The healthmatters blog; commentary, observation and review
One in eight consumers in England (13 percent) have had their personal medical information stolen from technology systems, according to results of a new survey from Accenture (www.accenture.com.).
The survey of 1,000 people in England revealed that the vast majority (78 percent) believe healthcare providers have a great deal of responsibility for keeping digital healthcare data secure, compared to only 40 percent who believe it is their personal responsibility. Despite this, the findings show that more than half (56 percent) of those who experienced a breach were victims of medical identity theft and more than three-quarters of those victims (77 percent) had to pay approximately £172 in out-of-pocket costs per incident, on average.
In addition, the survey found that the breaches in England were most likely to occur in pharmacies — the location cited by more than one-third (35 percent) of consumers who experienced a breach — followed by hospitals (29 percent), urgent care clinics (21 percent), general practices (19 percent) and retail clinics (14 percent). More than one-third (36 percent) of English consumers who experienced a breach found out about it themselves or learned about it passively through noting an error on their health records or credit card statement. Only one-fifth (20 percent) were alerted to the breach by the organization where it occurred, and even fewer consumers (14 percent) were alerted by a government agency.
Among those who experienced a breach, the majority (70 percent) were victims of medical information theft with more than a third (39 percent) having personal information stolen. Most often, the stolen identity was used for fraudulent activities (cited by 82 percent of data-breached respondents) including fraudulently filling prescriptions (42 percent) or fraudulently receiving medical care (35 percent). And, a quarter of consumers in England (25 percent) had their health insurance ID number or biometric identifiers (18 percent) compromised. Unlike credit-card identity theft, where the card provider generally has a legal responsibility for significant account holder losses, victims of medical identity theft often have no automatic right to recover their losses.
Despite the myriad breaches occurring, consumers still trust their healthcare providers (84 percent), labs (80 percent) and hospitals (79 percent) to keep their healthcare data secure more than they trust the government (59 percent) or health technology companies (42 percent) to do so. About two-thirds of consumers in England (65 percent) either maintained or gained trust in the organization from which their data was stolen, following a breach. And, more than half (68 percent) of English consumers said they want to have at least some involvement in keeping their healthcare data secured, whereas only a quarter (28 percent) said that they have such involvement today.
In response to the breach, nearly all (95 percent) of the consumers who were data-breach victims reported that the company holding their data took some type of action. Some organizations explained how they fixed the problem causing the breach (cited by 29 percent), explained how they would prevent future breaches (23 percent) or explained the consequences of the breach (22 percent). Of those that experienced a breach, over half (53 percent) of respondents felt the breach was handled somewhat well while only 15 percent of respondents felt the breach was handled very well, indicating there is potential room to improve.
The findings in this news release relate only to the England portion of Accenture’s seven-country survey. The full research, “Accenture’s 2017 Healthcare Cybersecurity and Digital Trust Research,” represents a seven-country survey of 7,580 consumers ages 18+ to assess their attitudes toward healthcare data, digital trust, roles and responsibilities, data sharing and breaches. The online survey included consumers across seven countries: Australia (1,000), Brazil (1,000), England (1,000), Norway (800), Saudi Arabia (850), Singapore (930) and the United States (2,000). The survey was conducted by Nielsen on behalf of Accenture between November 2016 and January 2017. The analysis provided comparisons by country, sector, age and use. Visit www.accenture.com.for more details
For Infographic see infogdata
Niall Dickson, chief executive of the NHS Confederation, which represents health service organisations in England, Wales and Northern Ireland, said:
“We welcome the attention which all parties are giving to the issue of health and care funding. The current system is under immense pressure and is struggling to cope financially and clinically – significant extra money will be needed over the next Parliamentary session if we are to avoid a major crisis.
“It is vital that the next government commits to an objective assessment looking at which services are needed and the funding required to pay for them. We need an Office for Budget Responsibility for Health to undertake this and make sure that future funding is underpinned by a strong evidence base.
“And critically, we need a visible and objective measure of funding as we have seen for overseas aid and the armed forces – the next administration needs to commit to a minimum funding level for health and care linked to GDP. As the economy grows, so should health and care spending.”
Alzheimer’s Research UK, the UK’s leading dementia research charity, has welcomed a commitment in the Conservatives’ election manifesto, released today, to invest in dementia research. The charity is calling on other political parties to make similar commitments to ensure efforts to defeat dementia remain a priority in the next parliament.
Dr Matthew Norton, Director of Policy and Strategy at Alzheimer’s Research UK, said:
“It’s encouraging to see a commitment to dementia research investment in today’s manifesto, and we would urge all parties to make a similar pledge to ensure action against our greatest medical challenge. We also welcome recognition of the importance of the life sciences sector to the UK economy and commitment to take forward recommendations from the Accelerated Access Review. This will be vital for ensuring that people with dementia can benefit from future dementia treatments as soon as possible.
“It will be essential to see the detail of this commitment: with the government’s plan of action on dementia due for review next year, there is a real opportunity to scale up our ambition for research. Dementia is already the leading cause of death in England and Wales, and research suggests deaths from the condition will quadruple by 2040 if urgent action is not taken. With no treatments currently able to stop or slow the diseases that cause dementia, it’s vital that future investment in research matches the scale of this immense challenge.”
A massive cyber attack on the NHS began on Friday May 12th. The NHS has been warned about the hacking threat. In 2016, NHS Digital chair Kingsley Manning said cyberattacks were “a fundamental threat to the operations of hospitals” and chastised the health service for not taking digital security seriously enough. In recent years funding for IT services has been raided to fund other aspects of care.
In January 2017 the Health Service Journal reported a significant failure in cyber security, saying that a “major leak of patient data or a cyberattack that means health services across an entire region are flying blind for many days is overdue and yet completely absent from the risk registers of most NHS organisations”.
The attack begins
On May 12th, the “overdue” attack arrived and spread across the NHS, with trusts being targeted by a major ransomware campaign. There was a large outbreak of ransomware that spread at a rapid rate globally and also seemed able to spread internally within a network once the first host is compromised. At least 50 hospitals and community services have been affected, while CCGs and GP practices in some areas have also stopped using their computers. The attack has almost certainly had an impact on patients: some hospitals have diverted emergency ambulances, asked patients to go elsewhere, and cancelled elective care. Services affected include X-ray images, pathology test results, phone and bleep systems, and patient admin systems.
NHS Digital believes the malware used is Wanna Decryptor, (aka WCry, WannaCry, and WannaCryptor). Microsoft released a patch earlier this year to address the vulnerability that Wanna Decryptor exploits, but it appears that a number of hospitals and other users have not applied the patch. Dan Sloshberg of cybersecurity firm Mimecast, argues that: “Patient safety is at risk today because of archaic security across much of the nation’s critical IT systems. Studies consistently show that email is the number one attack method used to spread malware that holds critical services to ransom. A cyber resilient nation requires defence in depth security and continuity plans to keep critical services running every time they are attacked.”
There have been ransomware attacks on trusts before – such as Northern Lincolnshire and Goole in 2016 and Barts Health in January 2017 – but nothing on the scale of this attack. The attacks that have taken place do not appear to be targeted attacks; instead they appear to be part of a phishing campaign, though that has not been fully confirmed, according to Allan Liska, Senior Solutions Architect at Recorded Future.
Recovery from the attack
David Kennerley, Director of Threat Research at Webroot, said: It goes without saying that organisations should test their disaster recovery plan (DRP) regularly. This will help them understand the time it will take to restore systems to a useable state and what data is likely to be lost due to back up schedules. If this disruption is due to ransomware it will be interesting to hear what option the Trusts intend to take. Let’s hope they are all prepared, with the required backups readily available. The danger with paying the ransom is there’s no guarantee they’ll recover their encrypted data and this only makes ransomware more successful in the long run for hackers.
Israel Barak, CISO at Cybereason, described how these attacks are planned and carried out: “We know that ransomware purveyors are often savvy e-marketers that know their targets, and it is not uncommon for a ransomware gang to run multiple campaigns at the same time, with tiered pricing based on a variety of parameters such as vertical industry, region, age, etc. However, the attacks on the NHS Trusts across the UK seem to show particularly ruthless calculation even by criminal standards, banking on the Trusts having weak defences and being especially desperate to restore access to their systems due to health and even lives being at stake.
While ransoms have surpassed the hundreds of thousands mark, the goal is to set a price that makes it either cheaper or easier for the victims to pay the ransom then to recreate or restore the compromised systems, especially when the victim has a sense of urgency. Today’s ransoms show that this can still be very costly, especially when it comes to lost operational time and data. We’ve seen many examples where companies didn’t have the proper backups in place and decided to pay the ransom so that they could resume normal business operations, and that will obviously be a pressing concern for the affected Trusts.”
John Madelin, CEO at Reliance acsn, adds: Hospitals can make particularly soft targets for hackers due to the need to focus on putting tight budgets into patient care. As with other organisations, there is also a tendency to use an array of cyber-defence systems which inevitably work in silos and this very patchwork of ‘protection’ lulls institutions into a false sense of security when in reality they’re incredibly exposed. “Security strategies in the healthcare sector need a holistic treatment, with a more integrated, better executed, end-to-end approach – rather than multiple stand-alone security solutions working in siloes. The healthcare sector can engineer a culture-shift that will make it more resilient to cyberattack, allowing it to provide better care and prevent the need to cancel operations and treatments because of their networks being targeted by hackers.
There could be consequences beyond the disruption of medical services. Creighton Magid, a partner at the international law firm Dorsey & Whitney, commented “Although much of the focus in cybersecurity is in preventing data breaches, this attack points to the potential for an entirely different type of damage: shutting down entire businesses, hospital systems, banks, and critical infrastructure. Let’s hope that the attack on the National Health Service in Britain is simply a matter of inconvenience, and that nobody is denied essential care. But what happens if someone is, and is harmed as a result? What if a US hospital were attacked similarly, and someone’s health were to be seriously impacted? Beyond the human tragedy, it would suggest possible new liability targets, starting with the hospital that failed to ensure that it had updated all of its patches.”
Law firm Kemp Little’s head of data protection and privacy, Nicola Fulford, underlined this by saying: this is a stark reminder that everything is potentially vulnerable – and every business has a responsibility at some level under the law to protect against it even if absolute prevention is impossible.”
When the government announced unfavourable changes in taxes for self-employed staff a lot of IT technicians sub-contracted to NHS Trusts stepped away from their roles, leaving the NHS vulnerable to assaults like the present one. And some IT experts argue that the root cause of this attack was the use of non-standards- compliant internet browser technology used by Microsoft in the widely used Windows XP software. There is better, safer software that should be used. The Secretary of State for Health has told NHS Trusts to strengthen their IT defences (a pretty obvious response), whilst not conceding that his government’s budget squeeze has increased rather than decreased vulnerability to cyber attack.
THE FITTEST CITIES IN THE UK. Liverpool named the fittest city in the UK – Sheffield named as the least fit
LIVERPOOL has been named the fittest city in the UK following new research into fitness levels across the country.
A survey of 2,000 UK adults carried out by training and course provider Beabetteryou.com, found that scousers workout more than those in any other city in the UK with as 71% of locals claiming to exercise at least once per week.
Manchester and London followed in second and third place with 66% and 65% of each cities residents hitting the gym at least once a week.
Oxford came in fourth place, with 62% of locals exercising at least once per week, while 59% of those in Leeds do the same, completing the top five.
The research found that Sheffield was the least active city in the UK, with just 19% of residents sporting their trainers and exercising at least once per week.
Plymouth and Birmingham followed closely behind Sheffield, with just 22% and 24% of locals working out weekly.
As well as activity levels, the survey also quizzed respondents on their consciousness about what they eat.
While 77% of Liverpool residents claim to be careful when it comes to their diet, it is in fact Manchester which leads the way in the nutrition stakes as 85% of locals said they are careful about what they eat.
Simon Bubb, managing director at Be a Better You commented: “What I find interesting from the research is how we’re seeing such big variations from city to city.
“I am partly putting the fact that bigger cities such as Manchester, London and Liverpool boast higher fitness levels down to accessibility. For example, the main UK cities are home to more gyms, personal trainers, classes, and boot camps etc. so it’s likely this will impact on peoples’ motivation to get fit.”
The UK’s Fittest Cities
The UK’s Least Active Cities
Be a Better You is the UK’s number one personal trainer course provider, and offers REPs accredited personal trainer courses and fitness instructor courses around the country, as well as online at www.beabetteryou.com.
Niche markets flourish in the NHS
Marketisation has gone a long way in the health service. Some staff working for the NHS as agency workers or locums operate as a limited company to protect their income. Under new regulations, introduced on April 6th, all contractors to the public sector will be treated as employees and become subject to PAYE. The changes could lead to a substantial loss in earnings for some workers, with the Locum Doctors Union estimating that some could see their income reduced by up to 50%. Operating as a limited company may no longer be the best option for self-employed health workers but they can use member’s voluntary liquidation (MVL) to wind down their companies. MVLs are a tax-efficient way of wrapping up limited companies, as they allow money to be moved without being taxed at a higher rate through Entrepreneurs Relief. MVLs also give scope to benefit from the annual capital gains allowance. A free calculator from Johnston Carmichael enables staff in this position to check how much they could save (www.jcca.co.uk).
The Health Service Journal has unearthed an intriguing story about what happens when commissioners reduce funding to an out-of-hours service. In 2016/7 Wirral Community Health Services Trust breached its £1.7m cap on agency and locum spending by £322,000, of which 70% went on agency medical staff for the GP Out-of-Hours service. Wirral Clinical Commissioner Group in had reduced funding for the Out-of-Hours service by 10% for 2016-17, and is apparently planning a further 10% this year. In 2016-17 the Trust used an average of 660 agency hours per month, for 20 different locum GPs. A recruitment drive had enabled it to reduce its GP agency hours (in March 2017) by 41%, and a new service model based on multi-disciplinary teams – introducing “paramedic style” roles – has allowed it to reduce its GP hours by another 18%. The doctors are being replaced, in part, by other practitioners, but not because this will increase the skill mix in the Out-of-Hours service (although it may) but because it cannot afford the old system.
Up the ladder, down the snake
According to recent Care Quality Commission figures, of 151 practices initially rated ‘inadequate’, 40 have had their rating changed to ‘requires improvement’ and 80 to ‘good’, following a second inspection. However, 18 practices had their rating downgraded to ‘inadequate’ after being rated initially either ‘good’ or ‘requires improvement’. The moral that NfN draws from this snippet is that a kick up the backside works, but not always for long.
Inheriting the home
It’s been reported that Theresa May is considering plans to impose a social care costs limit of £85,000 to stop people having to sell their homes to fund their care in old age. The cap would represent the maximum amount anyone would have to contribute to the cost of their care, regardless of the value of their assets and savings. The move would help support the millions of UK adults who don’t fall within the £23K means-testing limit for funded care. Many of these people are completely unprepared to cover the cost of care in their later years, according to from financial planner Tilney’s Cost of Tomorrow report, among over-45s:
- Two thirds (71%) are not factoring the cost of long-term care into their retirement planning
- More than one in five (22%) think their long-term health care will be entirely funded by the government
- Two in five (39%) do not believe they will ever need long-term care
- Just one in ten (11%) said they had set aside funds to pay for care
- 8% think their family will pay for it
At the moment, a person only qualifies for funded care if their home, savings and investments are together worth less than £23,250, meaning a large portion of society will have to foot their own care bill, potentially denying their children an inheritance. Of the 2.8 million older people with care related needs in the UK, 900,000 currently do not receive any formal support (source: Age UK). This could be a crowd-pleaser and vote-winner.
Working on diversity
Equality, Diversity and Human Rights Week (#EQW2017) will highlight the work being done to create a fairer, more inclusive NHS for patients and staff. The May 15-19 event, co-ordinated by NHS Employers, allows organisations to showcase the work they do all year round to meet the needs of local people, to ensure NHS staff from all backgrounds feel valued and that the health service is seen as an inclusive and attractive employer. The theme for this year is “diverse, inclusive, together”, chosen to reflect moves across the health and social care sector towards greater collaboration.
NHS Employers will host its own programme of activity throughout the week, including a look at how widening participation strategies can help with recruitment from local communities on Tuesday, a tweetchat on intersectionality from 8-9pm on Wednesday, and on Friday, the week will conclude with the NHS Employers Disability Summit. Taking place at the Horizon Leeds conference venue from 9am to 3.30pm, the summit aims to create space for conversation and constructive challenge through debate. Spaces may be still available.
Danny Mortimer, chief executive of NHS Employers, said of #EQW2017: “Equality remains at the heart of the health service, and we must make sure we do all we can to celebrate and maintain the amazing diversity within the NHS. Throughout its history, the NHS has benefited from the contribution of colleagues from a vast range of backgrounds, whose experience is integral to the care of a huge spectrum of patients.
Almost a fifth of organisations in the UK healthcare sector have cancelled all preparation for the EU General Data Protection Regulation in the misunderstanding that it will not apply after Brexit. The regulation, which has been years in the pipeline, is designed to harmonise data protection regulation throughout Europe and provide citizens with more control over their personal data. It has been ratified by the UK and is due to come into force in May 2018 – almost certainly before Britain completes its exit from Europe. However a survey of IT decision makers in healthcare by information management experts Crown Records Management has revealed some shocking results.It showed that:
18 per cent have cancelled all preparations because of Brexit.
27 per cent think the regulation will not apply to UK business after Brexit.
9 per cent don’t even have plans for staff training on data protection.
This regulation is going to affect the UK in a big way. Although an independent Britain would no longer be a signatory it will still apply to all businesses which handle the personal information of European citizens. Given how many EU citizens live in the UK it’s hard to imagine many businesses here being unaffected. The potential in NHS Trusts for information to go missing is obvious and the GDPR will bring with it potentially huge fines – as high as 20million Euros or up to 4 % of global turnover -for data breaches. Experts believe that the best course is to prepare now to have a watertight information management system in place as soon as possible.
New research has found that almost 65% of NHS Trusts choose not to store any of their data in the private or public cloud. These results came from a freedom of information request sent by cloud and managed services provider ANS Group. Out of the 142 NHS Trusts that were approached, 86 responded. The findings revealed that 63% (54) did not store any of their data in the cloud, while the remaining 37% (32) stored some information in the cloud. Of those that use it, 63% (20) opted for a private cloud, while 13% (4) used public cloud and a further 25% (8) used a combination of the two. When asked if they were considering moving any data into the cloud during the next 12 months, the majority (59%) of NHS Trusts asked said they were not.
The Royal Society for Public Health (RSPH) has set out a manifesto of policy recommendations it believes political parties campaigning for next month’s UK general election should commit to, in order to improve and protect the public’s health. It’s challenging stuff, and you read it first on Health Matters!
The basics: health everywhere
The challenges facing the UK public’s health at a time of restricted public spending are too great to be met by the core public health workforce in traditional settings alone. Steps must be taken to ensure health promotion is embedded throughout society:
Activate the wider public health workforce: RSPH’s Rethinking the Public Health Workforce report has already identified an additional 15 million professionals, ranging from pharmacists and opticians to housing professionals and police officers, who have trusted contact with the public and the opportunity to promote healthy behaviours. They must be given the necessary training and support to do so.
Provide universal Personal, Social, Health and Economic (PSHE) education at all key stages: high quality PSHE is critical to empowering our young people to tackle all manner of health issues, from drugs and sexual health to healthy eating and social media addiction, but provision is currently patchy. The current Government made a positive step in March 2017 by announcing that sex and relationships (SRE) education is to be made compulsory in all English schools, but the next Government must ensure this acts as a stepping stone to full, universal, statutory PSHE across the whole of the UK.
Legislate to help make our high streets more health promoting: the environments we live in have a huge shaping influence on our health, and RSPH’s Health on the High Street report has demonstrated that more needs to be done to make our High Streets more health promoting. Steps to improve this could include planning controls that limit the ‘clustering’ of unhealthy business such as junk food shops and bookmakers, using business rate relief to incentivise healthier businesses, and making impact on the public’s health a criteria for licensing applications.
RSPH recognises obesity as the greatest public health challenge of our generation, with half of all adults predicted to be obese by 2050 at a cost to the NHS of £10 billion a year. While the Government’s recent childhood obesity plan included some promising moves, it also made a number of critical omissions, and further action must be taken:
Deliver and (if necessary) extend the sugar levy: the sugar levy on soft drinks announced by the Chancellor in March 2016 has already had a positive effect, with a number of manufacturers reformulating their products to avoid the tax. The new Government must commit to seeing through the implementation of the levy, reviewing its effectiveness and extending to other products if necessary.
Tighten junk food marketing restrictions: RSPH welcomed new rules announced by the Committee of Advertising Practice (CAP) in December 2016 banning the advertising of junk food products in non-broadcast media aimed at children. However, further action is needed on marketing, and RSPH supports a proposed ban on such advertising during any TV programmes shown before the 9pm watershed (not just those specifically defined as children’s programming).
End junk food sponsorship of family and sporting events: the sponsorship relationship between junk food manufacturers and sporting events continues to promote the false suggestion that these products are compatible with a healthy, active lifestyle and undermines efforts to combat obesity.
Drugs and addiction
Alcohol and tobacco remain two of the leading causes of preventable death and disease in the UK, while other (illegal) drugs continue to cause considerable harm among some of the most vulnerable in our society, exacerbating health inequalities. These challenges require not only education but strong legislation as well:
Introduce Minimum Unit Pricing (MUP) for alcohol: Public Health England’s (PHE’s) recent evidence review demonstrated that MUP is the most effective tool available to tackle alcohol harm. The next UK Government should follow Scotland’s example an introduce an MUP of 50p per unit.
Require calorie labelling on alcohol: alcohol calorie labelling not only fulfils the consumer’s right to be informed about what they are drinking, but also offers a potentially powerful tool to reduce consumption by drawing the link with obesity. Despite strong support in the European Parliament, efforts to introduce this labelling at an EU level have stalled. Brexit provides an opportunity for the UK to go further, faster in providing comprehensive health information on labels.
Lower the drink driving limit to 50mg: with the news announced in October 2016 that Malta is to lower its drink drive limit from 80mg to 50mg alcohol per 100ml blood, England and Wales will soon be left as the only part of Europe with such a high limit. With initial data from Scotland suggesting lowering the limit there has reduced drink driving, the UK Government must again follow Holyrood’s example.
Introduce outdoor smoking exclusion zones: following the success of the UK’s indoor smoking bar in helping encourage people to quit, RSPH believes the introduction of bans in selected outdoor areas, such as beer gardens, parks and public square, would represent a further important step in the denormalisation of smoking. However, any such exclusion zones must exempt e-cigarettes.
Decriminalise illegal drug use: in June 2016, RSPH’s landmark Taking a New Line on Drugs report set out the case for the decriminalisation of illegal drug use, as part of a wider package drug policy reform measures focused on public health and harm reduction. RSPH believes any new Government must make a serious reassessment of the UK’s approach to this issue, in line with progressive international developments.
Reduce the maximum stake on Fixed Odds Betting Terminals (FOBTs) from £100 to £2: FOBTs have been described as the ‘crack cocaine’ of gambling, and present a serious addiction and wellbeing issue. Accordingly, RSPH supports the call of the All Party Parliamentary Group on FOBTs for the maximum stake to be reduced to £2 to minimise harm.
Extend the human papillomavirus (HPV) vaccine to boys: RSPH welcomed recent news from Scotland that the vaccination of girls has led to a dramatic drop in prevalence of the sexually-transmitted HPV virus. However, the female-only vaccination programme is an imperfect solution which leaves many, including men who have sex with men (MSM) unprotected, and should be extended to all boys as well as girls across the UK.
Commuting accounts for a significant proportion of the lives of many in the UK, and in August 2016 RSPH’s Health in a Hurry report highlighted the negative impact this is having on our health, whether through the anxiety and stress of delays or the knock on effect on time available for healthy behaviours such as exercise. Action must be taken to make the commute a healthier experience, including:
Make health and wellbeing a specification for the award of rail franchises: to ensure no company is awarded a contract without making a proactive effort to improve and protect the health of commuters.
Remove first class carriages on commuter lines at peak times: to reduce overcrowding and stress.
New study in The Lancet: Weight Watchers is more effective than a brief intervention and self-help -Weight loss sustained two years down the line-
A new, two-year UK-based study published today (Thursday 4th May) in The Lancet indicates that overweight and obese adults referred to Weight Watchers®, the world’s leading community based weight management provider, for one year lost more weight for longer and had greater reductions in diabetes risk than those who were referred for a 12-week programme, and lost more than twice as much weight as those who received brief advice and self-help materials.
The large independent study, looked at weight loss among 1267 participants randomised to attend Weight Watchers for a 12-week or one year period, or to receive a brief intervention, alongside self-help materials and regular weigh-ins. It also analysed the cost effectiveness of these programmes. The study was conducted by research teams led by Dr. Amy Ahern, at the University of Cambridge; Professor Jason Halford and Dr. Emma Boyland at the University of Liverpool, and Professor Susan Jebb and Professor Paul Aveyard at the University of Oxford and involved 26 GP practices across the UK.
People assigned to the brief intervention were given a 32-page booklet of self-help weight management strategies with follow up weigh-ins at three, 12 and 24 months. Those assigned to Weight Watchers were asked to attend weekly meetings and had access to internet resources for the duration of their programme, 12-weeks or one year at no cost to themselves.
Participants assigned to a year of Weight Watchers lost, on average, more than twice as much weight as those in the brief intervention group1. They were also more likely to lose 5% and 10% or more of their initial weight, which are milestones that are associated with levels shown to have significant health benefits2. The superior weight losses in the one year Weight Watchers group were sustained even two years down the line.
Using microsimulation modelling, the study also estimated that over a 25-year period, the 12-week programme could be cost-saving for the NHS, and that, despite the greater initial investment, the one year programme is cost effective compared with the 12-week programme3.
The 12-week programme was predicted to prevent more illnesses than the brief intervention due to the greater weight loss. Over 25 years, the cost to the NHS of providing the programme would be more than offset by the later savings as a result of reductions in disease.
Offering a year-long programme was estimated to prevent an additional 1786 cases of disease (including 642 fewer cases of hypertension, 373 fewer cases of diabetes and 104 fewer cases of heart disease) for every 100,000 people, compared to the 12-week programme. And, although it was more expensive upfront, the study shows that the year-long programme is cost-effective by preventing more cases of weight related illness.
The study shows that Weight Watchers one year programme achieved improvements in type 2 diabetes risk factors comparable to more intensive (and costly) health professional-led interventions4. The data also demonstrates how a referral to Weight Watchers can be successful on a large scale in helping those with excess weight achieve medically significant health benefits, reducing the strain on the NHS.
This evidence comes as the problems of obesity worldwide result in huge demands on medical services, with the disease taking over smoking as the leading cause of preventable death. The worldwide prevalence of obesity more than doubled between 1980 and 2014 and World Health Organisation estimates that close to two billion people worldwide are currently overweight and more than 600 million are obese with 62% of the adult UK population being classified as overweight or obese. Healthcare systems around the world whether public, private or combination are under pressure, and have a desire to respond to the obesity crisis.
Lead author Dr. Amy Ahern of the MRC Epidemiology Unit at the University of Cambridge says: “We’ve seen before that a 12-week programme can help people lose weight, but for the first time we’ve shown that extending this to a full year leads to greater weight loss over a longer period and a lower risk of diabetes. Although the initial costs of the year-long programme are greater, it’s very likely that it will be good value for money over the long term because of the reduction in weight-related illnesses.”
Zoe Griffiths, Head of Programme and Public Health, Weight Watchers UK says: “Obesity is a chronic disease which puts enormous pressure on limited and already overburdened NHS resources. There is a clear need for practical treatments that are proven effective, affordable and scalable which have a population-wide impact. Trials like this are vital to identify effective solutions to tackle obesity and provide the evidence to inform policy decisions.
“For the first time, this study has shown that referring people to Weight Watchers is potentially cost-saving – it could actually save the NHS money. Unfortunately, the provision of GP referral schemes to services like Weight Watchers is patchy across the nation; with budgets being squeezed, many local authorities have no services in place at all. With government cuts, this situation is getting worse and worse, yet could offer the NHS one way of saving money.
Griffiths continues: “Once again, it has been proven that Weight Watchers is a highly effective weight management programme and is part of the solution to help tackle the high and rising levels of overweight and obesity. The study adds significant evidence and credibility for health professionals and Weight Watchers working together to transform the health of the nations in the short and long term. Success comes from GPs and Weight Watchers working together; GPs raising the issue of weight and referring them to a programme that gives them intense support via weekly meetings and digital tools and community. ”
The study design was a randomised, prospective, controlled clinical trial, the gold standard in medical research.
As further proof of the effectiveness and scalability of this public health approach, GPs across the UK have been referring overweight and obese patients to Weight Watchers for 12 years. An independent audit of this real world experience, published in BMC Public Health in June 2011, shows that it consistently delivers effective weight loss outcomes even across geographies5.
1 Mean weight change at 12 months was -3.26kg for brief intervention, -4.75kg in the 12-week programme and -6.76kg in the 52-week programme.
2 At 12 and 24 months, participants in the 52-week programme had greater reductions in waist and fat mass than participants in the 12-week programme or brief intervention group. At 12 months, participants in the 52-week programme had greater reductions in HbA1c than those in the 12-week programme and brief intervention and greater reductions in fasting plasma glucose than those in the 12-week programme and brief intervention.
3 When the impact of the 12-week programme was modelled over 25 years, it was cost-saving compared with the brief intervention. Although the 52-week programme was more expensive in the within-trial analysis, when the impact was modelled over 25 years, it resulted in the greatest gain in QALYs and the greatest reduction in disease incidence.
4 Reductions seen in the 52-week programme participants at 12 months are larger than those seen at the same timepoint in the intensive lifestyle intervention arm of the Diabetes Prevention Programme (DPP), whose participants were similar to those in the current study in baseline BMI, HbA1c and glucose and had similar weight loss at 12 months, but achieved at a fraction of the cost. Notwithstanding gradual weight regain and increase in associated risk factors observed over 15 years follow-up, DPP achieved a 27% reduction in the cumulative incidence of diabetes in the lifestyle intervention relative to the control group.
5 Ahern A et al (2011) Weight Watchers on prescription: An observational study of weight change among adults referred to Weight Watchers by the NHS, BMC Public Health, 11, 434.
Former government policy adviser, Adam Pike, has laid out his wish list for politicians in the run up to the General Election. Adam co-founded the revolutionary online home care business, SuperCarers, having experienced first-hand the pain caused by the failing social care system. Building on the recommendations of the Dilnot Commission on Funding Care in 2011 and the King’s Fund Barker Commission, Adam outlines his priorities below:
1. Individuals should be given state support once they have spent £35,000 of their own money on care, not be forced to lose their entire life savings
2. Individuals with assets of less than £72,500 should not have to pay for their care. Despite accepting this recommendation, the government have failed to deliver on it
3. People diagnosed with dementia or Alzheimer’s disease should have their care paid for by the state. It is not fair that people with dementia have to pay for their own care while people with cancer do not
4. There should be a single protected budget for health and social care and they should be commissioned together. People are living longer with more complex diseases that require co-ordination, the health and social care system needs to respond
5. Everyone should have the option of a personal budget so they can take control and have choice over their care
The UK’s care system is at breaking point. It has forgotten about people: The people who receive care; the people who pay for care; the people who provide care. In response, SuperCarers is calling for the public and politicians to take their care pledge online. The pledge has already been signed by Rt. Hon Paul Burstow (former Care Minister), Alan Rosenbach (former Head of Strategy of the Care Quality Commission) and Richard Humphries (Senior Fellow, Social Care, King’s Fund).
By signing the pledge, SuperCarers hopes the collective voice will demand that all political parties include the above points in their election manifesto and commit to the long-term reform of social care. You can sign up online at https://supercarers.com/care-pledge/.
New report highlights severe lack of dermatology training and support within primary care, and reveals a third of psoriasis patients have given up on seeing their GP regularly
“It is a serious concern that there appears to be an ‘inverse training law’ in operation in dermatology, whereby in the area which is most routinely seen by GPs, the amount of training is the least.” The British Association of Dermatologists
- Research shows nearly a quarter of the population have sought GP advice on skin matters in England and Wales,, yet some doctors have received as little as five days of dermatological training
- GPs in the UK handle around 13 million appointments about skin conditions every year,1 but only have 650 dermatology consultants to advise and support them1
- Report calls for improved dermatological training and support in primary care, and for people with psoriasis to be offered regular reviews, at least annually
Today, Wednesday 3 May 2017, the Patients Association, in partnership with LEO Pharma, released a report highlighting the lack of dermatological training and support available for GPs, and the resultant disconnect between the care the 2 million people living with psoriasis in the UK and Ireland need, and that which they currently receive.
Despite the World Health Organisation (WHO) recognising psoriasis as an area of focus, and recent advancement in treatments, the PSO What? Report – led by The Patients Association in collaboration with an expert Taskforce of healthcare professionals, patients and charities – highlights a pervading lack of undergraduate dermatology training,3 a chronic shortage of dermatologists,1 and regional inconsistencies in the availability of secondary care consultants.1 Katherine Murphy, Chief Executive of the Patients Association, said: “This new report shines a light on the shortcomings of dermatological training and staffing, which inevitably give rise to sub-optimal psoriasis care. It is essential these issues are addressed if we are to improve patient outcomes, and reduce the burden of the associated comorbidities currently weighing on individuals, health services, the economy, and society as a whole.”
A survey conducted as part of the PSO What? initiative highlights that a third of the people with psoriasis surveyed do not regularly visit their GP each year. The report goes on to show that GPs admit to lacking in knowledge and understanding regarding the effective management of the condition. This is particularly concerning given people with psoriasis are also at risk of developing other serious associated conditions,6including psoriatic arthritis,6 cardiovascular disease,,,, inflammatory bowel disease (IBD),6 liver disease,6 complications with vision and some cancers.
Katherine Murphy continues: “Vitally, the report calls for people from all walks of healthcare – from universities, to GPs, consultants, payers and policy makers – to pledge their personal and professional support to drive real change by visiting www.PSO-What.com. People with psoriasis must be offered regular reviews, at least annually, to assess the severity and impact of their condition, their response to treatment, and the wider physical and psychological factors affecting them. However, this will only prove effective if those in primary care are given the training and support required to confidently manage and treat the physical manifestations of psoriasis, as well as its associated complications andpsychological effects.”
Dr Angelika Razzaque, GPwSI Dermatology and Vice Chair of the Primary Care Dermatology Society (PCDS), comments: “Given the right access to appropriate treatments and information, most people with psoriasis can be principally managed in partnership with their GPs, nurses and pharmacists. The onus is on all primary care professionals, to continually assess how we’re treating the psoriasis itself, and to look beyond the skin at our patients’ individual needs, screening for associated complications. By regularly reviewing patients, at least once a year, we can improve outcomes as well as help to safeguard against life-limiting psoriasis complications and reduce the potential burden on the NHS later down the line.”
Even when effectively managed in primary care, up to 60% of people with psoriasis could need specialist referral at some point, however given the dearth of consultant dermatologists this may not be possible1. Contrary to recommendations from the Royal College of Physicians, no region in England has enough dermatology consultants1. Dr Anthony Bewley, Consultant Dermatologist at Whipps Cross and St Bart’s NHS Trust comments, “It is essential to address the current lack of training and formal assessment of practical dermatology skills that exist in medical school curricula. Beyond that, we, as healthcare professionals, need to move away from the misconception that psoriasis is ‘just a skin condition’, and look for the best possible whole-person care for each individual. The unfortunate truth is that past failings have seen some patients simply slip through the net. The PSO What? report signals a sea-change, encouraging patients to demand more from their doctors, and to make sure that medical professionals do not undermine their experience of living with psoriasis.”
To find out more visit the PSO What? website (www.PSO-What.com) and make a personal pledge to help make a difference for the nearly 2 million people living with psoriasis in the UK4 and Ireland5.
 King’s Fund. How can dermatology services meet current and future patient needs while ensuring that quality of care is not compromised and that access is equitable across the UK? Source report, 7 March 2014.
 Schofield JK, Grindlay D, Williams HC. Skin conditions in the UK: a health needs assessment. 2009. Centre for Evidence Based Dermatology, University of Nottingham.
 Primary Care Commissioning. Quality standards for dermatology. Providing the right care for people with skin conditions. July 2011. Available at: https://www.bad.org.uk/shared/get-file.ashx?itemtype=document&id=795
 Mental Health Foundation, Psoriasis Association. See psoriasis: look deeper. Recognising the life impact of psoriasis. 2012.
 Irish Skin Foundation. Securing the future for people with skin disease. Submission to Oireachtas Committee on the Future of Healthcare (Dáil Éireann). August 2016.
 World Health Organization. Global report on psoriasis. 2016. World Health Organization. Available at: http://apps.who.int/iris/bitstream/10665/204417/1/9789241565189_eng.pdf. Last accessed January 2017.
 Data on file. LEO Pharma. DERM-004 MAR 2017.
 Nelson PA, Barker Z, Griffiths CA, et al. ‘On the surface’: a qualitative study of GPs and patient’s perspective on psoriasis. BMC Fam Pract. 2013;14:158.
 Gelfand JM, Niemann AL, Shin DB, et al. Risk of myocardial infarction in patients with psoriasis. JAMA. 2016;296:1735-41.
 Ahlehoff O, Gislason GH, Jorgensen CH, et al. Psoriasis and risk of atrial fibrillation and ischaemic stroke: a Danish nationwide cohort study. Eur Heart J. 2012;33:2054-64.
 Lowes MA, Suarez-Farinas M, Kreuger JG. Immunology of psoriasis. Ann Rev Immunol. 2014;32:227-35.
 Langan SM, Seminara NM, Shin DB, et al. Prevalence of metabolic syndrome in patients with psoriasis: a population-based study in the United Kingdom. J Invest Dermatol.
 Fraga NA, Oliveira MF, Follador I, et al. Psoriasis and uveitis: a literature review. An Bras Dermatol. 2012;87:877-83.
 Lebwohl M. Psoriasis. Lancet. 2003;361:1197-204.
 National Institiue for Health and Care Excellence. Psoriasis: assessment and management. October 2012.