There's a fuller list of the health and wellbeing policy news items for the current quarter here, but some of the more significant items of the week are:
18 August 2016
The Government's delayed childhood obesity strategy has been widely criticised for not going far enough. It proposes a voluntary target to reduce the amount of sugar in children's food and drink by 5% next year and by 20% in four years. Primary schools are to be asked to provide 30 minutes of physical activity a day, with a further 30 minutes at home. Proposals in earlier drafts of the strategy are said to have been dropped including measures to reduce advertising and promotion of junk foods to children. Those criticising the strategy for not going far enough included charities, medical bodies, the LGA and the Chief Executive of Sainsbury's. The British Retail Consortium said it was disappointed at voluntary reductions as some manufacturers might use it to try and take advantage. [The whole strategy is only 13 pages.]
(19/08/16) (Rgn) https://www.nursingtimes.net/7010049.article
(20/08/16) The Royal Society for Public Health says it won't help parents resist 'pester power': https://www.theguardian.com/society/2016/aug/20/failure-to-curb-junk-food-ads-parents-public-health-chief
(22/08/16) More criticism, from Action on Sugar and Cancer Research UK: https://www.theguardian.com/society/2016/aug/21/theresa-mays-first-test-was-obesity-strategy-and-she-has-failed-health-experts-say
25 August 2016
The first quarter financial deficit of NHS trusts was half the previous year, but only because of additional funding according to a performance report from NHS Improvement. The deficit was £461m, £5m ahead of plan, compared to £930m at the same point last year. However, it would have been £911 without an injection of funds from the £1.8bn sustainability and transformation fund (STF), available to trusts that can meet their financial control totals and trust-specific waiting-time targets. 185 out of 238 trusts were able to access the first quarter STF, amounting to £450m. The report also says that A&E attendances were 6.3% higher than the first quarter last year and there were continued difficulties with delayed transfers of care. Many targets continue not to be met, including A&E, all key response times for ambulance services, diagnostic and referral to treatment and cancer treatment targets. Future financial sustainability is threatened by lower budget increases to come, with the increase of 3.7% this year followed by ones of 1.3% next year and 0.4% the year after, (2018/19). Polling by NHS Providers found that only a third of trusts were fairly confident of meeting their financial targets with 38% not confident and a third unsure.
26 August 2016
Details are starting to emerge of proposals for large structural changes to the configuration of hospitals in England, as Council leaders refuse to sign up to plans to make changes to hospitals in north west London, under one of the 44 sustainability and transformation plans (STPs) across England. The plans would see two major hospitals, Ealing and Charing Cross, losing their A&E and other services. Leaders at Ealing and Hammersmith and Fulham councils have refused to sign up to the changes. The Guardian says NHS England is describing the STP's as internal documents and the paper has seen only two of them. The plan proposes reducing the number of acute hospitals in the area from 9 to 5 alongside a 'local hospital model'. The Guardian says the plan is one of the most detailed and comprehensive produced so far. In the Leicestershire area there are plans to reduce the number of acute hospitals from three to two and in the Black Country to reduce the number of acute units from five to four and to close one of two district general hospitals. NHS England said it expected local leaders to be talking to the public regularly , although other reports said they had insisted the draft plans were kept private.
Anonymous feature on STPs from someone working in a CSU: https://www.theguardian.com/healthcare-network/views-from-the-nhs-frontline/2016/aug/26/nhs-plans-bring-benefits-barred-telling-public-sustainability-transformation-plans
Incisive Health report on STPs: www.incisivehealth.com/uploads/images/services/38%20Degrees%20-%20STP%20Early%20Action%20Report%20-%20August%202016.pdfhttp://www.incisivehealth.com/uploads/images/services/38%20Degrees%20-%20STP%20Early%20Action%20Report%20-%20August%202016.pdf
NHS England response: https://www.england.nhs.uk/2016/08/stp-statement/
22 August 2016
The biggest risk to achieving a 'seven day NHS' is workforce overload, with a lack of GPs, consultants and other health professionals, according to an internal risk assessment and other documents seen by the Guardian and Channel 4. NHS staff are seen as a barrier to achieving change because they are thought not to believe in the case for change. Other risks include the possibility that the aims of improving quality of care at weekends and reducing the death rate from weekend emergency admissions might not be met. The Brexit decision could also impact on the plans since the NHS employs 55,000 staff from elsewhere in the EU. Labour calls for an enquiry into the revelations and some medical Tory MPs criticise the Government's approach. An internal DH briefing paper suggests that the focus on the weekend effect has not been helpful in the move towards seven day services.
Extract from the risk register with commentary: https://www.theguardian.com/society/2016/aug/22/nhs-weekend-working-risk-management-document
The view of a junior doctor: https://www.theguardian.com/commentisfree/2016/aug/22/leaks-flaws-jeremy-hunt-deception-seven-day-nhs
15 August 2016
Owen Smith has said a 100% publicly funded NHS would be a 'red line' for him if elected Labour leader. He said that the recently published DH annual report showed that NHS spending on private providers had doubled from 4% to 8% since 2010. He also reiterated a promise to increase spending on the NHS by 4% a year. Meanwhile, Jeremy Corbyn set out plans for a 'National Education Service' modelled on the principles of the NHS. Both candidates said they would restore the bursary for nurse and midwife training.
21 August 2016
Women and BME people are under-represented on NHS trust boards, according to information from freedom of information requests covering 1,450 board members in 114 trusts, published in a report, 'Action not Words - Making NHS Boards More Representative'. People from a BME background hold only 2% of trust boards chairs, despite making up 15% of the population as a whole. People from a BME background make up 4% of executive directors and 7% of non-executive directors on trust boards. While 80% of NHS staff are women, they make up 28% of chairs, 47% of executive directors and 38% of non-executive directors. [While Labour peer Lord Philip Hunt is quoted in the Guardian article, it is not clear who is the author of the report]
22 August 2016
The proportion of 14 year old girls suffering depression and anxiety has increased from 33% to 37% since 2005 according to a survey carried out for the Department for Education. On the other hand the figure for boys, at 15% had fallen slightly. There were falls in the proportion of the young people who drank alcohol, took drugs, smoked or missed school. Those who said they had drunk alcohol fell from 30% to 12%. The problems were more marked among children of parents educated to at least degree level.
17 August 2016
GPs' confidence in CCGs has fallen according to the results of the latest 360 degree stakeholder survey conducted by MORI. There were falls from the 2015 results in a number of areas, including confidence amongst GPs of CCGs' ability to deliver results for patients from 64% to 59% and those thinking arrangements for participation in decision making were effective from 68% to 59%. Only 33% of GP practices felt they could influence CCG decision-making a great deal or a fair amount and 49% said their views were not listened to.
15 August 2016
The agency cap is likely to save the NHS £800m in its first year of operation, with no evidence of an impact on patient safety, NHS Improvement has said. Since the cap was introduced in November. two incidents of potential harm have been reported, 23 incidents with no harm and 11 incidents of service closure. It appears that trusts have breached the cap rather than risk patient safety, with 90% of trusts (214) exceeding the cap in each week of the first quarter of 2016-17. [Further figures are available on cap breaches.]
15 August 2016
There is not a 'weekend effect' of greater mortality for emergency surgery undertaken at the weekend, although there was previously and it has fallen over the last decade, according to research from Queen Elizabeth Hospital in Gateshead based on 30 day mortality for emergency general surgical admissions in the North of England between 2000 and 2014, published in the British Journal of Surgery. The overall 30 day mortality rate fell from 5.4% in 2000-2004, to 2.9% in 2010-14.
17 August 2016
A report on progress in children's mental health since March 2015's Future in Mind, has been published by an Education Policy Institute Commission chaired by Norman Lamb. This is the second report from the commission and includes information from foi responses from CAMHS providers. It finds that 83% of trusts had experienced recruitment difficulties. Recruitment challenges had led to an 82% increase in staff spending in the last two years. Of 122 Local Transformation Plans, they assessed only 15% of them as 'good' with 85% 'requiring improvement'. Although £119m has been allocated to local areas, because this is not ring fenced and it is only part of the support provided, it is possible that overall spending on children and young people's mental health may not have increased.
(19/08/16) (Rgn) https://www.nursingtimes.net/7010054.article
18 August 2016
A consultation on the soft drinks industry levy (sugar tax) has been launched by HMRC and the Treasury. The consultation closes on 13th October.
25 August 2016
The new alcohol guidelines have been approved by the Government following consultation. The reduction in recommended intake from 21 to 14 units for men remains as does the advice that pregnant women should not consume any alcohol at all. It was decided not to include guidance on the maximum number of units that could be consumed in a single session as it was considered to be lacking in evidence and likely to make the guidelines confusing.
25 August 2016
244,000 children will be affected by the reduction in the benefit cap from £26,000 to £23,000 in London and £20,000 in the rest of the country, reducing the incomes of affected families by £60 a week on average, according to the Government's latest impact assessment of the policy.
27 August 2016
The Prime Minister has announced an "audit of public services to reveal racial disparities" to show how outcomes differ by ethnicity in areas including health, education and employment. The work is to be led by a new team in the Cabinet Office, reporting to Communities Secretary Sajid Javid and Cabinet Office minister Ben Gummer.