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
Thousands of mental health patients spend years on secure wards (20 July 2017)
Thousands of mental health patients are being kept in secure wards for years at a time when they should be being rehabilitated and preparing to leave hospital, a NHS watchdog has revealed.
The Care Quality Commission (CQC) criticised both NHS and for-profit mental health providers for forcing such a large number of patients to endure what it called “outdated and sometimes institutionalised care”, often miles from home. The practice leaves already vulnerable patients feeling isolated and less likely to recover, the CQC warned.
More than 3,500 patients in 248 mental health wards are kept locked-in. In 2015-16 some stayed for 45 days, but others had been there for up to 1,744 days – four and a half years – the care regulator found.
“More than 50 years after the movement to close asylums and large institutions, we were concerned to find examples of outdated and sometimes institutionalised care,” said Paul Lelliott, the CQC’s deputy chief inspector of hospitals.
“We are particularly concerned about the high number of people in ‘locked rehabilitation wards’. These wards are often situated a long way from the patient’s home, meaning people are isolated from their friends and families. In the 21st century, a hospital should never be considered ‘home’ for people with a mental health condition.” ... read more
Call for tighter checks on private hospitals used by NHS after MRSA case (20 July 2017)
Theresa May has been urged to tighten checks on private hospitals used by the NHS after a Labour MP raised the case of a young patient with an open wound who contracted MRSA on a private mental health ward.
Louise Haigh, a Labour frontbencher, called for the NHS to thoroughly investigate the quality of care before it commissions beds and treatment from private providers.
She cited the case in her of a “young women with MRSA with open wounds” on a child and adolescent mental health ward at Cygnet hospital Sheffield, which a report by a healthcare watchdog rated as inadequate in terms of safety.
“NHS England commissions child and adolescent mental health beds at a private hospital in my constituency, which recently received a damning Care Quality Commission report,” she said.
“Does the prime minister share my concern that a shortage of mental health beds risks the NHS placing vulnerable young people in unsafe environments, and will she consider giving NHS England the responsibility for, and the resources to investigate, the quality of care before it commissions?”
In response, May promised to ask Jeremy Hunt, the health secretary, to investigate, while highlighting a “a number of steps to improve mental health” provision in the NHS, including an increase in funding.... read more
NHS England 'urgently needs 2,200 more A&E consultants' (19 July 2017)
Hospitals are being urged to urgently more than double the number of consultants on duty in A&E units in order to ensure that patients receive safe care. The NHS in England must recruit 2,200 extra A&E consultants in the next five years, more than the 1,632 who already work there, according to the body representing emergency medicine doctors.
The increase is needed to help the NHS avoid the sort of winter crisis that occurred last winter and to stop A&E doctors quitting due to burnout, the Royal College of Emergency Medicine (RCEM) claims. Dr Taj Hassan, the college’s president, said the costs of such a dramatic rise could be covered by redirecting the £400m a year hospitals currently have to spend on locum and agency A&E doctors as a result of understaffing.
“It is vital that we get our staffing right. Each emergency medicine consultant in England is responsible for around 10,000 patients a year. Our staff are working to the very limits of their abilities to provide safe, compassionate care. This is leading to burnout and doctors leaving the profession, creating a vicious circle,” said Hassan, a consultant in Leeds.
The growing number of doctors choosing to work part-time, and the continuing rise in demand for A&E care, also help explain why so many more consultants are needed, Hassan added. The 1,632 existing consultants make up over one in four of the 6,261 doctors overall who work in A&E in England; the others are mostly trainees.... read more
HPV vaccine: anger over decision not to extend NHS scheme to boys (19 July 2017)
A decision not to vaccinate boys against a cancer-causing sexually transmitted infection has been condemned by health bodies and campaigners.
The Joint Committee on Vaccination and Immunisation (JCVI), which has been reviewing the human papilloma virus (HPV) vaccination programme, concluded that it was “highly unlikely to be cost-effective” to extend the scheme to include adolescent boys as well as girls.
Since 2008, all girls aged 12 to 13 are offered the HPV vaccination as part of the NHS childhood vaccination programme, and the JCVI has been considering whether to include boys on the scheme since 2014.
Up to eight out of 10 people will be infected with the virus at some point in their lives and it has been linked to one in 20 cases of cancer in the UK, according to health professionals. Campaigners have been calling for a gender-neutral approach to the vaccination, which would ensure that 400,000 school-age boys are not left at risk.
The committee, which has yet to publish its final recommendation, said in an interim statement that studies “consistently show” boys are afforded “considerable herd protection” when there is high uptake of the vaccine in girls.
Critics called the decision “indefensible”. The Faculty of Sexual and Reproductive Healthcare (FSRH), a membership body for healthcare professionals who work in sexual and reproductive health, said the decision should be reversed when the JCVI meets again in October.... read more
Midwives call for 'urgent' funding for mental health care for new mothers after postnatal depression death (18 July 2017)
There is an "urgent need" for more funding for mental health care for expectant and new mothers, leading midwives have said.
The comments from the Royal College of Midwives come after a report claimed services across the UK are "under resourced".
Researchers wrote the report following an online petition which gathered more than 55,000 signatures calling for the NHS to review how it treats and cares for women with postnatal depression.
The petition was set up by Lucie Holland, whose sister Emma Cadywould died following a battle with postnatal depression.
The report states that Ms Cadywould took her own life six months after giving birth to her first son - despite having been under NHS-led mental health care.
Her family urged health officials to look into the care of women with the condition, saying that if she had been referred for specialist care she would have recovered.
Dr Alain Gregoire, chairman of the Maternal Mental Health Alliance, added: "Emma's tragic death as a result of a severe perinatal mental illness offers us all an urgent wake-up call.
"We must act now to prevent more women from suffering or dying unnecessarily.
"Recovery through good support and care should be the norm if women and families everywhere have access to high quality specialist services, but it is still a postcode lottery. This has to change." ...read more
NHS staff shortages to blame for big rise in cancelled operations on children and young people, Labour warns (17 July 2017)
Operations on children and young people are being cancelled in huge numbers as NHS staff shortages bite, Labour reveals today.
More than 12,000 procedures – including for broken bones and treatments under anaesthetic – were scrapped last year, a rise of 35 per cent in just three years, the party said.
A lack of available anaesthetists, surgeons, consultants or theatre staff, as well as bed shortages and a lack of theatre time, were key reasons given by health bodies for the cancellations.
Labour’s research had uncovered 12,349 cancellations of surgical procedures planned for children and young people in 2016-17, across 76 health trusts, Mr Ashworth said.
This was 35 per cent higher than in 2013-14, when 9,128 cancellations were recorded, he said.
The total number of cancelled children’s operations since 2013-14 was 46,211 – with by far the highest number in London at 12,904.... read more
Sick patients dying ‘unnecessarily’ in NHS because of poor care (15 July 2017)
Some of the sickest patients that hospitals treat are dying unnecessarily because they receive poor care, blighted by shortages of staff and equipment, a new NHS inquiry has revealed.
A death rate of one in three among inpatients who need emergency help with breathing is already high by international standards, and is getting worse.
The analysis by the National Confidential Enquiry into Patient Outcome and Death of NHS services for the 50,000 patients a year who receive emergency oxygen treatment uncovered a series of major flaws in the care they received. It described its findings as “shocking”.
The growing numbers of patients who receive non-invasive intervention (NIV) – oxygen through a face mask – usually have chronic obstructive pulmonary disease, pneumonia or other conditions which mean they cannot breathe unaided. Despite their lives being at risk, the vast majority receive sub-standard care, according to an in-depth examination of 353 patients during February and March.
“The care of these patients was rated as less than good in four out of five cases. The mortality rate was high: more than one in three patients died,” the inquiry found. “Supervision of care and patient monitoring were commonly inadequate. Case selection for NIV was often inappropriate and treatment was frequently delayed due to a combination of service organisation and a failure to recognise that NIV was needed.” In addition, investigators found from examining case notes that “the quality of medical care provided was often poor. This poor care included both non-ventilator treatment and ventilation management, which were frequently inappropriate”.... read more
Ambulance trust accused of jeopardising patients by sending cars (13 July 2017)
Health chiefs have been accused of putting lives at risk by sending cars instead of ambulances to emergencies. East of England Ambulance Trust is sending rapid response vehicles (RRVs) to 999 calls to hit targets, even when the patient needs an ambulance for transport to hospital, a paramedic has claimed, with the result that patients sometimes wait for hours for an ambulance to reach them.
Patient safety is being compromised by the trust’s focus on hitting response targets, the paramedic told the Health Service Journal (HSJ). Speaking on condition of anonymity, he said: “The trust has become so fixated with hitting the target by sending out RRVs to stop the clock.
“Care, patient safety and dignity are really being badly compromised. Everyone has horror stories. It’s as bad as I can ever remember.”
The paramedic said “elderly, frail patients” were sometimes left “lying on the ground waiting up to two or three hours for an ambulance to turn up”. “Often they’re in pain, maybe with a broken hip. When it’s in the winter, it’s often in cold, frosty conditions. Sometimes they are lying on a limb, and who knows what damage is being done as a result?” ...read more
NHS faces staff crisis as student nurse applications plummet after Tories scrapped their grants (13 July 2017)
Nursing leaders today warn the NHS faces a staffing crisis after figures showed a sharp fall in applications for training places.
The number applying to be student nurses has dropped from 65,620 to 53,010 - a fall of 12,610 on last year.
The fall comes after the Government axed student bursaries for trainee nurses and midwives.
From this September they have to take out loans to cover living costs and £9,000 a year fees.
The Royal College of Nursing said the figures case doubt on the ability to train enough nurses to fill the 40,000 vacant nurse posts in England.
The figure by the university applications service UCAS showed applications in England for student nursing places were down 23% in England.
There was also a 28% fall in the number of people aged 25 and over applying and a 27% fall in number of male applicants.... read more
Theresa May to oversee £85m in cuts to public health budgets this year, analysis reveals (12 July 2017)
Theresa May has been accused of taking her “eye off the ball” over public health as it was revealed budgets for a range of services including sexual health and help to stop smoking face new cuts of £85m.
Local authorities in England are being forced to spend more than 5 per cent less this year on public health initiatives than in 2013-14, according to a new analysis from the King’s Fund.
David Buck, the health think tank’s senior fellow in policy, used data from local governments and the Department of Communities to calculate that planned spending on sexual health services has fallen by £64m, or 10 per cent, over the past four years.... read more
Chickens coming home to roost: local government public health budgets for 2017/18 (Kings Fund: 12 July 2017)
The Department for Communities and Local Government has released new data on local authorities’ planned budgets for public health in 2017/18. It does not make good reading.
Since 2013, when local authorities were first given responsibility for many aspects of public health, they have received a grant for this from the Department of Health. It is easy to forget that in the first few years the growth in this grant was quite generous: 5.5 per cent in both 2013/14 (against an estimated primary care trust baseline) and 2014/15, reflecting the coalition government’s commitment at that stage to investing more in public health. But in 2015/16 things changed dramatically.... read more
Exclusive: NHS needs 5,000 more beds, warn leading A&E doctors (HSJ: 7 July 2017)
The NHS needs at least 5,000 more beds to achieve safe bed occupancy levels and hit the four hour waiting time target, according to a report by senior medics shared exclusively with HSJ.
The Royal College of Emergency Medicine winter flow project said the NHS needed to add to its 130,000 beds to “combat exit block, overcrowding in emergency departments [and to] maintain flow through the system”.
The college’s report tracked performance of 50 trusts running 60 sites across the UK between October 2016 and March 2017 on a weekly basis. It also found some trusts saw their four hour waiting performance drop to under 50 per cent over winter, against the 95 per cent target.
The vast majority of the sites were in England (50), with two from Scotland, five from Wales and three in Northern Ireland. The trusts, which the RCEM said were representative of the sector, provided the data on the condition of anonymity.
The 4 per cent bed base boost would equate to an average hospital with a type one accident and emergency department, of which there are 184 in England, adding only around 20 beds, although there would be significant variation across the system.... read more
NHS bosses warn of mental health crisis with long waits for treatment (The Guardian: 7 July 2017)
Mental health services are so overwhelmed by soaring demand that patients are facing long delays to access care, a powerful group of NHS mental health trust bosses have warned.
Widespread shortages of specialist nurses and psychiatrists mean Theresa May’s pledge to tackle the “burning injustice of mental illness” is at risk according to chief executives and chairs from 37 of England’s 53 specialist mental health trusts.
Their concerns are contained in a new report by NHS Providers, which represents almost all of England’s 240 NHS hospital, mental health and ambulance trusts. The report concludes that children, older people and people in a mental health crisis too often receive inadequate care for conditions such as anxiety, depression and eating disorders.
“These concerns point to a growing gap between the government’s welcome ambition for the care of people with mental health needs and the reality of services they are receiving on the frontline,” said Saffron Cordery, NHS Providers’ director of policy and strategy.
“In some cases core mental health service provision by mental health trusts is actually getting worse,” she added.
Eighty per cent of bosses of NHS trusts in England it surveyed fear they will have too little money this year to provide timely, high-quality care to the growing numbers of people seeking mental health support. Many do not believe that the more than £1bn of extra funding pledged by ministers is reaching its intended destination....read more
Sharp decline in doctors' pay (The BMA: 6 July 2017)
Doctors’ salaries have declined sharply over the last decade following years of pay restraint policy from successive governments.
A study by University College London and the National Institute of Economic and Social Research found public pay policy had led to a fall of around 22 per cent in doctors’ pay in real terms – with staff shortages rising and morale plummeting at the same time.
The report, commissioned by the Office of Manpower Economics, found that average hourly earnings of UK workers – measured by the median average – dropped in real terms by almost 6 per cent between 2005 and 2015.
BMA council chair Chaand Nagpaul said the report provided further evidence of the difficulties faced by doctors over the last decade.
Dr Nagpaul added: ‘There is clearly growing support for doctors, nurses and allied health professionals’ message to the Government: that the pay cap is unfair, unacceptable and must be lifted.
‘With the NHS at breaking point, politicians cannot continue to duck this issue. Investing in the NHS workforce and providing fair terms and conditions must be a priority for this Government, otherwise the NHS simply won’t be able to attract and keep the frontline staff needed to deliver safe, high-quality patient care.’
It comes just months after the DDRB (the Review Body on Doctors’ and Dentists’ Remuneration) report recommended a 1 per cent pay rise for frontline staff.....read more
Doctors forced to plead with NHS for treatments for patients, BMJ finds (The Guardian: 5 July 2017)
Growing rationing of healthcare is forcing more doctors to plead with the NHS to fund treatments patients need, including cataract removals, new hips and knees, and removal of varicose veins.
GPs and hospital consultants in England submitted 73,927 exceptional requests on behalf of patients in 2016-17 in a bid to persuade the NHS to fund drugs or surgery they were initially denied, an investigation by the BMJ has found. That was almost 50% more than the 50,188 individual funding requests (IFRs) doctors put in to clinical commissioning groups (CCGs), the bodies that hold the NHS budget in local areas, in 2013-14.
The revelations have prompted fresh concern among doctors and health experts that the cash-strapped NHS is increasingly denying patients treatments that were routinely available until recently. The sick “have misguidedly become soft targets for NHS savings”, the Royal College of Surgeons (RCS) has said.
The BMJ’s findings are based on freedom of information requests sent to England’s 207 CCGs, of which 192 responded. Just over 50,000 IFRs were submitted in both 2013-14 and 2014-15. But that suddently rose by almost 20% to 60,425 in 2015-16 and then by about a fifth yet again to last year’s total of 73,927.
The commonest reason for an IFR last year was for surgery to remove unsightly skin, such as skin tags. Doctors did that on behalf of 6,079 patients.
The next most common after that were: cosmetic and aesthetic surgery (4,426 IFRs), plastic surgery (1,889) and fertility treatment (1,151).
Mental health conditions were the sixth commonest reason for a request. Despite the NHS’s pledge to improve access to care, doctors still had to submit an IFR to try to get 1,150 patients what they judged to be the care they needed....read more
More nurses and midwives leaving UK profession than joining, figures reveal (The Guardian: 3 July 2017)
More midwives and nurses are leaving the profession in the UK than joining for the first time on record, with the number departing having risen by 51% in just four years.
The figures, which will add to concerns about NHS staff shortages, show that 20% more people left the Nursing and Midwifery Council (NMC) register than joined it in 2016/17. The overall number of leavers was 34,941, compared with 23,087 in 2012/13.
While concerns have previously been raised about a large drop in EU registrants in the wake of the Brexit vote, the NMC figures, published on Monday, show that it is the departure of UK nurses – who make up 85% of the register – that is having the biggest impact. In 2016/17, 29,434 UK nurses and midwives left the register, up from 19,818 in 2012/13, and 45% more UK registrants left than joined last year.
Unions say there is a shortage of 40,000 nurses and 3,500 midwives in England alone and they, and NHS trusts, blamed the pay cap and workplace pressures....read more