Health & Care Review

Health & Care Review

December 15, 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.

1.4 million people referred to NHS mental health therapy in the past year

NHS Digital has published an analysis of psychological therapies in England, which includes information on recovery and waiting times.

The analysis shows that:

  • There were 1,391,360 new referrals in 2016/17;
  • 567,000 people finished a course of NHS talking therapy in 2016/17; this is 30,000 more patients than in the year before;
  • waiting times are improving, with 88% of people waiting less than 18 weeks for treatment, and nearly 90% waiting less than six weeks; and
  • as well as recovery rates improving to an average of 49% over the course of the year, 65% of patients showed ‘reliable improvement’ as a result of treatment.

NHS England has commented on the statistics and states that this type if intervention will mean people’s conditions are spotted and treated sooner, reducing the need for more intensive and higher cost treatments.

Mental Health Bulletin: 2016/17 Annual Report

NHS Digital has published annual statistics relating to mental health services in England during 2016/17, which includes information on children for the first time.

Key facts include:

  • 2,637,916 people were known to be in contact with secondary mental health, learning disabilities and autism services at some point in the year. 556,790 of these were under 18 years of age;
  • this means that 4.8% of people in England were known to have accessed secondary mental health, learning disabilities and autism services during this year; and
  • 9% (101,589) of people known to be in contact with secondary mental health, learning disabilities and autism services spent time in hospital as part of being in contact with these services during 2016/17.

Transforming children and young people’s mental health provision: a green paper

DH and the Department for Education have opened a consultation in which they seek people’s views on a green paper setting out measures to improve mental health support for children and young people.

The green paper focusses on earlier intervention and prevention, especially linked to schools and colleges.

The proposals include:

  • creating a new mental health workforce of community-based mental health support teams;
  • every school and college will be encouraged to appoint a designated lead for mental health; and
  • a new 4-week waiting time for NHS children and young people’s mental health services to be piloted in some areas.

The consultation closes on 2nd March 2018.

Mental health services for post 16 students in England

The House of Commons Library has published a briefing which outlines recent studies on the mental health of students, Government mental health policy for students, support in further and higher education providers and the legal duties of providers.

Thriving at Work: a review of mental health and employers

An independent review of mental health and employers, published in October 2017, has had a response from the Department of Health (DH) and the Department for Work and Pensions. The paper published in response sets out plans to transform employment prospects for disabled people and those with long term health conditions over the next ten years.

The plan also serves as a response to its Work, health and disability green paper consultation which closed earlier this year and received around 6,000 responses from stakeholders and the public.

The plan involves making improvements in the following key areas:

  • employment and financial support;
  • supporting employers to create healthy, inclusive workplaces;
  • supporting employment through health and high quality care for all; and
  • working together with stakeholders.

Local area performance metrics

DH and the Department for Communities and Local Government have worked with stakeholders to produce the NHS social care interface dashboard which provides a set of measures indicating how health and social care partners in every local authority (LA) area in England are performing at the interface between health and social care.

Included in the dashboard is a breakdown of delayed days attributable to social care per 100,000 of the population and the equivalent for NHS-attributable delays.

More cancer specialists to be employed by the NHS

DH has announced that the NHS will be employing more cancer specialists in areas where there are shortages to speed up diagnoses and start people on treatments more quickly. The move is part of Health Education England’s new Cancer Workforce Plan.

Announcements of extra provision include:

  • 200 clinical endoscopists – to investigate suspected cancers internally;
  • 300 reporting radiographers – to identify cancers using x-rays and ultrasound; and
  • support for clinical nurse specialists – to lead services and provide quality care.

Promoting professionalism, reforming regulation

DH has opened a consultation which seeks views on proposed reforms to the regulation of healthcare professionals in the UK.

Some of the proposed reforms up for consultation include:

  • establishing a single, shared, public-facing register of all health and care professions and occupations;
  • there should be greater implementation of co-operative working, in particular to use regulatory data and insight in partnership with others to reduce harm; and
  • establishment of a licensing regime should be investigated. Language change should be adopted to align with a licensing process, similar to the Driver and Vehicle Licensing Authority. This should be informed through exploration of the scope for issuing licences within existing legislation and proportionate approaches to different professions.

The consultation closes on 23rd January 2018.

Introducing ‘opt-out’ consent for organ and tissue donation in England

DH has made available a consultation to seek people’s views on changes to make it easier for people to consent to become organ donors. The proposed changes includes a system in which people are considered willing to be an organ donor after their death unless they have opted out.

The consultation closes on 6th March 2018.

Substance misuse treatment for young people: statistics 2016/2017

Public Health England (PHE) has published new statistics report relating to alcohol and drug treatment data for people under the age of 18.

Key facts in the report include:

  • specialist substance misuse services saw 4% fewer young people in 2016/17 than in the previous year. This continues a downward trend, year-on-year, since a peak of 24,053 in 2008/09;
  • two-thirds of the young people accessing specialist substance misuse services were male (66%) and half (50%) of all persons were aged 16 or over;
  • the most common drug that young people presented to treatment with continued to be cannabis followed by alcohol;
  • the most common routes into specialist substance misuse services were from education provision (29%), youth justice services (25%), and children’s social care (15%); and
  • the majority of young people presenting to specialist substance misuse services have other problems or vulnerabilities related to their substance use, such as:
    • having mental health problems;
    • being ‘looked after’;
    • not being in education, employment or training; or
    • wider factors that can impact on their substance use (such as offending, self-harming, experiencing sexual exploitation or domestic abuse).

PHE profile updates for 2017

PHE has updated several profiles relating to a range of topics and presenting a range of indicators using the latest available data.

The profiles are designed to improve the availability and accessibility of information around specific topics and data is presented in a user-friendly format.

Topics include:

Measles outbreaks confirmed in 5 areas across UK

PHE is advising people to ensure they have had the measles, mumps and rubella (MMR) vaccine after recent outbreaks in England have been confirmed in children and adults who have not received two doses of the vaccine.

As of 8th December 2017, there have been 28 confirmed cases in Leeds, 18 confirmed cases in Liverpool, 13 confirmed cases in Birmingham, 7 confirmed cases in Surrey, and 4 confirmed cases in Manchester.

PHE local health protection teams are working closely with the NHS and local authorities to raise awareness of the outbreaks in England and Europe with health professionals and local communities.

Enhanced health in care homes: learning from experiences so far

The King’s Fund has published a report to highlight progress in developing enhanced health in care homes.

The report is based on interviews with people in 15 selected areas to provide a range of different experiences, as well as published research and guidance related to the topic.

The report sought to answer the following questions:

  • what is the case for enhanced health in care homes?
  • why do areas start developing enhanced health in care homes?
  • how do areas start implementing enhanced health in care homes? and
  • how do areas develop and sustain enhanced health in care homes?

Delayed discharge funding opened to local authorities

NHS Digital has announced funding of £1.4 million for LAs and their NHS partners to reduce delayed discharges. The funding will enable the integration of patient discharge from hospital into LA social care processes.

Applications are now open for LAs to work with at least one of their NHS partners to create integrated digital assessment, discharge and withdrawal notices.

Challenging Health Inequalities: Support for CCGs

NHS England has created a guide for Clinical Commissioning Groups (CCGs) to help identify areas of variation in emergency admissions in more and less deprived CCGs. Data in the guide is from the Hospital Episode statistics and Population Figures, both provided by NHS Digital.

Poorest cancer patients let down at end of life, says new report

Macmillan Cancer Support has published new research into more than half a million cancer patients’ final months and years to provide an overview of the experiences of people dying of cancer.

The report shows that:

  • each year, around 57,000 people die within a year of being diagnosed with cancer – and they have over 85,000 emergency visits in the short time between being diagnosed and dying.
  • cancer patients from the most deprived areas were 18% more likely to die in hospital than those from the least deprived areas. This is despite previous Macmillan research finding that most people with cancer, across all socio-economic backgrounds, prefer to die at home or in a hospice; and
  • cancer patients from the most deprived areas had in total around 15,000, or 15%, more emergency hospital admissions in the final year of life than those from the least deprived areas.

NHS trusts have prepared for a tough winter, but patient risk remains

NHS Providers has published a briefing Ready and resilient? How NHS trusts have prepared for winter which outlines in detail what has been done nationally and locally to prepare for extra winter pressures.

The report identifies continuing challenges and pressures facing hospital trusts:

  • lack of beds – the NHS is already running at 87% bed occupancy;
  • shortages of key staff groups including paramedics, GPs and A&E consultants and nurses;
  • funding pressures – the additional NHS funding for winter in the Budget was welcome but has come very late to be used to maximum effect; and
  • flu – this year’s strain is potentially the worst we have seen in two decades, having already placed health systems in Australia and New Zealand under severe pressure earlier this year.

Specific actions taken by trusts include:

  • steps to ensure the seamless flow of patients through to discharge;
  • local resilience plans with partner organisations such as social care services;
  • support to ensure people with mental health needs are treated in the right place;
  • initiatives that make it easier for staff to do the right thing; and
  • communications to complement the “Stay well this winter” national campaign.

Sharing best practice from clinical leaders in urgent and emergency care

CQC has developed a best practice resource for all NHS acute trusts to help meet the challenges of managing capacity and demand.

The publication, Meeting the quality challenge; sharing best practice from clinical leaders in emergency departments is a result of a workshop held earlier this year which brought together 36 senior clinicians and managers from 17 hospital trusts across the country.

Professor Ted Baker, Chief Inspector of Hospitals, said: ‘This resource provides practical examples and strategies that are being used by staff in emergency departments across the country to help manage risk and provide high quality care. By sharing these examples of best practice, we hope that staff in all hospitals can learn from them and adapt them to support improvement in the quality of emergency care for their own patients.

Reaching out: influencing the wider determinants of health

The New Local Government Network has published research which calls for public health to be more fully recognised as contributing to our nation’s growth potential.

Key findings include:

  • the Government must acknowledge health as an economic asset that boosts workforce productivity;
  • over 85% of senior public health officers surveyed found that economic development departments are not as engaged as they could be; and
  • £65 million should be invested in Health and Wellbeing Boards to enable them to invest in innovative public health pilots that address the wider determinants of health.

Working with schools to improve the health of school-aged children

The Local Government Association (LGA) has published a report which showcases the work being done by schools and LAs across the country to improve the health of children.

The case studies cover various topics such as mental and emotional health, healthy behaviours, sex education, oral health and nursing services.

Active people, healthy places

The LGA has published a report which aims to share good practice and help decision-makers consider how their council can deliver sport, leisure and physical activity in the best way for local people and communities.

This report includes 12 case studies from different LA areas. Six look at how councils are working with charitable leisure trusts to deliver services, facilities and activities while the other six have a focus on in-house provision of sport and leisure or sports development teams by councils.

The bill of health

A calculator has been created by GoCompare to enable people to find out how much their health has cost the NHS by totalling up operations, visits to the GP and A&E, number of prescriptions and various other diagnostics.

There is also a salary calculator to find out how much an individual has contributed towards the NHS.

Brexit: the implications for health and social care

The King’s Fund has published an article highlighting the developments that have taken place since the 2016 referendum.

Key facts in the article include:

  • Brexit appears to already be having an impact, especially on the recruitment and retention of European Union (EU) nationals in some parts of the workforce which is contributing to shortages of key staff;
  • Brexit may present some opportunities for the UK, in particular the chance to go further and faster on public health regulation and remove rules on competition that are currently inhibiting further integration and collaboration between health services; and
  • the UK’s membership of the European single market, customs union and Euratom has provided significant benefits. Securing equivalent access to new drugs and treatments must be a priority in the next phase of negotiations.

What’s going on with A&E waiting times?

The King’s Fund has published an article to highlight reasons for patients waiting longer in A&E departments.

The article looks at what different types of A&E departments there are, how A&E performance is measured, recent trends in waiting times and possible contributing factors.

It concludes that high levels of hospital bed occupancy, delays in transferring patients out of hospital, and staff shortages throughout the urgent and emergency care system have all had an impact on A&E waiting times.

NHS becomes first healthcare system in the world to publish numbers of avoidable deaths

DH has announced that every trust in England will be publishing quarterly data relating to the number of deaths due to problems in care. The data will not be comparable and will not be collated centrally. This will allow trusts to focus on learning from mistakes and sharing lessons across their organisations and their local healthcare systems.

Out in the cold: lung disease, the hidden driver of NHS winter pressure

The British Lung Foundation has published a new report which explores how the NHS can take a more seasonal approach to supporting people with lung disease, reduce unnecessary attendances and admissions, and ultimately improve patient care and outcomes.

Key facts in the report include:

  • in 2016/17, respiratory admissions peaked in December at 32,492 – far above the average of 10,652 for the 20 most commons disease areas;
  • there are 80% more lung disease admissions in the winter months of December, January and February then there are in the warmer spring months of March, April and May;
  • the vast majority of respiratory admissions are in infants and children aged 1 to 4 (17%), and people aged 65 and above (54%); and
  • over the last 7 years lung disease admissions to hospital have risen at over three times the rate of all other conditions (36.6% vs 11.1%).

Why it’s prime time to protect children from Junk food adverts

The Obesity Health Alliance has commissioned the University of Liverpool to analyse the adverts shown during some of the TV shows popular with children in February 2017 to examine how many adverts for food and drink products high in fat, sugar and salt (HFSS) children were exposed to. The findings of the analysis have been published in a new report.

Key findings include:

  • the majority (59%) of food and drink adverts shown during family viewing time would be banned from children’s TV, yet hundreds of children are exposed to these ads every week;
  • in the worst case example, children were exposed to nine HFSS adverts in a 30-minute period;
  • adverts for fruit and vegetables made up just over 1% of food and drink adverts shown during family viewing time; and
  • adverts for fast food and takeaways appeared more than twice as often as any other type of food and drink adverts – largely due to their tactic of sponsoring popular family shows.

Media monitoring

On Sunday 26th November 2017 the following story was published:

  • The Sunday Telegraph reports that paramedics are to be given new powers to prescribe medication in an effort to speed up access to treatment and prevent thousands of needless hospital visits. Ambulance workers with special training will be able to take on duties traditionally performed by GPs and hospital doctors, meaning many more patients can be treated on the spot.

On Monday 27th November the following story was published:

  • The Guardian reports that NHS England is urging parents to vaccinate “super-spreader” children against the flu, so vulnerable grandparents will be less at risk over the Christmas period. Children are “super-spreaders” because of the greater likelihood of them contracting the flu at nursery or school. But fewer than one in five school-age children, 18%, have had the nasal spray immunisation, according to the latest figures. This was also covered by the Times, the Telegraph and the BBC.

On Tuesday 28th November 2017 the following stories were published:

  • The Times reports that scarlet fever is at a 50 year high.
  • The Times reports that The NHS is to recruit up to 5,500 nurses from overseas in an “earn, learn and return” scheme to plug staffing shortages, health officials have said. The exercise comes as more UK graduates abandon the profession and the number of nurses coming from the EU falls sharply. This was also covered by the
  • The Times also reports that Viagra will be available for sale at your local chemist for about £5 a pill from the spring after a decision by the medicines regulator. The drug, used to treat sexual dysfunction, will be reclassified from a prescription-only to a pharmacy medicine, in 50mg tablet form. This was also covered by the BBC, Telegraph, Daily Mail, the Guardian, the Sun and Independent.
  • The Telegraph has also reported on new guidance by NICE which says that as many as 30% of people diagnosed with asthma may not have it.

On Wednesday 29th November 2017 the following stories were published:

  • The Times reports that The NHS is to recruit up to 5,500 nurses from overseas in an “earn, learn and return” scheme to plug staffing shortages, health officials have said. The exercise comes as more UK graduates abandon the profession and the number of nurses coming from the EU falls sharply. This was also covered by the
  • The Times also reports that Viagra will be available for sale at your local chemist for about £5 a pill from the spring after a decision by the medicines regulator. The drug, used to treat sexual dysfunction, will be reclassified from a prescription-only to a pharmacy medicine, in 50mg tablet form. This was also covered by the BBC, Telegraph, Daily Mail, the Guardian, the Sun and Independent.
  • The Telegraph has also reported on new guidance by NICE which says that as many as 30% of people diagnosed with asthma may not have it.

On Thursday 30th November 2017 the following story was published:

  • The Times and the BBC have covered warnings from the MHRA that slimming pills bought online could be dangerous, saying that patients should seek advice from a doctor before taking such pills.

On Friday 1st December 2017 the following story was published:

  • Prescribing restrictions are prominent in lots of the coverage, including the Times and the Independent as are the comments on waiting time targets and implementing NICE guidance.

On Sunday 3rd December 2017 the following story was published:

  • The Sunday Times reports that the UK has the third-lowest number of hospital beds per person in the European Union as well as the third lowest number of doctors, with only Romania and Poland worse off, a European Commission report has found.

On Monday 4th December the following story was published: 

  • The Times has reported that the growing popularity of buying medications online is a public health crisis in the making, writing that a growing number of unscrupulous and illegal websites have sprung up to meet the demand, exploiting regulatory loopholes to make huge profits.

On Tuesday 5th December the following stories were published:

  • The Independent reports on cuts to public health budgets and the effect on smoking cessation services.
  • The Mail has a story on millennials failing to turn up to GP appointments.

On Wednesday 6th December the following stories were published:

  • The Guardian has reported on a pioneering project which aims to double the amount of voluntary workers in hospitals and alleviate the pressure on staff in the health service.
  • The Independent has reported on the findings of a new study which show that three quarters of British people have cured an ailment or illness after Googling the symptoms on the internet, a study found. Research revealed that seven in ten people now self-diagnose and treat minor health issues rather than try and secure an appointment with their local GP.

On Monday 11th December 2017 the following story was published:

  • The Sunday Times and Mail on Sunday reported that the number of women using the contraceptive pill has dropped as women increasingly use an app called ‘Natural Cycles’ to avoid unwanted pregnancy.

On Tuesday 12th December 2017 the following story was published:

  • The Telegraph reports on an article in the BMJ which blames the cartoon Peppa Pig for fostering unrealistic expectations about family doctors. This was also covered by the Daily Mail and  Independent.

On Thursday 14th December 2017 the following stories were published:

  • The NHS Health Survey for England has indicated that half of all adults are taking prescription statins or antidepressants on a regular basis. The survey has been reported in the Daily Mail, Sun and Telegraph.
  • Health Education England has also published a report, covered by the Sun and the Times, in which it claims that the NHS staffing crisis has been caused by millennials insisting on only working part-time.
  • Channel 4 News had a piece on the 1,400 people with dementia who are facing spending Christmas in hospital.
  • The BBC has reported a BMJ study which says that larger wine glasses are encouraging greater alcohol consumption.

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