The healthmatters blog; commentary, observation and review
Smokers who undergo a CT scan of their lungs are more likely to quit than those who don’t, concludes a trial led by Cardiff University.
The findings of the study, looking at the effect of CT screening on smokers at high-risk of developing lung cancer, dispute the belief that a negative screening result offers a ‘licence to smoke’ and reveal that engaging with lung screening can give smokers an opportunity to access smoking cessation support, at a time when they are likely to be receptive to offers of help.
Dr Kate Brain, Reader at Cardiff University’s Division of Population Medicine, said: “Our trial shows that CT lung cancer screening offers a teachable moment for smoking cessation among high-risk groups in the UK. We now need evidence about the best ways of integrating lung cancer screening with stop-smoking support, so that services are designed to deliver the maximum health benefits for current and future generations.”
The trial, led by researchers at Cardiff University working with the University of Liverpool, King’s College London and Queen Mary University, involved 4,055 participants aged 50-75 years who were randomised either to a group who underwent low-dose CT screening for early detection of lung cancer, or to a control group who did not undergo screening.
Of the smokers who took part in the screening, 10% had successfully quit after two weeks, and 15% had quit at two years – both higher than rates in the control group.
The UK Lung Cancer Screening (UKLS) pilot trial is the first to assess the feasibility, cost-effectiveness and behavioural impact of lung cancer screening, using a single low-dose CT screen on a high-risk population in the UK.
Lung cancer is one of the most common and serious types of cancer and has the highest mortality of all cancers in the UK. Around 44,500 people are diagnosed with the condition every year in the UK.
The UKLS pilot trial was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme.
The full scientific publication ‘Impact of low-dose CT screening on smoking cessation among high-risk participants in the UK Lung Cancer Screening Trial’ is published in Thorax.
Nutrition research in the UK needs an urgent boost if it is to provide real benefit to the UK and global populations.
The Medical Research Council (MRC) and the National Institute for Health Research (NIHR) have responded to a wide-reaching review of nutrition research in the UK with new proposals aimed at revolutionising the field.
The Review of Nutrition and Human Health Research, commissioned by the Office of Strategic Coordination for Health Research (OSCHR), was overseen by an expert Review Group and its aims included:
To ascertain the strengths and weaknesses of nutrition research relevant to human health in the UK; to assess whether the research base was well placed to meet the needs of policy makers; to identify opportunities for further interaction with the food/nutrition science industry both in the UK and globally; to consider whether there is sufficient capacity to provide a sustainable future for nutrition research in the UK.
The Review praised the excellent nutrition research in the UK, but warned that the field was facing a potential crisis as fewer younger scientists entered the field and experienced researchers approached retirement. It noted that while the behavioural/social science aspect of nutrition research remained strong, the basic mechanistic understanding of nutrition research and its translation to healthier food was beginning to fall behind.
The report’s recommendations may be found here.
In response to the review and after broad discussion, the MRC and NIHR have identified three courses of action to take place immediately which will be followed with longer term activities. The three key pillars will be:
A UK nutrition and human health research partnership
The MRC and NIHR will establish a UK Human Nutrition Research Partnership comprised of experts from academia, health research and industry to develop and realise an implementation plan for the review recommendations. The focus will be on some of the tougher scientific challenges such as: linking cohorts to interventional nutritional research; linking nutritional epidemiology to mechanistic understanding; and looking at longer-term solutions to fundamental problems such as standardising measures. The partnership’s outputs will feed into decision-making bodies, devolved health administrations and policy units, and inform industry and public guidance.
Developing plans for global nutrition research
Global nutrition research has the potential to transform health and wellbeing across the world. Nutrition, and its influence at all life stages, plays a pivotal role in non-communicable diseases in lower and middle income countries and also has an impact on response and resilience to infectious diseases. Working across the Research Councils, the Department for International Development (DFID) and the Department of Health (DH), through the Global Challenges Research Fund (GCRF), the MRC will launch new funding opportunities to tackle some of these global challenges. Full details will be available via www.rcuk.ac.uk/funding/gcrf/ This approach will link groups that have expertise in working in these countries with nutrition researchers here and in LMICs, while allowing groups not traditionally involved in LMIC research – or even nutrition – to form new partnerships and seed small projects.
Working with the food industry
The OSCHR review highlighted that to truly understand the nutrition ecosystem we must work with all stakeholders, including the food industry – agricultural, retail, food production, packaging etc. Industry must be seen as part of the solution and partnership with the food/nutrition science industry is vital so that research can lead to healthier products and improved nutritional support. This partnership must be governed by clear principles for engagement. The MRC is working with key stakeholders to build on its existing guidance in this area by developing a framework for engagement between researchers and industry.
Professor Chris Day, Vice-Chancellor and President of Newcastle University, who chaired the Review, said: “The UK has a well-earned reputation for its nutrition research but we are in danger of falling behind if we don’t consolidate our strengths and build up capacity in key areas.
“A new nutrition research partnership will identify challenges in the area and then direct resources to meet those challenges. Most importantly, it will inform policy.
“Working more closely with industry partners will provide opportunities to build capacity in the field, enhance the sharing of expertise and resources, and ensure that excellent nutrition science is available to all.”
Dr Louise Wood, Director of Science, Research & Evidence at the Department of Health, welcomed the report:
“The UK has a strong history in undertaking high quality and impactful nutrition research and the report highlights the huge potential of building on this for the benefit of the health and wellbeing of the public – both nationally and globally.
“To realise the potential highlighted in this report, we shall be working with a range of stakeholders and, via NIHR, with other research funders including industry to take forward the recommendations.”
The Royal Society for Public Health (RSPH) has warmly welcomed the publication of a new report, ‘Creative Health: The Arts for Health and Wellbeing’, launched today (19 July 2017) by the All Party Parliamentary Group on Arts, Health and Wellbeing (APPGAHW), which illustrates and champions the hugely valuable role the arts can play in supporting health and wellbeing.
RSPH provided input and consultation in the delivery of the report, which comes after two years of evidence gathering from service users, health and social care professionals, artists and arts organisations, academics, policy makers and parliamentarians from all parties and both Houses. The evidence shows overwhelmingly the beneficial impact that arts can make to health and wellbeing:
- The arts can help keep us well, aid our recovery and support longer lives better lived.
- The arts can help meet major challenges facing health and social care: ageing, long-term conditions, loneliness and mental health.
- The arts can help save money in the health service and in social care.
The report also explores a number of projects across the UK, such as Artlift, a charity delivering an arts-on-prescription scheme;The Alchemy Project, which uses dance as a form of early intervention in psychosis; and The Homeless Library, a collaborative project between arts organisation Arthur + Martha and Manchester’s homeless population, offering a space for potential healing and shared experience.
To more fully exploit the role the arts can play for health and wellbeing, the report makes 10 recommendations, including:
- Leaders in the arts, health and social care sectors to establish a national strategic centre for arts, health and wellbeing.
- A cross-governmental strategy to support the delivery of health and wellbeing through the arts and culture.
- Designated individuals to be responsible for arts, health and wellbeing within NHS England, Public Health England and each clinical commissioning group, NHS trust, local authority and health and wellbeing board.
Read the full report, Creative Health: The Arts for Health and Wellbeing, here.
Shirley Cramer, Chief Executive, RSPH, said: “At RSPH we have long championed greater awareness of the significant health and wellbeing benefits of the creative arts, both in preventing ill-health or poor wellbeing, and in aiding recovery. We are delighted that this comprehensive report illustrates and champions these benefits, and we hope that it will transform the conversation in the health sector around arts and stimulate the widespread implementation of new and innovative approaches. We fully support the APPGAHW’s calls to action to help support the integration of the arts into health and social care, and we truly believe that this can make a real impact on the public’s health and wellbeing.”
The Royal Society for Public Health (RSPH) has expressed its disappointment and frustration that the Joint Committee on Vaccination and Immunisation (JCVI) has today (19 July 2017) announced its decision not to extend human papillomavirus (HPV) vaccinations to all adolescent boys. This interim decision precedes a six week consultation period, after which time the decision will be made final unless the JCVI can be persuaded to change its mind.
HPV is responsible for 5% of all cancers, and while the existing vaccination scheme for adolescent girls provides a level of ‘herd protection’ to boys, the decision not to extend the vaccination means some 400,000 boys remain at risk of contracting the virus. A decision to extend the programme today would have brought the UK in-line with 11 other countries who currently offer universal HPV vaccinations.
Shirley Cramer CBE, Chief Executive RSPH, said: “We are deeply disappointed by the JCVI’s decision today, which suggests that fundamental priorities are focused more on saving money than on saving lives. Such a simple vaccination programme has the potential to make such a big impact on the public’s health on a national scale. We hope that the Government’s advisory committee reconsider this decision as soon as possible and put the public’s health and wellbeing before cost-saving. This process has already dragged on for a considerable period, and every moment we delay lives continue to be unnecessarily put at risk.”
Peter Baker, HPV Action Campaign Director, said: “It is astonishing that the Government’s vaccination advisory committee has ignored advice from patient organisations, doctors treating men with HPV-related cancers, public health experts and those whose lives have been devastated by HPV. The decision not to vaccinate boys is about saving money not public health. HPV Action will continue to make the case for a national vaccination programme that protects men and women equally. There may also be grounds for a legal challenge on the grounds that the decision breaches equality law.”
Matt Crossman, engagement manager at Rathbone Greenbank Investments, comments:
“Ethical investors have long avoided the tobacco sector because of its clear links to premature death and disease. Tobacco companies have consistently demonstrated poor levels of corporate responsibility, often undermining public health bodies through their advertising and messaging. Although tobacco use is a matter of personal choice, and its usage still legal, the arena in which we exercise our choice is not neutral: the messaging and promotional activity of the industry has created a situation where smoking has fallen in countries like the UK, America and Australia, but risen in the developing world and in Eastern Europe. This trend is confirmed by WHO reports that cite ‘aggressive’ marketing in these regions.
“It’s no exaggeration to say that the industry has only ever moved in more responsible directions when it has been forced to do so by regulation; at the same time, the industry has become more and more adept at shifting its growth efforts to areas where regulation is weaker. It has also actively fought the restriction of advertising. Having broadly lost those battles on advertising, it has now considerably upped its investment into the ‘vaping’ trend. Although public health bodies are still split on the long-term health benefits of e-cigarettes – with some seeing the technology as a useful tool in giving up smoking – commentators have been quick to point out that the tobacco industry’s increasingly large-scale investment in the technology might be an attempt to ‘normalise’ smoking and retain their market position, rather than a genuine effort to mitigate the harmful effects of tobacco.
“Put simply, smoking remains a leading cause of preventable harm in the world. Treating its effects on populations is a huge drain on healthcare systems. As more countries take up the WHO recommendations and begin to implement stricter control, we expect growth opportunities to stall for the industry. Responsible investment is about investing in companies making useful goods and services which benefit society, pursued in a responsible manner. Tobacco does not pass this test.”
Responding to a report published today by the Commonwealth Fund, which judged the NHS as the best, safest and most affordable healthcare system out of 11 countries analysed, BMA council chair, Dr Chaand Nagpaul, said:
“This report provides clear evidence that the NHS is one of the top-performing healthcare systems in the world, and the most cost-effective in this study.
“We need to make sure our NHS is protected, invested in and maintained, especially as a combination of rising patient demand, staff shortages and falling funding is seeing the health service reach breaking point. These pressures may be a factor in why the NHS has scored lower in the report’s comparison of health outcomes. However, the study also shows the UK to be one of the worst funded health systems. It is unfortunate that funding for public health and social care has been drastically cut, with large chunks of funding set aside for “sustainability and transformation” in England being used to plug holes in hospital finances, and with local decision makers being told to find billions of pounds of efficiency savings.
“To ensure we stay at the top, as well as improve health outcomes, the NHS needs an end to the short-termism that has plagued the delivery of health care for too long and the government to agree a long-term, credible plan to deliver the fully funded and supported NHS that staff want and patients deserve.”
- The report can be found here.
Responding to the publication today of NHS Resolution’s Annual report and accounts 2016/17, which shows the cost of clinical negligence claims increasing by 14%, Niall Dickson, chief executive of the NHS Confederation, which represents health service organisations in England, Wales and Northern Ireland, said:
“We cannot go on like this with the NHS spending more and more on litigation. We now have fewer claims but we are paying more to claimant’s lawyers in legal fees – that went up 19% last year to nearly £500 million.
“What is more the decision by the last Lord Chancellor to change the way compensation claims are calculated is about to make the costs even higher.
“The Office for Budget Responsibility has estimated that this decision alone will cost the public sector an extra £1.2bn a year. According to one report, as a result an NHS trust saw the cost of one claim go from under £4 million to more than £9 million.
“It seems madness that we are now paying out sums greater than almost any other country in the world, when we have a universal, government funded system of healthcare.”
The total bill for agency staff within NHS trusts in England decreased by £700m in 2016/17 from £3.64bn to £2.86bn, representing a 20% reduction.
Hourly pay rates across all grades of locum staff in the NHS fell during 2016/17, as rate caps introduced by NHS Improvement (NHSI) and more stringent workforce management began to curb the spiralling cost of temporary staff. Commission rates simultaneously continued to fall.
The biggest reduction in pay rates was seen among Consultants, who make up 40% of all locum spend, as average rates fell by 2.3% to £91.89 an hour.
Despite a reduction in both average rates and the total cost to the NHS, the annual cost remained £3.3m in 2016/17 for the top ten highest earning locums. If these locums’ pay rates were limited to within the price caps, the annual saving would be £888,197, the equivalent of almost 1,500 Core Consultant shifts.
The findings are in the fourth annual ‘Taking the Temperature’ report produced by Liaison, the organisation which provides financial and workforce services to two thirds of the NHS, and benchmarks the last financial year (2016/17) with the previous findings. It is the largest review of NHS spending on medical locums carried out.
The report analyses pay and commission by grade and specialty across 61 trusts and boards that Liaison supports with its workforce services, and compares results by size, type, region and agency.
The trusts and boards researched in the report booked over 6,000 locums for a combined total of more than 2.3 million hours and paid out £160m in pay and commission during the year.
Pay and commission rates have shown significant variation regionally, with a difference of £21.44 per hour between the most and least expensive regions across all grades and specialties. At £50.49 per hour, average pay rates continue to be lowest in London, compared with £69.78 in South Central, which shows the highest rates despite a £3.04 decrease on 2015/16 figures.
Unfilled substantive vacancies were the cause of 86% of hours booked in 2016/17, an increase of 20% over two years. Bookings due to sickness and service pressure have fallen by 2.1% since 2015/16, indicating trusts and boards are introducing better workforce planning practices, but are continuing to suffer from a lack of supply, especially in specialist roles, which was the cause of 51% of escalated rates in 2016/17.
Andrew Armitage, Managing Director of Liaison, said:
“It’s been a year of positive change for our clients. We have seen significant signs of progress as the rates introduced in 2015 and agency expenditure ceilings set out in 2016 begin to make a real impact in reducing the cost of temporary staff to the NHS. The lower overall bill, reduced pay rates and a reduction in commission across most staffing grades represent a real breakthrough and emphasise the fact we are seeing significant issues being addressed.
“In addition to the impact of NHSI measures, we are also seeing an increasing appetite for more collaborative working from our clients, to understand their agency spend and share best practice on how to reduce it.
“We know the NHS faces an ongoing battle and there is clearly still work to be done with a supply shortage continuing to force the hand of trusts and boards in regards to some specialist locums, but where there is scope for improvement, progress is being made and we will hopefully see this trend continue in 2017/18.”
Among the report’s key findings:
- Average hourly pay rates decreased most notably for Consultants, by £2.19 per hour.
- Commission, as a percentage of the total pay and commission bill dropped from 11.27% in 2013/14 to 9.77%.
- Some trusts are paying almost three and a half times the £55 wage rate for Consultants in General Medicine, at highest rates of £187 per hour.
- Bookings due to substantive vacancies have increased 20% between 2014/15 and 2016/17.
- Across the top ten highest earning locums, the annual cost to the NHS was £3.3m for the equivalent of 17 Whole Time Equivalents (WTE). If rate caps were enforced for these Consultants, the annual saving to the NHS could be £880,000 a year.
- Overall average pay rates increased in six out of 11 regions, most significantly in the West Midlands where hourly rates increased by £2.89. At £50.49 per hour, average pay rates in London remain the lowest, showing a decrease of £0.76 since 2015/16.
- Overall pay rates paid by South Central trusts remain the highest in the country, despite showing a demonstrable improvement of a £3.04 reduction on 2015/16.
- Commission rates vary by 38% regionally. Overall commission rates decreased the most in London where – at £6.22 per hour – rates are now the lowest in the UK.
Liaison works with NHS trusts and boards to give more control over temporary staff spending, directly addressing each of the key issues faced, including, maximum hourly rates for agency staff, ensuring trusts are only engaging with framework agencies and highlighting maverick buying that can be flagged and challenged.
By encouraging further collaboration between trusts and boards, Liaison helps to keep locums working within the system rather than them relying on costly third parties for staffing requirements. It is estimated that around 60-70% of medical locums are already employed elsewhere within the NHS, meaning such cooperation can have a significant impact in reducing costs.
The data in this ‘Taking the Temperature’ report is derived from Liaison’s direct engagement service, part of its STAFFflow and TempRE offering that comprises a range of services helping trusts and boards control their agency staff spending. Over 20% of all NHS trusts and boards in England and Wales are using Liaison’s services to help them to better manage their temporary staffing costs.
Liaison’s independent support provides NHS trusts and boards with a technology enabled service that offers transparency, guidelines and benchmarking to help them track performance, identify areas of necessary improvement and enable significant movement towards control of agency staffing spend. Prior to Liaison’s contribution, trusts and boards often lacked the power to check, challenge and change rates at the point of booking. The information they receive on their temporary staff usage helps them manage this spend more effectively by building their own bank, negotiating discounts and eradicating invoice errors.
The 2016/17 annual ‘Taking the Temperature’ report can be downloaded here: http://liaison.co.uk/taking-temperature-annual-report-201617.
Intergenerational Mental Health Conference – how a whole-family approach can improve children’s health and wellbeing
Join professionals, academics and families at the 1st Annual UK Maternal Mental Health Alliance Conference this September.
Join practitioners, service users and academics to explore how a whole-family approach can break the intergenerational cycle of mental health problems at the first annual Maternal Mental Health Alliance conference: Intergenerational Mental Health: working with mums and babies in perinatal mental health practice on 13 September 2017 at Imperial College, London.
Special rates available for students and not-for-profits, book your ticket here.
The conference will highlight ground-breaking academic research, showcase innovative practice, and tell the stories of perinatal mental health service users across the UK, including:
- the relationship between maternal mental health and parent-infant relationships
- trauma-focused care and taking an intergenerational perspective
- using evidence-based psychological approaches in your practice – such as videofeedback and mentalisation
- working holistically with families experiencing domestic abuse
- assessing psychosocial risk and resilience in complex cases
Speakers include international experts:
- Susie Orbach, author, journalist and psychotherapist
- Mark Hanson, Director of the Institute of Developmental Sciences and British Heart Foundation Professor of Cardiovascular Science at the University of Southampton.
- Shiela Redfern, Consultant Clinical Psychologist and Head of Clinical Services, Anna Freud National Centre for Children and Families
- Louise Howard, Head of Women’s Mental Health, King’s College London & Consultant Perinatal Psychiatrist
- Claudia Buss, Professor of Medical Psychology, Charité University Medicine Berlin
- Carmine Pariante, Professor of Biological Psychiatry, King’s College London & Consultant Perinatal Psychiatrist
If you have practice or project to share, we’d love to hear from you. Submit a poster on your service, project or new idea here.
Is there something that inspires you? Nominate a project or service for one of the first ever perinatal mental health awards here. Deadline: 31 July 2017.
Responding to King’s Fund analysis which has found central government cuts have forced councils to reduce planned spending on public health services by £85 million, Niall Dickson, chief executive of the NHS Confederation, which represents health service organisations in England, Wales and Northern Ireland, said:
“The government’s whole approach to reforming health care has been based on the promise of a radical upgrade in prevention and public health, yet all we have seen is cut after cut in this budget. It is self defeating to reduce public health spending while looking to transform care.
“Our members report direct cuts to front-line services, including the treatment of substance misuse, smoking cessation and sexual health. Further gaps in out-of-hospital and social care funding intensifies the pressures on health services.”