Virgin set to bid for £260m children's services contract (HSJ: 25 January 2018)
Fifth of prescribed antibiotics are unnecessary, study finds (The Guardian, 27 February 2018)
GPs are fuelling the growing threat of antimicrobial resistance by wrongly giving antibiotics to one in five patients who has a cough or sore throat, a government-funded study has found.
Family doctors are displaying “substantial inappropriate antibiotic prescribing” when dealing with patients who have an infection, according to research published by Public Health England (PHE), the government’s public health advisers.
Of the 32.5m antibiotics GPs in England prescribe every year “at least” 20% – 6.3m – are unnecessary, a panel of experts has concluded.
They said only 10% of patients with an acute cough should be given antibiotics, but 41% received the drugs, theydiscovered when they examined GP records.
Senior doctors and Jeremy Hunt, the health and social care secretary, seized on the overprescription to urge GPs to do more to thwart the growing ineffectiveness of some antibiotics, which leads to about 25,000 deaths a year in Europe.
The findings of the study – the first to quantify the number of antibiotics issued inappropriately in primary care – has led to renewed pressure on GPs to prescribe fewer. GPs record no clinical reason for issuing the antibiotics in a third of all prescriptions, they discovered.
Most antibiotic prescriptions are issued for respiratory and urinary infections, the experts found, but GPs are giving out far too many for conditions for which they are not justified, they say in a series of five articles in the Journal of Antimicrobial Chemotherapy. ...read more
Hunt to crack down on NHS drug errors linked to up to 22,000 deaths (The Guardian, 23 February 2018)
Jeremy Hunt is ordering an NHS crackdown on errors in dispensing drugs to patients, which research shows could be contributing to as many as 22,000 people dying every year.
The health and social care secretary says mistakes involving medication, both in the NHS and globally, are “causing appalling levels of harm and death that are totally avoidable”.
In a speech on patient safety on Friday he will outline new measures to reduce errors that researchers from York, Manchester and Sheffield universities say cause 712 deaths a year in England and may be implicated in between 1,700 and 22,303 others.
Patients can suffer harm or die when they are given the wrong drug or the wrong dose, and also from their prescription taking an hour more to be dispensed than it should, they found.
About 270m drug errors happen every year, though three-quarters result in no harm to patients, according to the findings, which were commissioned by the government.
Under Hunt’s plans hospitals will be able to access prescribing data collected by an admitted patient’s GP to see if drugs they have been taking have led to them being admitted to hospital. Initially that will involve only patients being treated for gastro-intestinal bleeding, which can cause harm or death. Doctors will be able to check, for example, if a patient has been taking a non-steroidal anti-inflammatory drug but not been given another drug to reduce the chances of them suffering digestive bleeding. The system will be extended later to other conditions.
The introduction of electronic prescribing systems into the NHS, which only a third of acute trusts have, will also be sped up. And pharmacists will be able to use new defences if they make a mistake with a patient’s drugs, replacing the current system, under which they can be prosecuted. ...read more
Virgin Care has indicated it will bid for an NHS contract to provide children’s community and mental health services in Devon worth at least £259m over seven years, HSJ has learned.
The company is the incumbent provider of most of the services being tendered after winning a contract in 2012.
A company spokesman said: “We’re looking forward to… continue to integrate and improve services in Devon from April 2019.”
Virgin’s contract was due to expire in the spring but last October it was given £35m to continue to run the service for another 12 months while Northern, Eastern and Western Devon Clinical Commissioning Group prepared for re-procurement.
The re-procurement process will begin next month, subject to the proposal being approved at a governing body meeting today....read more
Health visitors overstretched because of ‘cash-strapped’ councils (LocalGov.com: 5 December 2017)
A third of health visitors worry there will be a tragedy in their area because they are overstretched since ‘cash-strapped’ councils took over the service, a new survey reveals.
The Institute of Health Visiting’s (iHV) annual survey 2017 of over 1400 health visitors found one in three were concerned their heavy workload would lead to a tragedy in their area. This is up from 25% in 2015.
The poll also revealed more than one in five (21%) health visitors in 2017 are working with caseloads of over 500 children, which is in stark contrast to the one in eight (12%) reported in the iHV survey in 2015.
The iHV recommends an average of one health visitor to 250 children to deliver comprehensive health improvement....read more
Government cuts 'leave sexual health services at tipping point' (3 August 2017)
Sexual health services are at “a tipping point” with clinics unable to keep up with demand for tests and treatment, local council leaders have warned.
Central government cuts to local authorities’ public health budgets have left sexual health services struggling to cope with a 25% rise in patients seeking help over the last five years, the Local Government Association claims.
People with sexually transmitted infections face longer waits to see a specialist, and efforts to tackle outbreaks of STIs could be hit, the cross-party body says.
Whitehall-ordered cuts of £531m to public health budgets – almost a tenth of the total – “has left local authorities struggling to keep up with increased demand for sexual health services”.
The number of people attending sexual health clinics in England grew from 1.94 million in 2012 to 2.46 million last year, a rise of 25%. But the government clawed back £200m of the money it was due to give councils in 2015-16 for public health schemes and is cutting another £331m by 2020-21.
Councillor Izzi Seccombe, chairman of the LGA’s community wellbeing board, said: “We are concerned that this will see waiting times start to increase and patient experience deteriorate.
“The reduction in public health funding could also compound problems further and impact on councils’ ability to meet demand and respond to unforeseen outbreaks. We cannot tackle this by stretching services even thinner.”
The Department of Health’s own research shows that every £1 spent on sexual health services, including contraception, saves the public purse £11 in the long-term as a result of fewer unintended pregancies, for example.... read more
Jeremy Hunt has repeatedly failed to meet pledges on mental health care (The Guardian: 1 August 2017)
Jeremy Hunt, the health secretary, has announced plans to expand mental health provision with a £1.3bn injection that will see thousands of new posts created. This would be welcome news were it not for the fact that so far Hunt has failed to deliver on pledges that could have improved services.
For a start, the Health and Social Care Act (2012) made it unlawful to discriminate between physical and mental health. So far, regardless of whether it’s financial budgets or service delivery, mental health services have seen no significant improvement.
Indeed, we have seen the opposite; more than 50% of clinical commissioning groups cut their mental health budgets last year. There has been a trend that when the NHS is under financial strain, mental health budgets get disproportionate cuts. All too frequently we have seen health commissioners raid these budgets to plug growing deficits in the acute hospital sector. Hunt has had ample time to correct the chronic underfunding, and with many mental health organisations struggling with his government’s imposed austerity cuts, we would argue that this is too little, too late.
Mental health services are also facing increasing demand. One in four adults experience at least one diagnosable mental health problem in any given year. A leaked report by a government taskforce painted a devastating picture of England’s mental health services, revealing that the number of people killing themselves is soaring, that three-quarters of those with psychiatric conditions are not being helped and that sick children are being sent “almost anywhere in the country” for treatment. The failure to prioritise and ringfence resources for services has led to a crisis in mental health provision in this country.... read more
CCGs face 'impossible' choices to deliver higher savings targets (HSJ: 26 July 2017)
Local commissioners must deliver efficiency savings of almost 4 per cent to meet their financial targets this year, despite failing to get close to last year’s target of 3.2 per cent.
HSJ also understands around 20 clinical commissioning groups have been asked to resubmit their plans with a “more challenging” savings target. If they do so, this would push the average savings requirement higher.
The financial plans for CCGs, which are based on their funding allocations and have now been assured by NHS England, demand average efficiency savings of 3.8 per cent in 2017-18, according to NHS England’s finance report for July.
In 2016-17, CCGs had to plan for savings of 3.2 per cent but only achieved 2.6 per cent.
Julie Wood, chief executive of NHS Clinical Commissioners, which represents CCGs, said the funding allocations and targets mean local leaders are having to make “really difficult, bordering on impossible, choices”.
She added: “Recent NHSCC analysis highlighted how rising inflation, along with a growing population, means that while on paper the funds allocated to CCGs are going up, in reality the value of the CCG pound is shrinking.
“Far more CCGs are in deficit or have deficit control totals. Their quality, innovation, productivity and prevention programme [efficiency] targets are getting higher and for many they don’t have formal plans for how they will deliver all of what is needed.
“Previous QIPP targets were lower but still the commissioning sector struggled to deliver them fully, so confidence to deliver these higher levels is low.”
In 2016-17, CCGs reported an in year overspend against their plans of £550m. If CCGs achieved the same level of savings in 2017-18 as last year (2.6 per cent) this could result in an overspend of around £900m.... read more
Cuts a huge step back for public health (20 July 2017)
Doctors have warned of a ‘huge step back’ in public health after research revealed big cuts to sexual health, quit-smoking and substance-abuse services.
The reductions were identified in King’s Fund analysis of financial figures from the local authorities, which took over the services from the NHS in 2013.
The think tank’s study shows a 5 per cent drop in planned expenditure in 2017/18 compared with 2013/14.
Planned expenditure on some services has fallen even further. Stop-smoking services have been cut by 15 per cent; support for drug addicts has dropped by 5.5 per cent.
Sexual health services have been reduced by 10 per cent over the past four years – despite significant rises in sexually transmitted diseases including syphilis and gonorrhoea.
BMA public health committee chair Iain Kennedy said such cuts signified ‘a huge step backwards for public health’.
The cuts will have a ‘damaging impact on people’s health and well-being, inevitably costing the NHS far more in the long term’, he added.
‘Public health services are more vital than ever in delivering preventive care.’
A third of Britons are projected to be obese by 2030 and smoking accounts for around 100,000 deaths a year in the UK.... read more
Exclusive: New national savings drive will 'challenge the values' of NHS leaders (HSJ: 5 June 2017)
Closing wards and services, blocking choice of private providers, systematically extending waiting times, and stopping some treatments are all being considered under a national programme targeted at the health economies with the highest overspends.
The controversial measures are currently being discussed privately by national NHS England and NHS Improvement officials, with senior local NHS leaders, as part of the new “capped expenditure process”. The principle of the process, introduced this year, is to “cap” NHS spending in the targeted areas so that they meet ”control total” budgets in 2017-18.
NHS leaders from areas covered by the CEP have been told to examine “difficult decisions” and “think the unthinkable”, including modelling changes which are normally avoided as they are too unpleasant, unpopular or controversial. HSJ has spoken to senior officials in most of the areas... read more
Our entire country is in denial about the NHS, including Philip Hammond (The Independent: 21st February 2017)
Imagine a large barrel that we pull apart, reconstruct and expand (at considerable expense) every year.
Imagine we need to store a certain amount of precious liquid in that barrel. Now imagine that the amount of liquid we need to store each year is rising faster than the volume of the renovated barrel. The result is overspill and flooding, which makes everyone unhappy.
Here we have a description of the NHS crisis...Read More
NHS loses 9% of public health nurses in a year, triggering fresh workforce warnings (The Nursing times: 17th February 2017)
The number of health visitors working in the NHS in England has fallen by almost 9% in the space of a year, leading to warnings by senior nurses that the workforce could soon return to previous dangerously low levels.
New analysis by Nursing Times of the latest official data has revealed NHS school nurse numbers have also dropped by 6% in the same amount of time.
The reduction in staffing levels has taken place in the 12 months since the commissioning of public health services fully transferred over to cash-strapped local authorities, in October 2015.
The data appears to confirm fears that ongoing cuts to council public health budgets by the government are leading to a significant reduction in nurses working in children’s services...Read More
Public health cuts put Cornwall and Isles of Scilly STP savings at risk (National Health Executive: 28 November 2016)
Cornwall Council has warned that savings in the Cornwall and Isles of Scilly STP may not be achieved because of cuts to its public health budget.
Caroline Court, the interim director of public health at Cornwall Council, who represents the council on the STP project board, raised the concerns in a report published ahead of a meeting of the Health and Adult Social Care Overview and Scrutiny Committee tomorrow.
In 2015-16, £2m of Cornwall’s public health budget was reallocated to other services, such as prevention within adult social care. The council agreed not to reallocate any other funding until 2019-20, but it still faces a further £4m budget reduction because of cuts to the national government grant.
It has met the cuts so far by scaling down staff in the core and health promotion teams; reducing the value of contracts for drug, alcohol and sexual health services; and cutting the budget for NHS health checks in primary care. ...Read More.
'Desperate situation' faced by public health (BMA: 24 June 2016)
In 2014, the Five Year Forward View said ‘… the future health of millions of children, the sustainability of the NHS and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health’ — to which the chancellor has responded by cutting public health budgets. Twice — and with more on the way.
The impact of the cuts in areas such as drug misuse and alcohol was a major focus of this year’s BMA annual representative meeting.
In his keynote address, BMA council chair Mark Porter condemned the ‘shoddy sleight of hand’ by which the Government had circumvented its promise not to decrease NHS spending by placing public health outside the NHS.
He said smoking cessation and sexual health services were among those under threat, adding: ‘You can't trade a public health policy for an e-cigarette and crossed fingers.’
At the ARM, doctors condemned the cuts in strong terms — for their impact on patients and on the workload of doctors as the opportunity to tackle the burden of avoidable illness was squandered.
Cambridge GP Alice Hodkinson said the Government had ‘initially supported public health’ before embarking on the damaging cuts.
She added: ‘What will those cuts mean? Reductions in services, impacting on the poorest families… Public health cuts put pressure on the NHS. These cuts will impact most on the vulnerable.’
The threat posed by the reduction in public health budgets, now in the hands of local authorities, are very real, according to our research.
Cuts to Brighton and Hove’s sexual health service risk ‘increasing the prevalence of sexually transmitted diseases, including HIV’, its council says.
Meanwhile, cuts in Surrey are predicted to have an adverse effect on support for women suffering domestic abuse, while older and vulnerable adults in south London are likely to be lonelier and more isolated when its befriending service is cut, according to an impact report from Merton Council....read more
Threat of public health nurse cuts now becoming a reality (Nursing Times: 3 May 2016)
Council cuts to budgets for health visiting and school nursing services that are putting jobs at risk threaten to “unravel” recent national efforts to boost the workforce, it has been warned.
Local authorities took over the responsibility from the NHS for commissioning for services for all 0 to 19 year-olds in October. But since then the government has announced a string of cuts to the public health funding it provides to local councils.
Last summer, it announced £200m public health in-year cuts for 2015-16, which it later confirmed would be applied evenly as a 6.2% reduction for each council.
Earlier this year, the Department of Health announced it would decrease local council public health grants by £77m in 2016-17, with additional reductions expected the year after.
Nursing Times has now learnt of several regions where authorities are cutting or reviewing the budgets for health visiting and school nursing, which are paid for out of the public health grant.
Due to proposed workforce cuts and reconfigurations, it has been claimed these services could in the future be run at “dangerous” and “unsustainable” levels....read more
Liverpool NHS jobs face the axe because of community health funding cuts (The Liverpool Echo: 17 February 2016)
Up to 30 NHS staff in Liverpool could lose their jobs as services including exercise classes for dementia patients and anti-smoking sessions face the axe.
Liverpool council is cutting the amount of cash it gives to Liverpool Community Health NHS Trust (LCH) – leaving staff in a “difficult and uncertain time”, according to trade union Unison.
Services that could be cut include healthy eating campaigns, stop smoking sessions for pregnant women, exercise classes for dementia sufferers and work to promote dental health. Unison warned the cuts will damage the city’s health in the long run by storing up problems for the future. A statement from the union said 30 LCH staff now fear losing their jobs due to the cuts...read more
GP contraceptive services cuts are 'impacting on patient care' (Pulse: 15 February 2016)
Public health experts have warned that cuts to GP-run contraceptive and sexual health services will lead to worse access and lower quality of care for patients.
The Faculty of Sexual and Reproductive Health (FSRH) said the loss of GP contracts, as exposed by Pulse last week, had ‘worrying implications’ for the provision of long-active reversible contraception (LARC) in particular.
In a statement the Faculty said it had been contacted by a number of concerned GPs since Pulse's article was published and that its 'members are saying these cuts are impacting directly on patient care’.
Pulse's investigation revealed that GPs are losing contracts to provide LARC services in both York and London, while in one area of Devon, GP practices are facing a cut in the number of LARC fittings GPs are funded to perform – meaning they will have to drop the service altogether...read more
GP contraceptive services cut as councils target public health budgets (Pulse: 10 February 2016)
Local councils in England are scaling back GP-run contraceptive and sexual health services under a new wave of cost-saving plans that GP leaders have warned will reduce access for patients and cut off an important funding stream for practices.
A Pulse investigation has found more than 20 local councils so far that are potentially taking away the services from GP practices.
This includes complete closure of GP-run sexual health and contraceptive services in York, while 19 London boroughs are putting services out to tender, which GP leaders warn will mean fewer practices carrying out the services...read more
LMC sounds alarm over council's £8m cut to public health (Pulse: 25 January 2016)
GP practices will ‘struggle to cope’ as Government policy is forcing public health budget cuts of several millions in some areas.
GPC deputy chair Dr Richard Vautrey, a GP in Leeds, said already under pressure practices would be picking up work when Leeds City Council is forced to cut £7.8m off its public health budget over the course of the next two years.
The council has just annunced its latest round of cuts, of £3.9m in 2016/17 and £1.1m in 2017/18, as public health funding is already due to reduce by £2.8m by the end of the current financial year - amounting to a reduction of almost £8m in total.
The council still has to find £600,000 further savings by April, with local reports suggesting Leeds’ only HIV support service, run by BHA Leeds Skyline, could lose its contract in March.
Ahead of the April deadline, the council has already cut £2.2m from 22 public health services including smoking cessation services worth £127,000 and £25,000 from sexual health services...read more
Councils cut hundreds of thousands of pounds from stop smoking services (Pulse: 22 January 2016)
Councils are cutting their smoking cessation budgets by hundreds of thousands of pounds - a move that experts warn will see ‘far fewer people’ quit smoking in the coming years.
Pulse has learnt of six major metropolitan and county councils that are cutting smoking cessation budgets.
GPs have warned that this will set smoking cessation back ’15 years’.
Smoking charity ASH reported as many as 40% of local authorities will have to shrink their budget for stop smoking services.
This follows the Government’s decision to cut £200m from the public health budget last year – which it said will not result in frontline services being cut.
However, Pulse has found six councils that are cutting services...read more
Medical training and public health budget hit as chancellor slashes non-NHS funding (Pulse: 25 November 2015)
The Government is cutting the Department of Health’s budget for non-frontline services such as medical training and public health by £1.5bn next year, it revealed in today’s long-awaited Spending Review announcement.
Chancellor George Osborne confirmed that he was increasing the NHS budget by £3.8bn from next year, as part of plans to raise the overall budget by £10bn by 2020.
However, today’s announcement revealed that some of this funding will come from cuts to other parts of the budget.
Health experts said that such cuts were a ‘false economy’, and would lead to greater costs further on...read more
Government cuts to sexual health services could cost NHS ‘billions’ over next decade (Pulse: 17 November 2015)
The Government’s planned cuts to public health budgets could end up costing the health service in the region of £3.5bn over the next 10 years as unintended pregnancies and sexually transmitted infections (STIs) go up, sexual health experts are warning.
A report by the Family Planning Association anticipated cutbacks as a result of the Government’s £200m cut to local councils’ public health budgets, due to take effect from January, will hit sexual health and contraceptive services particularly hard.
The possibility of further cuts to be announced in the Chancellor’s spending review next week will exacerbate this, it added.
Assuming a 10% reduction in access to these services, economists estimate this could cost an extra £2.4bn over the next 10 years on healthcare related to unwanted pregnancies, and an additional £1.1bn on dealing with STIs.
Slashed budgets and STIs: The painful truth about birth control services in Britain today (The Independent: 16 June 2015)
‘Very worrying for sexual health, as well as other services: Government announces £200m cuts to public health budget.’
So tweeted the All-Party Parliamentary Group on Sexual and Reproductive Health last week, after George Osborne’s announcement that the Department of Health must make £200 million pounds worth of savings from public health budgets.
The news was met with alarm from the UK’s sexual and reproductive health (SRH) services.
Already a ‘Cinderella service’, SRH care has historically been less well funded or supported than other areas of health, and often finds it hard to attract and retain staff.
The proposed cuts could make huge differences to whether you can get an appointment when you need it or even the contraceptive you want.... read more
Only support service for vulnerable people with HIV in Leeds to be axed by city council (Yorkshire Evening Post: 15 October 2015)
Leeds’ only HIV support service faces closure, prompting fears it could leave hundreds of vulnerable people at risk.
BHA Leeds Skyline, on The Headrow, has received notification from Leeds City Council that its contract will not be renewed as of March 31 next year.
The council cited the £2.8million public health cut handed down by the Government earlier this year as a major reason for the decision but said it will work with service users and staff to address any uncertainty.
The director of the HIV support service has branded the decision “short sighted” and called on policy makers to consider the wellbeing of the 1,200 to 1,300 people in the city living with HIV and AIDS. Further cuts to services such as smoking cessation, physical health work and suicide prevention will be discussed by the council’s health scrutiny board on Tuesday...read more
GP funding withdrawn as direct result of Government public health cuts, says local council (Pulse: 21 September 2015)
Public health commissioners were forced to cap funding of GP-run NHS Health Checks as a direct result of the Government’s mid-year cuts in funding, a local authority has said. Hertfordshire County Council told Pulse it needed to make savings as a result of the cuts – and hoped GPs would come to an agreement with them over how to achieve this. The Government introduced a £200m cut in the public health budget in June as part of a raft of measures to ‘bring down public debt’ – although it insisted this was on projected underspends and would not affect frontline services. As revealed by Pulse, public health commissioners in Hertfordshire recently wrote to GP practices to request the change to their contracts – meaning they will be paid only for the health checks they have already completed so far this year. Local GP leaders have vowed to fight the contract change, warning that it will force practices to lay off staff and cut other GP-run services, but say they have been accused of putting GPs’ ‘personal interests’ ahead of the need to sustain other public health services such as those for drug and alcohol misuse...read more
Doctors say public health cuts will hurt NHS (On Medica: 26 June 2015)
Doctors have voted to oppose cuts to public health budgets that they say will damage the nation’s health and increase costs and pressures on the NHS.
In an emergency motion at the BMA’s annual representative meeting in Liverpool yesterday, doctors voted unanimously for the motion, which condemned Chancellor George Osborne’s decision to cut £200 million from the public health grant given to local authorities.
They also rejected what was called the “spurious justification” that the public health grant is non-NHS funding. Public health became the responsibility of local authorities as a result of the Health and Social Care Act 2012.
Dr Iain Kennedy, chair of the BMA’s public health committee, said that Mr Osborne’s decision would directly damage the public’s health and increase pressure on the NHS.... read more