution: coronary heart disease; stroke; lung cancer; and child asthma;
  • when diseases with weaker evidence of association are also added, including chronic obstructive pulmonary disease; diabetes; low birth weight; lung cancer (for NO2 only); and dementia, the costs were £157 million in 2017 and could reach £18.6 billion by 2035; and
  • there could be around 2.5 million new cases of all of the above diseases by 2035 if current air pollution levels persist.

First measure of industry progress to cut sugar unveiled

PHE has published the first assessment of progress on the sugar reduction programme by measuring how far the food industry has gone towards reducing the sugar children consume through everyday foods.

As part of the Government’s programme to cut childhood obesity, the food industry has been challenged to reduce the amount of sugar by 20% in a range of products by 2020, with a 5% reduction in the first year. This includes retailers, manufacturers, restaurants, cafes and pub chains.

Eight food categories have been assessed; key findings include:

  • there have been reductions in sugar levels across five categories;
  • yoghurts and fromage frais, breakfast cereals, sweet spreads and sauces have all met or exceeded the initial 5% sugar reduction ambition; and
  • sugar levels are generally the same across all sectors, however for the eating out of home sector, portion sizes are substantially larger – on average more than double – than those of retailers and manufacturers.

Under pressure: safely managing increased demand in emergency departments

The Care Quality Commission has published a report which presents findings from inspections of emergency departments over winter 2017/18 and workshops held with frontline staff. Workshops were held with frontline clinicians to gain their experience, understand the issues they face and what needs to change.

The report found specific concerns over delayed ambulance handovers; patients waiting too long before their first clinical assessment; and patients who needed urgent care were not always identified in a timely way. There were also concerns about many hospitals caring for patients in inappropriate places such as corridors.

The report recommends solutions which focus on:

  • what can be done to help keep people well and reduce visits to emergency departments;
  • what emergency departments can do to manage how patients flow through the hospital; and
  • ways to help avoid unnecessary admissions and ensure early discharge.

Dementia – the true cost: Fixing the care crisis

The Alzheimer’s Society has published the findings of an investigation it conducted on emergency admissions for people with dementia.

The investigation, which involved Freedom of Information requests to NHS Trusts in England and a survey of frontline paramedics, revealed a sharp rise in emergency admissions over the last five years – up 70% since 2012, with more than 50,000 avoidable emergency admissions of over-65s with dementia in the last year alone.

The report recommends key areas for the Government to urgently address:

  • access – everyone with dementia to have access to timely, preventative and integrated care and support;
  • quality – all health and social care workers to be provided the training and support they need to deliver quality dementia care; and
  • cost – the cost of additional care charges for a health condition such as dementia to be covered by the state.

Health, ageing and support survey: 2017

Ipsos MORI has published the findings of research it conducted into the views of people after 50 and over on health, ageing and support for 2017. It was conducted on behalf of the Department of Health and Social Care (DHSC) and is based on two surveys.

Key findings include:

  • people aged 50 and over are slightly less positive about their health than a year ago, but still take their physical and mental health seriously;
  • eating healthily is seen as important for both physical and mental health, though nearly half do not think a healthy lifestyle can prevent dementia;
  • loneliness continues to be seen as a big problem for older people and most think society is not doing enough to prevent it; and
  • concern about meeting the cost of care and support services has increased since last year. However, this has not translated into greater action and people are still not preparing substantially for the financial cost of care and support they might need.

Securing the future: funding health and social care to the 2030s

The Institute for Fiscal Studies, the Health Foundation and NHS Confederation have collaborated to produce a report examining NHS spend now and in the future.

Key facts highlighted in the report include:

  • to meet funding pressures, an extra £95-124bn would need to be spent per year on health by 2033/34;
  • if funding pressures are met through taxes, it is estimated that the average household would need to pay £1,200-2,000 more in tax in 2033/34;
  • more tax is needed because in 2033/34:
    • there will be 4.4 million more people in the UK aged 65 and over;
    • more people will be living with a chronic disease and many with multiple conditions;
    • the cost of hospital drugs is likely to increase; and
    • the NHS will need to pay more to recruit and retain the staff it needs.

The growing problem of treatment waiting times

The Health Foundation and Nuffield Trust have published an analysis of treatment times in the NHS which has been published in QualityWatch.

Key findings include:

  • in March 2018, only 87% of patients had a treatment waiting time of less than 18 weeks;
  • the total waiting list has been growing since 2012, and we now have a waiting list that exceeds 4 million;
  • the number of people waiting longer than 52 weeks to start treatment has been increasing since 2013. In March 2018, 2,755 people had been waiting for longer than a year, the highest number since July 2012; and
  • by deferring the targets and removing the financial penalties, hospitals will have the opportunity to move away from managing the target to improving patient scheduling based on need.

£30 million of funding to tackle antimicrobial resistance

DHSC and the Department for International Development have announced that £30 million of funding will be committed to tackle antimicrobial resistance (AMR).

The funding will be delivered through four new projects as part of the Global AMR Innovation Fund. These projects are funded by UK aid and will primarily benefit people in low- and middle-income countries, where the burden of infection is greatest.

Media monitoring

On Monday 21st May 2018, the following stories were published:

  • Analysis by NHS Providers suggests that the NHS drive to treat patients at home rather than in hospital has ‘fallen flat’. An NHS spokesman has said the report ‘highlights the inescapable pressure on GPs, hospitals and community services from a growing, ageing population, which will have to be properly factored in to NHS funding decisions for the decade ahead’. Featured in The Mail, The Guardian and BT News.
  • NHS to divert ‘frequent flyers’ to A&E with coffee and counselling, reports The Telegraph. ‘Frequent flyers’ to A&E departments are being kept away under a new scheme to offer a coffee and counselling to those coming to casualty for the wrong reasons. The initiative, which is set to be rolled out nationwide, comes amid soaring emergency admissions to hospitals, which have risen 50% in a decade. The scheme has been piloted in the North East, but NHS England now wants it rolled out the rest of the country in a bid to manage demand. Also featured in The Express and Star and The Mirror.
  • An initiative to train 700 paramedics to prescribe drugs would help to take the pressure off GPs, reports The Mirror. As many as seven out of ten patients seen by paramedics may need help but don’t necessarily need to be taken to hospital. These patients include elderly people with UTIs and asthma patients in need of steroid tablets.
  • The critically ill should not be made to die away from home, reports The Guardian. An IPPR report says that one in three people who die in hospital could spend their final days at home if the government introduces and adequately funds a modern community-based health and social care system.

On Tuesday 22nd May 2018, the following stories were published:

  • Research published in the British Journal of General Practice has found that patients at risk of heart disease are failing to take statins because they worry GPs are being paid to hand them out. The research found a widely held belief among British patients that GPs have a tendency to over-prescribe statins, leading to suspicion over whether they personally needed the drugs. Reported in The Telegraph, The Sun and The Times.
  • The Government is considering scrapping or changing parts of the 2012 Health and Social Care Act. The Lansley reforms brought in huge changes to the way the NHS in England is run, placing a stronger emphasis on competition and markets in the provision of care. This follows recent coverage of promises for more resources and a longer-term funding settlement for the health service. Featured in the BBC.
  • Bad lifestyles mean patients arrive at A&E sicker than a decade ago, reports The Times. Almost one in three people admitted to hospital as an emergency has at least five illnesses, threatening NHS efforts to treat people closer to home.
  • In a BBC documentary, Dr Chris van Tulleken revealed that children are taking three times more Calpol than 40 years ago. Calpol, and other paracetamol-based medicines, have been linked to asthma and kidney, liver and heart damage, although cases are fairly rare. Featured in The Sun.

On Wednesday 23rd May 2018, the following stories were published:

  • Elderly patients are being discharged from hospital with potentially lethal mix of drugs, reports The Mail. Pensioners are often prescribed up to nine different treatments, which can cause severe side-effects when combined. Research from Brighton and Sussex Medical School and King’s College London found that a third of pensioners suffered medication harm as a result of the drugs they were given, but 52% of the complaints suffered could be prevented. Also featured in The Sun.
  • A judicial review by a group of campaigners challenging government health policy in England got under way at the High Court, reports the BBC. The group, which includes leading members of campaign groups Doctors for the NHS and Keep Our NHS Public, are fighting the creation of accountable care organisations. These are to act as partnership bodies incorporating hospitals, community services and councils, which campaigners say risks privatisation, although this is denied by ministers.
  • The Telegraph features an opinion piece by Professor Dame Sally Davies, Chief Medical Officer for England, saying by 2050 one person will die every three seconds if we don’t tackle antibiotic resistance. Currently it is estimated that around 5,000 people die a year in England because they develop infections that are resistant to antibiotics.
  • One in eight people set to have type 2 diabetes by 2045, says study. Global rates for the disease will rise from 9% to 14% unless obesity levels are reduced, according to research funded by Novo Nordisk. Featured in The Guardian, The Sun and The Telegraph.

On Thursday 24th May 2018, the following stories were published:

  • The Mail features a study published in The Lancet ranking healthcare providers in the world. The UK’s NHS ranks 23rd out of 195 countries, three points below its position in 1990. The research also suggested that the quality of care varies substantially throughout the UK, with the south east of England performing better than the North East.
  • Rising antidepressant prescriptions could be contributing to increasing obesity levels, study finds. All 12 most commonly prescribed antidepressants were associated with increased weight gain. Reported in The Independent.

On Friday 25th May 2018, the following stories were published:

  • The Telegraph features a piece on the cost of treatments and conditions that aren’t available on the NHS. It includes eye tests, dental work, podiatry and some tests and scans.
  • A study has found that graph cigarette-style health warnings can help dissuade people from buying sugary drinks. Featured in The Guardian, The Independent, The Telegraph and The Mirror.


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