The healthmatters blog; commentary, observation and review
The Cavendish Coalition has responded to the triggering of Article 50 by calling on the Government to safeguard the UK’s ability to recruit and retain staff with the skills needed to deliver high quality health and social care to local communities.
The coalition, a group of 34 social care and health organisations working to ensure the system is properly staffed after the UK leaves the EU, has set out what the Government needs to focus on during EU withdrawal negotiations to maintain safe, high quality health and social care services.
We have today written to the Secretaries of State for the Home Department, Exiting the European Union and Health making clear our offer to work with the Government to help inform a future immigration system where public service value is used as a key assessment of ‘skill’ as opposed to salary, and which guarantees the status of EU staff already working in health and care.
We are also calling for a straightforward and responsive transitional system for people from the EEA during the period between any ‘cut off’ date after which EU nationals coming to live and work in the EU will not be guaranteed leave to remain and having a new and operational immigration system.
Cavendish Coalition co-convener Danny Mortimer said:
“It is absolutely critical that the Government takes all possible measures to safeguard the supply of health and social care workers needed to continue delivering safe, high quality care.
“We are ready and available to support the Government in a way which allows it to plan a future immigration system which assesses skill levels based on public service value, as opposed to salary. This will be central to the PM’s commitment to make the UK a magnet for global talent.
“It is also vital that any transitional system provides clarity and certainty so that people entering the UK are clear on their status – as certainty supports stability and sustainability in health and social care.
“Such a system must be flexible enough to allow social care and health to recruit from Europe when staffing needs cannot be met through additional domestic recruitment and training.”
Drop in US drug approvals but no similar trend is seen in EU
Glasgow, United Kingdom (March 28, 2017) – NDA Group announced findings from their fourth annual comparison of drug approvals in Europe and the United States, ahead of this year’s DIA EuroMeeting in Glasgow. This year’s Status of New Drug Approvals report emphasises the need for a streamlined global development and commercialisation process across the world’s two biggest markets.
The report – based on preliminary research figures from the EMA and FDA websites in January 2017 – found that there has been a drop in US approvals but not in EU. For 2016 there were 74 new drug approvals granted in the US and EU. Of these new products, 19 were approved only in the EU, 19 only in the US, and 36 were granted in both regions. However 17 drugs that were approved in the EU in 2016 had received prior approval in 2015 or earlier in the US, while only six products registered in the US in 2016 were previously approved in the EU.
Johan Strömquist, CEO, NDA Group “Understanding the evolving regulatory landscape and requirements is a key concern for the drug developing industry, as is it for us at NDA. It is intriguing to see how expedited pathways shape this year’s statistics just like it did last year, but with a very different outcome. It’s also interesting to see the continued rise of smaller companies in the percentage of products taken to market.”
“Our analysis for 2016 shows that NDA maintains an exceptional position in supporting new drug product approvals in Europe. During the last four years NDA supported over 40% of the new drugs approved with a broad range of services. I’m also excited to see the increase of products going through the FDA that received NDA’s support. NDA supported over 20% of new drugs that achieved approval by the FDA during 2016.”
Terese Johansson, PhD, NDA’s consultant behind the research commented: “The findings show that FDA has had a significant drop in drug approvals but continues to grant more expedited and nonstandard review approval status than the EMA. The drop is not as pronounced in the EU but is likely to be more prominent in 2017. Expedited drug development and nonstandard review approval pathways are the new norm in the US, but in the EU special approval procedures are not as common. The US situation could be explained by the increased use of the shorter nonstandard approval pathways since there has also been a significant increase in complete response letter (CRL). During 2016 FDA issued 14 CRLs, compared to just two in 2015.”
“The report also highlights the continued trend that many companies first seek approval in the US. Both the EU and US show increases in drug approvals from small and medium sized pharma but big pharma still dominates the drug approval statistics. The busiest therapeutic area was oncology.”
citizenAID was distressed to see the events in London unfolding yesterday and its sympathies go out to all those involved in the attack. citizenAID would also like to take this opportunity to praise the emergency services for their response to the event and the sacrifices that they make each day to keep the public safe.
citizenAID is an app and pocket guide that has been developed to advise members of the public on what they can do in the aftermath of a multiple casualty incident to keep safe and provide vital first aid for the injured people around them.
citizenAID has been set up by a team of senior clinicians with civilian and military experience and is a part of the Queen Elizabeth Hospital Birmingham Charity. This military experience has been gathered during recent conflicts in Iraq and Afghanistan and has been the basis of the information provided in the guide. For more information please see citizenaid.org
Professor Sir Keith Porter, co-author of citizenAID, said “On behalf of citizenAID I urge everyone to download the free app (available on iTunes and Google Play) and familiarise themselves with the information on it. The app gives people the information that they need to keep safe in the immediate aftermath of a multiple-casualty incident and shows them how they can help to save the lives of the injured people around them.”
Artificial intelligence to help create automated virtual GPs to advise patients online in ground-breaking university partnership
Orbital Media, digital and social specialists, and the University of Essex have today announced they are joining forces to use artificial intelligence to save the NHS millions of pounds per year by creating automated online GPs to revolutionise the way patients are treated.
In partnership with Innovate UK, the project will exploit Artificial Intelligence (AI) and Machine Learning technology to provide medically approved health advice to the increasing numbers of users who seek medical information online. The technology developed, via the partnership, will be used to serve interactive advice via groundbreaking, photo realistic avatars. Information supplied by the platform will focus on minor ailments such as colds, coughs, flu and hay fever. These self-treatable conditions currently account for a significant proportion of GP time and are identified by the Proprietary Association of Great Britain (PAGB) as one of the five examples of wastage in the NHS system¹, amounting to a cost of £2 billion per year².
The resulting technological solution will provide a visual, reliable and robust online health advice service, to meet the rapidly growing demand for online ‘symptom searches’.
Due to its public importance and potential impact, the 30 month project will be part-funded by the Engineering and Physical Sciences Research Council (EPSRC), The Economic and Social Research Council (ESRC) and Innovate UK. Taking place through the university’s Knowledge Transfer Partnership (KTP) initiative – a world-leading programme that helps businesses innovate by connecting them to the UK’s wealth of academic resources – the project will be managed by a carefully recruited Computer Scientist – known as the KTP Associate – who will base themselves at Orbital Media full-time and work closely with the Academic team.
Orbital Media CEO, Peter Brady, commented on the importance of this innovation to the NHS: “GPs are currently under immense pressure, with significant amounts of money devoted to dealing with minor ailments. This comes at a time when the NHS is required to find £22 billion of efficiency savings by 2020³. The potential for AI technologies to help relieve pressure from the heavily burdened primary care system is significant. Even if we can reduce the cost spent on minor ailments by as little as 1%, the potential saving to the NHS would be approximately £20 million per annum. AI has a key role to play in supporting future healthcare needs and this is just the beginning of our exploration into its potential applications within healthcare pathways. It’s hugely exciting for Orbital Media to be at the foreforont of this cutting edge technology, which could produce genuinely revolutionary improvements for our healthcare system.”
Dr Luca Citi from the School of Computer Science and Electronic Engineering at the University of Essex added: “Artificial intelligence and machine learning technology have the potential to transform so many aspects of our everyday lives. We are excited about this opportunity to work with Orbital Media to see how we can share our expertise to have a significant impact on how health services might be delivered in the future.”
¹ PAGB Five Examples of Waste in the NHS;
² PAGB Self Care, Making the case for self care at the heart of the heath agenda, assessed July 2016.
³ PAGB Five Examples of Waste in the NHS; http://www.pagb.co.uk/content/uploads/2016/11/Five-examples-of-waste.pdf
UK employees work some of the longest hours in Europe, but produce 30% less per hour than workers in France, Germany and the US (according to the London School of Economics). Low productivity has been a thorn in the side of successive Governments and predictions for any future change are pessimistic. Whatever form Brexit takes, it will further expose the UK to global competition and stark comparisons in areas like productivity.
Looking from a health and wellbeing perspective, the productivity conundrum doesn’t look so complicated. The harder employers push their staff to be productive – focusing on efficiencies in practices, cost-savings from digital working, ‘always on’ availability – the less they get from people over time. On a rational level, all the changes are sensible, but they are also mechanical. People wither under the combination of pressures and productivity suffers.
As the Willis Health & Productivity Survey Report 2015 argued, employers need to think more holistically when it comes to what impacts on productivity, not just trying to pull levers that ratchet up what employees do in the time available.
Employee wellbeing is based on inter-relationships between work and home life, physical and mental health. The work we’ve been doing at Bluecrest with our employer partners is based on this understanding of the importance of taking a ‘public health’ approach: making low-cost health screenings available to all staff; providing comprehensive anonymised data to inform wellbeing strategies; and spending time with employers to explain trends and what they could be doing to improve organisational health overall and for particular groups of staff.
The workplace culture and environment can be the root of poor mental wellbeing as a result of unrealistic time pressures and targets, strained relationships and bullying. But also has the potential to be the basis of a positive culture of wellness, supporting health and wellbeing initiatives.
Secondly there’s the personal dimension. Whether employees look after their own health – at the basic level of getting sleep, eating well, taking exercise – is fundamental. There’s also the issue of their personal values, beliefs and attitudes to work, and their ability to cope with demands from relationships, finances and responsibilities like caring for family.
And thirdly, the impact of risks to health. Ongoing medical conditions (such as obesity, diabetes, heart disease etc) have all been shown to decrease productivity. Undiagnosed conditions, both physical and mental, have the potential to lead to more serious health problems. Early recognition and flagging any increased risks to health is vital to help employees avoid chronic long-term conditions.
Critically, organisations need to move away from simply viewing investment in wellness as purely about cost reduction (the Return on Investment) and towards a focus on the `Value of Investment` looking at a wider set of outcome metrics: absenteeism, worker morale, employee turnover, presenteeism costs, workers compensation, disability, employee loyalty and tenure. All of these factors add up to a significant impact on productivity.
Employers that adopt a public health culture will be best placed to improve productivity. When the University of Birmingham looked at workplace wellbeing programmes and their impact, it pointed to the importance of interventions that target whole organisational cultures and practices; run sustained programmes, such as annual health screenings, and by tailoring the health and wellbeing offerings to particular groups of staff and their needs.
Health benefits can’t keep being seen as just a perk, separate from issues of business performance. Join up the thinking and there’s a solid platform for turning productivity levels around for the long-term.
Dr Nick Summerton, GP and Medical Director at Bluecrest Wellness, www.bluecrestwellness.com
Paula Kathrens, an employment specialist at law firm Blake Morgan, said: “Today’s consultation is good news for NHS staff and ultimately good news for the NHS and the public it serves. The health sector has one of the highest instances of whistleblowing reporting and currently the law does not protect job applicants who have blown the whistle in a previous employment. This is one area where the UK whistleblowing legislation differs significantly from protection against discrimination under the Equality Act 2010. Under the Equality Act 2010, not only are job applicants protected against discrimination generally, but there are victimisation provisions which protect job applicants who have made a discrimination complaint against a previous employer.
“By contrast a worker who has blown the whistle against a previous employer might be protected from reprisals, but only if they are already working for the new employer. In all employments, but particularly the NHS, this leaves a big gap for whistleblowers who are not yet re-employed and looking for another job. Following the Mid Staffs inquiry and the Francis Review it was recognised that action needed to be taken to challenge the culture within the NHS that deterred staff from raising concerns and legislation was passed in 2015 to pave the way for protection for applicants in the NHS. The consultation launched today is on the detail of the regulations. They are based on the regulations which prevent blacklisting for trade union reasons.
“In the draft regulations, the emphasis is on whether “it appears to the NHS employer” that the job applicant has blown the whistle – it does not matter if in fact it turns out that they have not done so. It will also be for the NHS employer to prove that there has not been discrimination, rather than for the job applicant to prove that there has. It will be interesting to see the case law developments in this area.
“Discriminatory conduct by NHS staff in the course of recruiting a whistleblower, or an agent on behalf of the NHS employer, would be treated as if it had been done by the employer itself. It would not matter if the NHS employer did not know or approve of the conduct. It will be a defence for the NHS employer to show it took all reasonable steps to prevent its staff or agents from discriminating. This mirrors the defence currently under the Equality Act 2010 and places an emphasis on the employer to show it has put in place thorough training and done everything it can to develop a culture where such discrimination is not tolerated.
“As with other whistleblowing claims, under the draft regulations, the amount of an award for a successful claim will be what is fair in the circumstances, with no maximum ceiling. Employment Tribunals will, however, be required to take into account a number of specified factors. An award could even be increased if an Employment Tribunal has made a recommendation that the NHS employer takes action to remove or reduce the effect of the discrimination on the job applicant, and the NHS employer has not done so. There are also ways that a job applicant could restrain an employer from discriminating against him or her.
“The consultation on the draft regulations is open until 12 May 2017. At the same time, the European Commission has just launched a consultation on whistleblower protection across the EU. The UK’s whistleblowing laws were introduced completely independently of the EU and are in many ways more robust than those in other EU Member States, but it will be interesting to see what conclusions are drawn about the best way of protecting whistleblowers across the EU.”
Cancer Research UK is urging NICE to reconsider proposals to introduce a £20 million impact test on new drugs which include vital end-of-life medication. Presently the National Institute for Health and Care Excellence (NICE) decides which medicines are good value for money for NHS England.
The new proposals are to have an extra affordability test which could mean that from next month NHS England will be able to delay drugs if the total cost to the health service is more than £20 million a year.
Sarah Woolnough, Cancer Research UK’s executive director of policy and information, said: “If NICE thinks a cancer treatment is clinically effective and represents value for money, then patients should receive it without delay. A system that could add up to a three year delay before patients can access treatments deemed clinically and cost effective is unacceptable. Cancer patients may lose their lives whilst they wait.
“We need to decide whether we want a world class health system in the UK, and if so we need to pay for it.
“Manufacturers should be encouraged to price drugs responsibly, but we hope the Government will reconsider the introduction of this new test, otherwise it will be patients, their families and carers who could pay the heaviest price.”
The Great British Sunday roast could become a thing of the past as new research reveals Brits are ditching the family favorite in favor of quicker and healthier alternatives. A survey by 1,034 UK adults by appliances etailer, AppliancesDirect, found that just 11% now enjoy the British tradition every week.
- Just 1 in 10 now sit down for a Sunday roast every week
- Brits are put off by the 800 calories per serving
For a health conscious 1 in 5 the 800 calories in a typical roast dinner was enough to put them off, opting to make healthier Sunday meal choices.
Sixty one percent cite not having enough people at home to cook a dinner as one of the reasons for not eating a Sunday roast weekly, while more than half said that it takes too long to make. A typical roast dinner with all the trimmings takes over two hours to cook, even more if you consider the washing up.
The cost of meat was a reason for 39% and 1 in 5 said they were too busy with social commitments to attend the weekly ritual.
Mark Kelly, marketing manager at AppliancesDirect comments: “Given the busy lives we now all lead and the number of children living away from home or at university it’s not surprising that less families are taking part in this much-loved tradition. However, appliances like pressure cookers and halogen ovens can help speed up the process. Sitting round the table with family or friends no matter what you’re eating is really important, as it gives people the chance to catch up after a busy week and spend quality time together.
“The data shows the way in which Brits are enjoying the tradition is changing with the times, but I believe that the Sunday roast will remain a favourite meal among Brits for many years to come. It’s just becoming an occasional treat rather than a weekly staple.”
The Sunday roast capital is Birmingham, who’s residents enjoy a roast dinner four times a month, compared to the people of Glasgow where the average consumption is just twice a month.
New analysis from Alzheimer’s Research UK has revealed that the number of dementia researchers working on the condition has almost doubled over six years. The charity’s report, published today (14 March) at their annual research conference in Aberdeen, highlights major improvements in the UK dementia research landscape as funding for research into the condition has increased. But while the gap between dementia and other disease areas has narrowed over time, with progress being made in scientists’ understanding of the condition, the analysis shows dementia research has still not caught up when compared to the huge impact of the condition. Figures from the report show that for every one dementia scientist, there are now four cancer researchers – compared to six in 2008/9.
- Alzheimer’s Research UK report reveals boost in people power following greater research investment.
- Despite this, dementia research capacity still lags behind other serious conditions.
The report, Keeping pace: progress in dementia research capacity, also comes as the charity launches its new Dementia Statistics Hub – an online ‘one-stop shop’ for the latest facts and statistics on dementia and research into the condition.
In 2012, Alzheimer’s Research UK published its influential Defeating Dementia report, which found that despite massive costs to the UK economy, there were relatively few scientists working to tackle dementia compared to other conditions such as cancer. Since then, there has been a drive to step up the fight against dementia on both a national and global scale, with an increase in research funding from Government and charities such as Alzheimer’s Research UK. Five years on, the charity set out to investigate the impact of this funding by repeating the original analysis.
Its new report, which compares the research landscape in 2015/16 to the 2008/9 picture, shows that:
- The number of UK dementia researchers has almost doubled, from 1,614 to 3,169.
- UK dementia research productivity has nearly doubled, from 3,209 scientific publications a year to 6,141.
- For every dementia researcher, four work on cancer – compared to six cancer researchers in 2008/9.
- In 2014/15, 61% of UK dementia publications were internationally collaborative, compared to just 51% in 2008/9.
While the number of dementia researchers has increased, the total number of scientists working in other disease areas has also risen. As a result, the gap in research capacity between dementia and cancer, while narrower, still exists six years after the original study. The analysis shows that there is still only one dementia researcher for every £2m of costs to the UK economy attributed to the condition, compared to 10 for cancer.
Hilary Evans, Chief Executive of Alzheimer’s Research UK, said: “Five years ago we challenged the UK Government to commit to long-term support for dementia research, and today we see the impact that greater investment can have. It’s heartening to see funding increases have resulted in more scientists focusing on this devastating condition, and more discoveries being made in the search for new treatments. Today we understand more than ever before about the diseases that cause dementia, now the challenge is to translate that knowledge into breakthroughs that will transform people’s lives. Dementia research has also benefited hugely from increasing international collaboration, and it will be crucial to ensure this trend continues as we negotiate our exit from the European Union.
“We still need parity for dementia research: having started from a low base, we are still playing catch-up with other disease areas and we must increase the pace. Already 850,000 people are living with dementia in the UK, and that number will rise to over 1million by 2025 unless new treatments and preventions can be found. At Alzheimer’s Research UK we have stepped up our own research and have bold plans to go even further, but we still need the continued focus of Government and other funders if we are to tackle what is fast becoming the greatest medical challenge of our generation.”
To see figures from the report as well as up-to-date facts and statistics visit Alzheimer’s Research UK’s Dementia Statistics Hub at www.dementiastatistics.org
Dr Linda Patterson OBE FRCP
I’m Linda Patterson and I write about current issues in healthcare. To find out more of my background click here.
I want to give a realistic commentary, based on my experience as a physician and leader in the UK NHS, having a wider system perspective .
I want to avoid the “catastrophic ” and knee jerk oppositional thinking which often characterises current debate. My opinions are informed by my absolute commitment to universal healthcare ,which is the mark of a civilised society, and I believe the NHS “financed out of general taxation and free at the point of use “is the most equitable system for delivery of that , and also a great achievement.