Health & Care Review
Health & Care Review
January 22, 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.
UK flu levels remain high according to PHE statistics
According to Public Health England (PHE)’s latest weekly national flu report, seasonal flu activity levels have continued to increase in the last week across the UK but various indicators show that the rate of increase is slowing.
The statistics show over the last week there has been an 11% increase in the flu hospitalisation rate, a 42% increase in the GP consultation rate with flu like illness compared to the previous week (when practices were open for 4 days), and an 8% reduction in the flu intensive care admission rate.
PHE is continuing to run the ‘Catch It, Bin It, Kill It’ campaign across digital, radio and press channels to help reduce the spread of the virus.
World leading cancer dataset shows improvements in diagnosis
The National Cancer Registration and analysis Service, part of PHE, has published the latest Routes to Diagnosis study which now covers demographic, organisation, service and person reasons for delayed cancer diagnoses. The study now includes 10 years’ worth of data and more than three million cases of cancer, making it the most comprehensive dataset of its kind in the world.
Key findings in the study include:
- diagnoses from emergency presentations, where outcomes are the worst, have improved falling from 24% to 20% between 2006 and 2015;
- diagnoses through urgent GP referrals – 2 week waits – have increased significantly from 25% in 2005 to 37% in 2015, meaning that around 110,000 cases are now diagnosed this way; and
- the number of cancer cases diagnosed in Accident and Emergency varies across the country, ranging from 8% of all cases in the Peninsular Cancer Alliance to 20% of all cases in the London Cancer Alliance – this is despite similar cancer incidence levels.
This latest update includes a new interactive tool which, for the first time, shows trends in cancer diagnosis for 53 different types of cancer. By using the tool doctors and managers will be able to quickly and easily see the differences between cancers and understand where survival rates are improving.
The wellbeing of 15-year-olds: analysis of the What About YOUth? Survey
PHE has published the findings of a survey it conducted in 2014 to understand the relationship between mental health behaviours and attitudes on the wellbeing of 15-year olds.
Key findings from the survey include:
- young people who engaged in behaviour which might harm their health such as drinking and smoking, having poor diet or exercising rarely, or who had negative feelings towards their body size reported lower wellbeing than those who did not;
- self-reported wellbeing varied depending on the relative affluence or deprivation of the family, with those whose families were in more affluent groups and living in the least deprived areas reporting higher average wellbeing;
Commissioners and providers of health, social care and education can use this information to target local resources where they are likely to have most impact in terms of improving the wellbeing of young people.
Teenage pregnancy prevention framework
PHE has published a framework which acts as guidance for local teenage pregnancy prevention programmes.
The framework helps local areas to prevent unplanned pregnancies and support young people to develop healthy relationships by:
- understanding what is working well;
- identifying any gaps; and
- taking a multi-agency whole-system approach.
The framework also contains a summary of national data, international evidence, and how to apply the ten key factors identified for an effective teenage pregnancy prevention strategy.
The teenage pregnancy narrative reports bring together key data and information for local authorities (LAs) to help inform commissioning decisions to reduce unplanned teenage conceptions and improve outcomes for young parents.
High impact change model examples of emerging and developing practice
The Local Government Association has published a new model that offers a practical approach to managing transfers of care.
The model identifies eight system changes that could have the greatest impact on reducing delayed discharge:
- early discharge planning;
- systems to monitor patient flow;
- multi-disciplinary/multi-agency discharge teams, including the voluntary and community sector;
- home first/discharge to assess;
- seven-day services;
- trusted assessors;
- focus on choice; and
- enhancing health in care homes.
The model contains an editable action plan which can be used to support collaboration across local systems.
Adoption and spread of innovation in the NHS
The King’s Fund has published an article which discusses how to speed up the adoption of service innovation in the NHS. It draws up eight case studies of successful spread of innovation supported by academic health science networks (AHSNs). The authors of the article interviewed, where possible, originators of innovations as well as the AHSN staff for supporting adoption and spread in order to understand their experiences and challenges.
Key facts in the article include:
- for many of the innovations in the case studies, success depended on much earlier diagnosis and intervention than delivered by previous approaches, fundamental changes to staff roles and empowering patients to play a more active role in their own care;
- the case studies highlight the opportunities for improvement that come from overcoming siloed thinking as much as operational silos; and
- the decision to introduce one innovation had a domino effect, triggering a series of changes to diagnosis, treatment and the roles of staff and patients and revealing new patient needs – this can help to explain why spread of innovation in the NHS is a difficult and costly process, even if the innovation appears simple.
No hospital is an island – learning from the acute care collaborations
NHS England has published a report which summarises learnings from 13 acute care collaboration (ACC) vanguards as part of the new care models programme. It outlines what they are doing to improve the quality and sustainability of services, and how their collaborations are managed and governed.
The report covers: ACC improvement strategies; implementation an ACC; and measuring the benefits of ACCs.
The report categorises ACCs into three types: hospital groups, multi-service networks and single-service networks.
The report concludes that although the majority of the models are still in their infancy, acute provider collaboration will remain vitally important in improving care for patients and securing the sustainability of the NHS.
Lessons from ‘home and away’ on transitioning to strategic commissioning in new NHSCC publication
NHS Clinical Commissioners has published a new report to support its transition to a more strategic commissioning function. It also contains key lessons identified, which national bodies and clinical commissioners need to be aware of when transitioning towards strategic commissioning arrangements. The lessons were drawn from the perspectives of those implementing and developing policy around the new care models and from research of international models, primarily of high performing place-based systems of care that have developed in New Zealand, Sweden, Spain and the United States.
Key recommendations include:
- the patient must be placed at the centre with a focus on quality;
- clinical commissioning leadership and engagement must be retained; and
- national clarity on the ‘end state’ is essential.
Making sense of accountable care
The King’s Fund has published information on accountable care as the latest ‘health policy buzz phrase’ to explain where it comes from and what it means. There is a longer version of the article and a shorter, easy-read version.
The term ‘accountable care’ originated in the United States at the time of President Obama’s health care reforms and it is increasingly used in the NHS to describe how the Forward View is being implemented. The context in which accountable care is being taken forward in England, where public financing and provision predominate, is, however, quite different to that in the United States.
The longer article explains the differences between accountable care partnerships, accountable care organisations and accountable care systems. It also discusses how accountable care is being implemented across the country and what is has achieved.
Funding system failing people with continuing healthcare needs
The House of Commons Committee of Public Accounts has published a report on continuing healthcare funding (CHC). CHC is a package of care provided outside of hospital that is arranged and funded solely by the NHS for individuals who have significant ongoing healthcare needs, who are deemed eligible. If someone is not eligible for CHC, they must pay for all or part of their social care costs.
The report concludes that people are waiting too long to find out if they are eligible for CHC and to receive CHC if eligible. Additionally, some patients are not receiving the care they are entitled to because the system is either too difficult to navigate, or they are being poorly assessed due to local interpretation of the eligibility criteria.
There are also recommendations made in the report on how the system could be improved for those with ongoing healthcare needs.
The effect of drug and alcohol treatment on re-offending
PHE and the Ministry of Justice have published a report on the links between substance misuse treatment and the impact on re-offending by people after leaving prison.
Key facts in the report include:
- 35% of those accessing treatment had been recorded as committing at least one offence in the two years immediately prior to accessing treatment in 2012;
- opiate clients had the highest prevalence, with 47% of those starting treatment in 2012 having a recorded offence in the previous two years;
- in the two-year period following the start of treatment, 56% of pre-treatment offenders went on to re-offend; and
- alcohol only clients showed the largest reductions in both re-offenders and re-offending.
Healthy High Streets: good place making in an urban setting
PHE has published a report which examines how high streets are used as an asset to improve the overall health of local communities. It aims to help with the implementation of street design principles to make high streets more inclusive, safe, and healthy, particularly in areas of high deprivation.
The report is aimed at local decision makers, town managers, public health professionals and others involved in implementing street design principles.
Broadcast regulations aren’t enough to protect kids from TV junk food ads, says CRUK
Cancer Research UK has published a new report by the Policy Research Centre for Cancer Prevention which considers whether new marketing regulations around junk food advertising are needed, ten years on.
The report, 10 Years On: New evidence on TV marketing and junk food eating amongst 11-19 year olds 10 years after broadcast regulations, finds that teenagers who watched more than three hours of commercial TV a day are more likely to eat hundreds of extra junk food snacks.
Key facts in the report include:
- teens who said they regularly streamed TV shows with ads were more than twice as likely (139%) to drink fizzy drinks compared to someone with low advert exposure from streaming TV, and 65% more likely to eat more ready meals than those who streamed less TV;
- on-demand streaming services with adverts were associated with increased risk of unhealthy eating/drinking; and
- genres watched by family audiences on evenings and weekends were perceived by participants to be the main source of exposure to junk food marketing.
Funding cuts mean stop smoking services can’t offer support
Cancer Research UK has published a new report, jointly produced with Action on Smoking and Health (ASH), has published a report focussing on LA budget cuts and smoking cessation service provision. Figures from Cancer Research UK and ASH show half of LAs cut budgets for Stop Smoking Services in 2017. Additionally, the report states that 40% of LAs are not providing support for smokers in line with guidelines from the National Institute for Health and Care Excellence.
Key facts include:
- budgets for smoking cessation medications were cut in 34% of LAs that paid some or all of these costs (they increased in 6%);
- specialist stop smoking services have been replaced by integrated lifestyle services in 17% of LAs;
- one LA reported no current stop smoking services of any kind for smokers; and
- in 75% of LA, stop smoking services support the use of e-cigarettes by smokers in their attempts to quit.
On Sunday 14th January 2018, the following stories were published:
- The Sun on Sunday reported that three million people were in need of a flu vaccination following the outbreak, but pharmacists have warned of shortages of the vaccine.
On Monday 15th January 2018, the following stories were published:
- The Times has also reported that trans patients are losing routine screening for gender-specific cancers, following changes to the way in which people register their gender with their GP.
- The Times has a story about a community café which has been established in Aldershot to support people with mental health issues and alleviate pressures on A&E.
- The Daily Mail has reported that the winter death rates have jumped by 6% following this year’s flu outbreak.
- The BBC reported on Saturday that a growing crisis in the dental service meant more children were having operations to have their teeth removed.
- The Observer reported that medical students have been encouraged to volunteer on A&E units to alleviate this year’s NHS crisis.
On Tuesday 16th January 2018, the following story was published:
- The Daily Telegraph has reported on the developing of the “digital pill” – a drug that tells a doctor when the patient has taken it.
On Wednesday 17th January 2018, the following story was published:
- There are reports in the Mirror, Times and BBC of a measles outbreak across the UK, with over 100 cases reported. The increase in cases is being blamed on the legacy of the MMR scare.
On Thursday 18th January 2018, the following story was published:
- GPs are seeing up to 40 patients a day and working beyond safe levels, says the Guardian.
On Friday 19th January, the following story was published:
- The Times says the NHS is facing a legal challenge from homeopaths over a decision to stop funding alternative medicine.
- The Daily Mirror reports that antacid pills taken by millions of Britons double the risk of getting stomach cancer, a major study has found.