Ambulance call-outs for mental health patients in England soar by 23% (13 August 2017)

The number of ambulance call-outs for people experiencing mental health problems in England has soared by nearly a quarter in two years.

Data obtained under the Freedom of Information Act shows paramedics helped over 30,000 more patients (172,799) in crisis in 2016-17 compared with 140,137 in 2014-15, a rise of 23%.

An additional 55,000 hours were spent supporting people with their mental health last year, compared with 2014-15 – up by 32%. In London the time spent rose by 45%, according to the request for information made by the Labour MP Luciana Berger.

Berger, a former shadow minister for mental health, said the numbers were “shocking” but came as no surprise. She accused the government of “dismantling” vital early intervention and prevention services so more people are ending up crisis.

The Labour MP said: “Jeremy Hunt has no other option but to introduce ringfenced budgets for mental health to ensure funding reaches the frontline. The health secretary must take urgent action for the sake of patients and staff.”

She added: “Too much money pledged for mental health is not reaching the sector. In the absence of ringfenced budget, funding is being diverted to prop up other areas of the NHS.” ... read more

 

Health inequality gap ‘is still growing’ in England, new Department of Health data shows (12 August 2017)

The health gap between rich and poor is growing in England, according to shocking figures compiled by the Department of Health.

Despite government pledges to reduce inequalities in areas such as life expectancy and susceptibility to disability and disease, those living in the most deprived areas of the country run a greater risk of premature death, seeing a child die soon after it is born, and of ending up in hospital as an emergency case. Differing health outcomes for the rich and the poor were identified by Theresa May last year as a “burning injustice”.

The health department data shows that in key areas the gap has widened since 2010 after narrowing over the previous decade. Seven years ago life expectancy for men in England’s most deprived areas was 9.1 years less than for those in the richest areas. By 2015 the figure had risen to 9.2 years. The equivalent gap for poor women also grew over that time, from 6.8 years to 7.1 years. The stark statistics are contained in the health department’s annual report, published this summer.

They have been seized on by David Buck, a senior fellow at the King’s Fund health thinktank and a leading expert in public health and health inequalities. Buck told the Observer: “These are shocking figures. It’s shocking that we live in a developed country where inequalities in health are so wide and are getting worse.

“For the poorest in the country this is a double whammy of early death and poorer health while still alive. They are going to die younger and are facing 20 more years of life spent in poor health relative to the richest. This should be a wake-up call to ministers.”... read more

 

NHS maternity wards in England forced to close 382 times last year (8 August 2017)

Maternity wards in England were forced to close their doors 382 times in 2016, according to new figures that have triggered claims of women being “pushed from pillar to post in the throes of labour”.

Campaigners warned that expectant mothers could be left in fear of giving birth at the roadside after a wide-reaching freedom of information request found a 70% increase in the number of maternity ward closures over two years.

Research by the Labour party found that 42 hospital trusts had been forced to shut their doors at some point over the last year – 44% of those who responded – with many blaming staff shortages and bed and cot capacity.

Fourteen of them admitted they had shut down more than 10 times, with some taking more than 24 hours to reopen.

In total, there were 382 occasions when units had to close in 2016. This figure is slightly higher than the 375 occasions from the year before, and an almost 70% increase on the 225 in 2014.

The findings triggered an immediate response from campaign groups, who pointed to the government’s own maternity policy, which says there should be enough midwives to prevent this happening.

Elizabeth Duff, senior policy adviser at NCT, the UK’s largest charity for parents, said: “It’s appalling that a shortage of midwives and equipment means that so many units have been closed time and again so that pregnant women are pushed from pillar to post in the throes of labour.”... read more

 

Grantham A&E unit's night closure policy to remain (7 August 2017)

A decision to close a hospital accident and emergency unit overnight has been backed by the government.

United Lincolnshire Hospitals NHS Trust (ULHT) closed Grantham Hospital's unit a year ago because a lack of doctors.

In February, Lincolnshire County Council asked Health Secretary Jeremy Hunt to review the decision.

Mr Hunt then called for the Independent Reconfiguration Panel (IRP) review and backed its view the unit should not reopen until it had "sufficient staff".

The county council's Conservative leader Martin Hill described Mr Hunt's decision as a "disappointing result".

"The fear that this 'temporary closure' would be anything but temporary, has proved to be entirely founded", said Mr Hill.

"It is unacceptable that Grantham district has had a substantial change to hospital services for over a year without proper consultation or planning."

ULHT employs about 17 doctors across its three sites in Lincoln, Boston and Grantham, and needs a minimum of 21 to keep all of them open for 24 hours.

The trust's actions led to protests from a campaign group opposed to the closure of the unit from 18:30 to 09:00.... read more

 

NHS trust sent cancer patient adverts for private clinic (5 August 2017)

A terminally ill cancer patient has protested after the NHS hospital where she receives palliative therapy included advertisements for a private clinic with her appointment letter.

Ali Schofield, 33, who has secondary breast cancer, said the inclusion of the leaflets for Nova Healthcare was “disgusting” and “distressing”. It would make patients believe that NHS care was “second class” and they should pay for private treatment.

“I felt really cold when I saw the leaflet because it suggested that I would have better healthcare if I was to go private,” she said. “It offered me access to the latest technologies and made me think: so what am I getting now? It’s disgusting. It puts the seed of doubt into you.”

Schofield, a lifestyle journalist and collage artist, said she was appalled that the NHS had used her medical records to include promotional material for a private company. She also criticised the fact that posters for Nova have been put on the walls of the oncology unit at St James’s University Hospital in Leeds where she goes for her chemotherapy.

Nova, which has a contract with NHS England to provide specialist “gamma knife” radiotherapy, uses the fourth floor of the Bexley Wing at St James’s to offer consultations and daycare for private patients, while NHS patients including Schofield receive their treatment on the first floor.

Leeds Teaching Hospitals NHS Trust, which runs St James’s, has apologised to Schofield and said it would no longer send the leaflets. “Since October 2016 we have sent out around one million letters to patients. Fewer than 1,000 Nova leaflets were included in patient letters,” a spokesman said.

The inclusion of the letters appears to be a breach of NHS England guidelines forbidding the practice. They state that: “Trusts that offer private healthcare services should market and promote their private healthcare services completely separately. They should not market or promote these services within their NHS communications to patients and the public, eg appointment letters [and] NHS test results.” The trust did not explain why the leaflets had been included in the first place.... read more

 

'Serious concerns' over new bed occupancy target ahead of winter (4 August 2017)

Leading clinicians have raised serious patient safety and efficiency concerns about a new 92 per cent bed occupancy benchmark for trusts.

The Royal College of Surgeons and the Royal College of Emergency Medics raised concerns following NHS England and NHS Improvement publishing guidance last month.

The Review of Winter 2016-17 set out several recommendations for the coming winter. It said: “Occupancy levels should be more actively monitored and actions taken to ensure that they remain below 92 per cent, to allow patient flow to be maintained to deliver A&E performance.”

RCEM president Taj Hassan told HSJ: “It is extremely concerning that one recommendation seems to revise the safe level of bed occupancy up to 92 per cent. [The college] would have serious concerns about this as a metric of safety and we would be interested in understanding the evidence base behind this thesis.

“Our strong view is that the evidence base all points to 85 per cent as being the safer [and more efficient] level that all systems should be aiming for.”

An RCS spokeswoman said: “Patient safety can be assured at higher levels [but] health experts agree, as a measure of average performance, levels should ideally be around 85 per cent for optimum efficiency.”

However, the colleges welcomed the national focus on bring down bed occupancy. “At present, hospital overnight bed occupancy is around the 94.5 per cent mark, so bringing it down to 92 per cent would be a step in the right direction,” the RCS spokeswoman said.

But they also argued NHS England’s official statistics significantly underestimate current bed occupancy rates – a view support by Nuffield Trust research last year. The think tank’s report said: “Occupancy at midnight is well below the peak number of beds needed on every day of the week. This highlights the serious limitations of a midnight census [used by NHS England] as a basis for understanding the real demand for beds.”... 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

 

Hospital stops children surgery in a bid to improve services (3 August 2017)

Children's surgery will move out of The Royal Orthopaedic Hospital to others "better placed" to provide the specialist care, says the trust which runs the hospital.

The board of The Royal Orthopaedic Hospital NHS Foundation Trust said the Birmingham hospital will cease providing paediatric surgery by 1 January next year but adds that patients currently awaiting surgery will see "no immediate changes".

The decision follows a report by the Care Quality Commission earlier this year which said the hospital "required improvement" within several areas, including it's services within intensive and critical care.

The Trust has undertaken a significant amount of work and investment to meet these recommendations, and progress has continued to be made. However, recent external reviews over the last few weeks have reiterated that paediatric inpatient surgery would be better delivered in a hospital setting with access to extensive centralised care facilities at all times.

The Royal Orthopaedic Hospital Statement
.... 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

 

Royal College of GPs warn profession could reach 'breaking point' (The Guardian: 31 July 2017)

A government pledge to increase GP numbers by 5,000 within three years is falling short amid fears the profession “could reach breaking point”, the Royal College of GPs (RCGP) has warned.

The RCGP’s annual report on plans to improve GP services in England raises concern that many doctors are yet to observe significant changes in GP numbers under the recruitment drive, with GP numbers having fallen since September 2016.

A survey of GPs for the report found that 39% think they are unlikely to be working in the profession in England in five years’ time.

The professional body for family doctors in the UK said the findings sparked fears the profession “could reach breaking point” unless progress on the shake-up was accelerated.

Prof Helen Stokes-Lampard, chair of the RCGP, said: “It takes at least three years in speciality training for new doctors to enter the workforce as independent consultant GPs, so while it’s fantastic that more foundation doctors are choosing general practice this year, if more people are leaving the profession than entering it, we’re fighting a losing battle.

“Above all else we need to see efforts stepped up to keep hard-working, experienced GPs in the profession, and the best way to do this is to tackle workload pressures and improve the conditions under which all GPs and our teams are working.... read more

NHS accused of shrouding £500m of planned cuts in secrecy (The Guardian: 28 July 2017)

Doctors’ leaders have accused NHS bosses of shrouding controversial plans for £500m of cuts to services across England in “totally unacceptable secrecy”.

Patients deserve to know how hospitals being told to “think the unthinkable” as part of the savings drive will affect their access to healthcare, the British Medical Association (BMA) said on Friday.

The doctors’ union voiced its frustration after trying but failing to obtain details of the cuts that are being planned in the 13 areas affected by the “capped expenditure process” (CEP), despite the NHS’s duty as a public body to respond to freedom of information requests.

NHS bodies in just eight of the 13 areas replied, and none gave anything other than vague, general details about what cuts were under consideration.

“It is bad enough that brutal cuts could threaten the services but it is totally unacceptable that proposals of this scale, which would affect large numbers of patients, are shrouded in such secrecy,” said David Wrigley, the BMA’s deputy chair.

In April organisations providing all types of care as well as clinical commissioning groups, the local bodies which hold the NHS budget in England, in the 13 areas were told to make an extra £500m of savings by the end of March 2018 over and above those already planned. The orders came from NHS England and NHS Improvement, the service’s financial regulator, which are keen that its books can be made to balance in 2017-18.... read more

 

Labour demands inquiry into privatisation of NHS-owned recruiter (The Guardian: 27 July 2017)

Labour is demanding an inquiry into the privatisation of a government-owned NHS recruitment firm that saves hospitals £70m a year.

NHS Professionals helps the health service in England tackle its staffing crisis by arranging for doctors and nurses on its books to cover potentially harmful gaps in rotas.

Labour has asked the National Audit Office to look into why Jeremy Hunt, the health secretary, is selling a profitable and effective company his Department of Health owns. The firm should be kept in public hands and allowed to continue playing a key role in alleviating widespread NHS understaffing, the party says.

Justin Madders, the shadow health minister, has written to Sir Amyas Morse, the comptroller and auditor general who heads up Whitehall’s spending watchdog, asking him to intervene before a sale is finalised, possibly as soon as next month.

“On the government’s own estimates NHSP saves the taxpayer around £70m a year by organising last-minute or replacement staffing for NHS trusts in England, and ensuring hospitals don’t have to rely on expensive private agencies”, Madders writes.

He wants the NAO to “examine the business case that has been produced [by the DH] to ascertain a better understanding of what additionality the private sector can bring to what on the face of it is already a successful organisation.”

NHSP supplies staff cheaper than those obtained through private agencies which Simon Stevens, the chief executive of NHS England, has castigated for charging “rip-off” rates.... 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

 

Lack of mental health support leaving children stuck in hospital – thinktank (The Guardian: 26 July 2017)

Children with serious mental health problems are becoming trapped in NHS psychiatric units, unable to leave because care is unavailable outside hospitals, a thinktank has said.

NHS figures show that between October 2015 and September 2016 children and young people in England spent almost 9,000 days in hospital after being declared fit to be discharged. Some end up stuck in units for several months.

NHS England did not tell the Education Policy Institute how many patients were involved in the 9,000 days, despite being asked this in a freedom of information request. But the thinktank said data showed the problem was growing.

The total number of what the EPI termed “wasted days” was 42% higher between December 2016 and February 2017 than in the same period in 2015-16. In January alone this year, under-18s spent 804 delayed days in mental health inpatient units, compared to 553 the previous January.

Delayed discharges of such patients can occur because their home area cannot provide the specialist support they need to ensure they remain safe.

Sarah Brennan, chief executive of the charity Young Minds, said: “Far too many young people are being left in limbo in mental health hospitals because the right support isn’t available in their community. In some cases they may have to wait weeks or even months before they are discharged.”... read more

 

Richards: NHS must protect waiting times and access to treatment (HSJ: 25 July 2017)

The NHS must protect waiting times for planned treatment and maintain access to evidence based care despite ongoing austerity, the outgoing chief inspector of hospitals has insisted.

Sir Mike Richards, one of the UK’s top medical leaders who has worked at the top level for more than a decade, is retiring at the end of this week.

He told HSJ in an exit interview: ”I would never support restricting access to evidence based care.”

Asked about concerns of national clinical leaders that clinical commissioning groups have introduced some restrictions on elective operations which they believe are not clinically justified, he said: “There are some patients who in the past may have had knee replacements who weren’t… likely to benefit from it, but where there is evidence for it I certainly want us to be able to deliver those treatments.”

He also warned that – with elective waiting lists and times growing – very long waits “mustn’t be allowed to happen again”.

Sir Mike added: “It is worth remembering about the 18 weeks, those that have been around long enough will remember, that why did they choose 18 weeks? Because it used to be 18 months, it is as simple as that. People used to wait 18 months for cardiac surgery.”

NHS England said in March that planned care was not one of the top priorities for the next two years, and that18 week elective waiting time target was, therefore, unlikely to be met.... read more

 

NHS England delay 'denies patients access to life saving treatment' (HSJ: 25 July 2017)

Patients are being denied access to heart treatments that could prevent strokes or save lives, after an NHS England project was delayed, a charity has told HSJ.

NHS England’s Commissioning Through Evaluation programme enables limited numbers of patients to receive treatment that shows “significant promise” but is not currently funded by the NHS.

Left atrial appendage occlusion (LAAO), which could reduce strokes in people with atrial fibrillation, is one of the CTE projects under consideration.

Patent foramen ovale (PFO) closure, aimed at preventing recurrent strokes and improving survival rates, and percutaneous mitral valve leaflet repair for mitral regurgitation (MitraClip) used to treat patients with heart failure and prevent the need for open heart surgery, are also part of the CTE scheme.

However, NHS England is warning patient groups and charities of a two month delay in evaluating data, making “a knock on effect” on future commissioning decisions possible.

A charity representing people with abnormal heart rhythms believes the delay will deny high risk patients access to treatment that could prevent AF related strokes or even save lives.

The Arrhythmia Alliance and AF Association said LAAO already has approval in the US and has written to NHS England expressing concern over the delay... read more

 

Soaring NHS vacancies prompt warnings of 'desperate' understaffing (The Guardian: 25 July 2017)

The number of vacancies in the NHS has soared by 15.8% over the last year, prompting warnings that the service is facing “desperate” problems of understaffing.

Figures for England released on Tuesday by NHS Digital show that the number of full-time equivalent posts available rose from 26,424 in March 2016 to 30,613 in March 2017 – the highest number on record.

A total of 86,035 such positions were advertised in the first quarter of this year, underlining the large number of health professionals and other staff that NHS trusts are seeking to fill.

However, NHS staff groups said the figures were a serious underestimate of the true number of vacancies, while NHS Digital itself admitted that they were undercounting, especially for nurses. The data also did not cover staff employed by GP surgeries, such as practice nurses.

NHS Digital said 11,485 (38%) of the 30,613 vacancies in March were for nurses and midwives – 17% up on the 9,784 in the same month last year – and another 6,575 (21%) for administrative and clerical staff. NHS Digital bases its figures on the number of positions advertised on NHS Jobs, the main NHS recruitment website.

But Janet Davies, the chief executive and general secretary of the Royal College of Nursing, said: “The true number of unfilled jobs is far higher than the number of online adverts and stands at 40,000 in England alone.”

NHS Digital data shows that the nursing workforce is shrinking. The total number of nurses employed by NHS organisations in England fell from 285,080 in April 2016 to 284,619 in April this year – down 461.

That follows the recent disclosure from the Nursing and Midwifery Council, the nursing regulator, that more nurses are leaving the profession than joining it....read more

 

General practice is being ground down so that private providers can take over (The Guardian: 24 July 2017)

“A GP, eh? Well I guess there are worse things you could do.”

That was the only careers advice I got in my final year at medical school.

The Royal College of General Practitioners (RCGP) has previously raised awareness of bad mouthing of GPs during medical school training.

The college highlighted the fact that many consultants teaching in medical schools talk about general practice as a second-rate career option to hospital medicine and that this is one of the reasons we are short of GPs.

I’ve no doubt that bad press does nothing to improve recruitment to our ranks, but the pressures on the family doctor service, which has led to the closure of dozens of practices across the country, has also played its part in making general practice less attractive to medical graduates.

GP surgeries are not part of the NHS in the way hospitals are. Most surgeries are still small businesses. In most cases the doctors own or rent their premises, they employ and pay their own staff and have all the usual responsibilities of running a business in addition to their work as doctors.

What many patients do not realise is how much general practice is being squeezed at both ends at the moment. Income for general practice is falling in real terms year-on-year, while the costs of running a practice are spiralling out of control.

Furthermore, 90% of all patient contacts in the NHS occur in general practice and in 2017-18 we were predicted to receive 7.29% of the NHS budget – general practice is exceptionally good value for taxpayers’ money. The RCGP is currently campaigning for general practice to receive 11% of the NHS budget....read more

 

GP appointment waiting times 'risk to patient safety', warns RCGP (Pulse: 24 July 2017)

Patients across England face waiting longer than a week for a GP or practice nurse appointment on more than 100 million occasions by 2022, according to new analysis from the RCGP.

The figures, from the GP Patient Survey, reveal that if current trends continue, the number of instances when patients will have to wait a week or more to see a GP or practice nurse will jump from 80 million in 2016/17 to 102 million in 2021/22.

The analysis comes after Pulse has revealed that the average wait for a GP appointment is around 13 days, despite measures introduced by the NHS to alleviate pressures on general practice.

The RCGP points out that the situation across England is patchy, with patients in some areas facing long waiting times even to see a practice nurse.

In 21 CCG areas, covering 5.6 million patients, waiting times for an appointment with a GP or practice nurse are at least a week for more than a quarter of the time, the figures reveal.

Some of the worst areas to secure a GP appointment include Corby (36%), Fareham and Gosport (34%), Swindon (31%) and Central London (Westminster) (31%) where currently more than three in 10 patients wait a week or more for an appointment with their GP or practice nurse.

Even in places where access is better there are still thousands of patients waiting a week or more for an appointment, says the RCGP. In Bradford City, for example, where access to general practice is best, one in 10 patients (9%) still has to wait a week or more.

The RCGP warns that if the situation does not improve there is a genuine risk to patient safety. It is now calling on the Government once again to deliver on the pledges made in NHS England’s GP Forward View as a matter of urgency, to ensure that patients get the timely, quality care they need, when they need it....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

 

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

 

‘Megalithic’ changes to health and adult social care agreed (18 July 2017)

Three years ago the county council formed the East Sussex Better Together programme with clinical commissioning groups, the trust running Eastbourne’s District General Hospital and Hastings’ Conquest Hospital, and Sussex Partnership NHS Foundation Trust.
Through a number of initiatives the partnership has been working to transform and integrate health and social care, and the latest stage of the programme is the ESBT Alliance, which will deliver an accountable model of care and strengthen current arrangements.
 
This will look at how the organisations best use the £850m they spend collectively each year and is undergoing a ‘test bed year’ in 2017/18 before officially launching in April 2018.
 

By 2020 a new accountable care organisation would be established, which could involve the creation of a new East Sussex Health and Care NHS Trust taking a lead role across the health system and providing the majority of services in the ESBT area.

Keith Hinkley, director of adult social care and health at the county council, argued that a three year incremental approach would allow them to engage with all the relevant organisations.
 
He said: “What’s really important is that we can actually build the new accountable care model by actually going through these building blocks and putting them in place to ensure a robust overall structure to enable us to deliver the outcomes that we want within East Sussex.”
 

Becky Shaw, chief executive of the county council, added: “It has been a megalithic undertaking by the director but also the teams across a number of county council departments.”... 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

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