Health & Care Review

Health & Care Review

November 13, 2017

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.

Latest statistics on community pharmacies published

NHS Digital has published new statistics for 2016/17 on activities carried out by community pharmacies and appliance contractors in England in the report, General Pharmaceutical Services: England 2007/08 to 2016/17.

Key facts in the report include:

  • community pharmacies dispensed 1.1 billion prescription items;
  • the average monthly items per community pharmacy is 7,218;
  • 4 million Medicines Use Reviews were carried out by 11,244 pharmacies; and
  • there were 872,296 provisions of the New Medicine Service from 9,972 pharmacies.

The Autumn Budget – Joint statement on health and social care

The Health Foundation, The King’s Fund and the Nuffield Trust have, in light of recent developments, published an updated briefing ahead of the Autumn Budget which analyses the funding position and its implications for health and care services.

Key messages in the briefing include:

  • total health spending in England is estimated to rise from £123.8 billion in 2017/18 to £128.4 billion by the end of this parliament in 2022/23;
  • this figure is below what is needed to maintain standards of care and meet rising demand. Based on projections from the Office for Budget Responsibility, the organisations estimate that health spending would need to rise to approximately £153 billion by 2022/23;
  • the organisations estimate that NHS spending will be at least £4 billion lower than is needed in 2018/19;
  • the social care sector is estimated to face a funding gap of £2.5 billion by 2019/20;
  • productivity in the NHS is improving by 1.7% a year and is outperforming productivity in the wider economy. Even so, this will not be enough to bridge the gap between rising pressures and planned funding.

What is happening to waiting times in the NHS?

The King’s Fund has published an article highlighting key NHS issues and recent NHS performance on waiting times ahead of the Autumn Budget.

Key issues highlighted include:

  • elective care: 18 week referral-to-treatment – the number of patients receiving elective treatment has grown from around 14.2 million in 2012/13 to 15.7 million in 2016/17, an increase of 11%. The total elective waiting list in April 2012 was 2.5 million; by August 2017 this had increased to 4.1 million – this is the highest level for the waiting list since 2007;
  • A&E – between 2012/13 and 2016/17 the number of attendances at A&E departments increased by more than 1.6 million (7.5%) and the number of emergency admissions from A&E increased by more than 481,000 (12.8%). The current A&E standard is for no less than 95 per cent of patients attending A&E to be admitted, transferred or discharged within four hours. This standard was met in 2012/13 (95.9%) and 2013/14 (95.7%) but has been missed for the past three years, with performance deteriorating each year to 89.1% in 2016/17;
  • cancer: 62-day wait for first treatment following GP referral – since 2012/13 the number of patients beginning cancer treatment within two months has increased, from around 103,000 in 2012/13 to around 120,000 in 2016/17, an increase of 16%. The most prominent standard for accessing cancer treatment is the standard that at least 85% of patients should begin treatment for cancer within 62 days of an urgent referral from their GP. From its introduction in 2009/10 to 2013/14 this standard was met; however, it has been missed every year since. Performance has deteriorated each year, and in 2016/17 was at its lowest ever level with 82% of patients beginning first treatment within two months, and performance continues to be challenged in 2017/18.

Call for women to get life-saving smear test after uptake drops

NHS Digital has published figures on the NHS Cervical Screening Programme 2016/17 which shows that coverage for women aged 25 to 64 had fallen from last year, and since the year that collection of coverage began.

Key statistics include:

  • coverage for women aged 25-64 was 69.6%, compared to 70.2% in 2016;
  • for women aged 50-64, coverage was 77.2%, a decline from 78% in 2016;
  • A total of 4.45 million women were invited for screening in 2016-17. This represents an increase of 5.6% from 2015/16, when 4.21 million women were invited; and
  • at a regional level, coverage of the full target group (ages 25 to 64) ranged from 65.7% in London to 75.4% in the East Midlands.

In light of this information, Public Health England (PHE) is urging all eligible women who are invited for the cervical screening to take the test.

Alcohol-specific deaths in UK: registered in 2016

The Office for National Statistics has published a statistical bulletin on deaths in the UK which are known to be direct consequences of alcohol misuse in 2016.

Key points include:

  • in 2016 there were 7,327 alcohol-specific deaths in the UK;
  • since 2001, rates of alcohol-specific deaths among males have been an average of 55% higher than those observed among females;
  • for both sexes, rates of alcohol-specific deaths were highest among those aged 55-64 years; and
  • in England, alcohol-specific death rates in 2016 were significant higher in the most deprived areas in comparison to the least deprived areas.

Substance misuse and treatment in adults: statistics 2016 to 2017

PHE has published a report containing information on individuals who were receiving help for problems with drugs and/or alcohol during 2016/17 in England.

Key facts in the report include:

  • overall, 279,793 people were in contact with drug and alcohol services in 2016/17; a 3% reduction from the previous year;
  • overall, the number of under-25s accessing treatment has fallen by 45% since 2005-06; this reflects changes in the patterns of drinking and drug use in this age group over the last 11 years;
  • males made up 69% of the entire treatment population in 2016/17; and
  • in England, the number of deaths from drug misuse registered in 2016 increased by 3.6% to 2,383.

The efficacy of public health spending

The TaxPayers’ Alliance has published a research report which examines the spending, access and cost-effectiveness of four areas of public health spending across the UK. The four areas in question are smoking, physical health, obesity and alcohol. Researchers asked public health authorities about interventions and programmes for adults across the UK to help them reduce or stop smoking, take up sport, reduce their weight and diminish their alcohol intake

The report contains a breakdown of findings from each public health authority.

Embedding a culture of quality improvement

The King’s Fund has published a report which identifies practical lessons and how to create the right conditions for quality improvement.

The report identifies three common themes for successfully launching a quality improvement strategy: having a clear rationale, ensuring staff are ready for change and understanding the implications for the organisation’s leadership team.  NHS leaders need to engage with staff, empower frontline teams and ensure there is an appropriate infrastructure in place to support staff and spread learning.

‘No deal’ Brexit would harm NHS and its patients, Nuffield Trust warns

The Nuffield Trust has published a briefing which explores five key areas where potential UK deals with the European Union can affect health and social care.

The report outlines the reasons why an exit deal and trade and co-operation deals are needed, and areas where the NHS could have greater flexibility after Brexit.

Cuts, closures and contraception

The Advisory Group on Contraception conducted a Freedom of Information request audit of all 152 upper and unitary tier local authorities (LAs) over the summer of 2017 to understand more about contraception services and budget cuts.

A report has been published which presents the findings and warns that the combination of deep public health cuts and a fragmented commissioning environment continues to place pressure on the provision of full and open access contraceptive care.

Key findings include:

  • 32 LAs closed contraceptive services in 2016/17, a significant increase from 12 LAs in 2015/16;
  • half of councils have cut spending on contraception in the current financial year;
  • over one third of LAs have reduced or plan to reduce the number of sites commissioned to deliver contraceptive services since 2015; and
  • 45% of LAs have reduced the number of intrauterine systems and devices fitted and removed in GPs.

Media monitoring:

On Saturday, 4th November, the following stories were published:

  • The Daily Mail reported that patients who go to their GP with a cough will undergo a blood test before being offered antibiotics, under an NHS trial. Those who aren’t found to have a serious infection will not be prescribed the drugs.
  • The Telegraph reported that the health service has spent more than £100,000 drawing up plans to make every trust move its NHS logo on stationery and signs.

On Sunday, 5th November, the following story was published:

  • The Sun reported on the results of a study by tobacco giant Philip Morris which suggests England could be “smoke free” by 2040. The goal, which means less than five per cent of adults using cigarettes, is getting closer due to the greater use of e-cigarettes.

On Monday, 6th November, the following stories were published:

  • The Times reported that millions of NHS patients will be offered the chance to consult family doctors around the clock by smartphone as the first “virtual GP” goes live. Video consultations are promised within two hours by doctors who say that they are bringing the health service into the digital age. This was also covered by the
  • The Sun covered a new report by the Care Quality Commission which says that NHS staff are exposing patients to excessive radiation during X-rays and CT scans due to poor training and outdated equipment.

On Tuesday 7th November, the following stories were published:

  • The RCGP criticised a new ‘GP at hand’ app which is being trialled, enabling patients to book an appointment at any time of day and get a video consultation on their ‘phone within two hours. RCGP say it will ‘lure’ GPs away from frontline practice and disproportionately help younger patients. This story was reported in the Guardian, Times and by ITV.
  • NHS Providers published a report which claims that uncertainty over Brexit and its implications for EU workers could lead to understaffing in the NHS and compromise patient care. This has been picked up by the Guardian, Telegraph and BBC.
  • The Times and Telegraph reported that Norfolk and Norwich University Hospital is to open the first A&E unit for elderly (over 80) patients, to try to speed up the time in which older patients are seen by a medical professional and reduce the length of their hospital stay.

On Thursday 9th November, the following stories were published:

  • Most of the papers led with Simon Stevens and Jeremy Hunt’s comments at the NHS Providers conference the previous day. The Telegraph, Times, BBC, Channel 4 News and ITV News have all reported that Stevens, as previously trailed, called for the £350 million a week figure cited during last year’s Leave campaign to be invested in the NHS to prevent waiting lists growing even longer. The Daily Mail and Telegraph have covered Hunt’s claim that the NHS was overspending on items such as rubber gloves, and called for Trusts to use funds more efficiently.
  • The Telegraph also reported that British GP appointments are amongst the shortest in Europe, according to a new study published in BMJ Open.

On Friday 10th November, the following stories were published:

  • The Times reported on concerns raised by drug companies that the supply of thousands of medicines could be disrupted if Britain leaves the European Union without a deal. More than 2,600 products have some stage of their manufacture in Britain. Forty-five million patient packs are supplied to other European countries each month, while 37 million move the other way, a survey by the European Federation of Pharmaceutical Industries and Associations has found.
  • The Guardian reported that the number of patients waiting more than six months for surgery in England was 40% higher in September than the same month last year, according to analysis by the Royal College of Surgeons. The 151,710 people waiting more than six months for hip or knee replacements, cataract removal, hernia repair and other non-urgent operations in September was also 5% up on August. This was also covered by the Telegraph.
  • The ‘I’ reported on the results of a poll by Pulse Magazine which show more than half of GPs would back plans to fine patients for not turning up to appointments in a bid to address the almost £1 billion a year that no-shows cost the health service.

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