The healthmatters blog; commentary, observation and review
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.
- Survey* of 6,600 people over 12 months found that sedentary people who increased activity levels to 150 minutes a week (21 minutes a day) – currently the government recommended level, saw life expectancy increase of 3.1 years
- People who increased their activity levels to 90 minutes saw an increase of almost three years (2.7 years) and exercising just 60 minutes a week saw an increase of more than two years (2.4 years)
- The research was calculated through analysis of each individual’s ‘Vitality Age’, an aggregate measure of wellness that evaluates the gap between physical body age and actual age. By surveying members before and after they made changes to their everyday behaviour, the data pinpointed the impact of behaviour on life expectancy
- Further research found the main barriers preventing people from taking part in sport or exercise include time constraints (31%), the expense (21%) and people not enjoying it (19%)
- Vitality’s ‘Everyday Athlete’ campaign aims to inspire the nation to make small changes to realise lasting health improvement, whether it’s getting off the bus a stop early, walking up the stairs rather than taking the lift, or walking the dog for an extra 10 minutes a day.
Vitality Ambassador Jessica Ennis-Hill said: “I am delighted to support the Everyday Athlete campaign – it’s a fantastic way to spread the message about the benefits of health and wellbeing in a fun and inspiring way. I truly believe in the core message of the campaign, which is that everyone, regardless of their current health and fitness, can take small steps to live a happier and healthier life. Being an Everyday Athlete doesn’t mean you have to run a marathon or climb a mountain, it just means changing everyday behaviours such as walking up the stairs rather than taking the lift, or getting off a bus stop or two early to walk the rest of the way to where you want to go. This campaign shows how easy it is for people to make small changes that can really benefit their short and long term health.”
Ten life hacks to becoming an ‘Everyday Athlete’
|Everyday Athlete activities||Calories burnt in a week (Women)||Calories burnt in a year (Women)||Calories burnt in a week (Men)||Calories burnt in a year (Men)||Details|
|One hour of gardening||279||14508||332||17264||One hour of vigorous gardening a week, multiplied by 52 weeks|
|Walking upstairs at work daily||93||4464||111||5328||Assuming a total of 5 minutes of walking upstairs a day, based on 48 working weeks in the year|
|Walking around house while carry an infant||285||14820||339||17628||Assuming a 15lb baby and walking 10 mins a day|
|Getting off the bus a stop early and walking||175||9100||208||10816||Assuming the walk between bus stops is 5 minutes each way, 5 times a week|
|Taking the baby for a walk in the pram||349||18148||415||21580||Assuming a 20 minute walk 5 days a week, based on 48 working weeks in the year|
|Doing 30 minutes of standing at the office everyday||385||20020||460||23920||Details calculated usinghttp://www.juststand.org/tabid/637/default.aspx|
|One hour of house work a week||210||10920||249||12948||Assuming one hour of vigorous house cleaning|
|Washing the car once a week||157||8164||187||9724||Assuming 45 minutes of car cleaning|
|Walking to the station everyday||524||25152||623||32396||Details. Assuming a 30 minute walk a day, 5 times a week, based on 48 working weeks in the year|
|Walking the dog an extra ten minutes a day||244||12688||291||15132||An extra 70 minutes|
The Young Foundation, led by CEO Baroness Glenys Thornton, is challenging the political parties and parliamentary candidates to ask themselves these key questions on inequalities when writing their manifestos.
You can play your part and help us to challenge inequality by asking your constituency candidates the following questions.
Join the conversation on Twitter and make sure what they tell you is #morethantalk
1) The Young Foundation believes inequality undermines the economy and corrodes our wellbeing, leaving its mark on communities, relationships, aspirations and self-worth. How will your Manifesto and policies reduce inequalities in our society? How will you know they will do so?
2) The Young Foundation supports people and organisations to take action together to create fairer communities where everyone can thrive. How will your policies allow communities to innovate and make change happen by stopping doing things to people and starting doing things with them?
3) The Young Foundation is a leading centre for social innovation; creating new solutions to society’s problems including developing innovations like the Open University, School for Social Entrepreneurs and Action for Happiness. How will your policies empower and promote sustainable solutions that tackle problems through social innovation, social investment and support for the social economy?
4) The Young Foundation’s research tells us that we need to change the way people think about society’s most pressing problems, who can solve them, and the possibilities for change. How will your policies facilitate systems change by focusing on the causes of entrenched issues rather than just short term reactions, often only when they have escalated into crises?
5) We believe that the democratic process should be inclusive and accessible. How will your party ensure your policies and your candidates represent and involve the diverse communities that make up UK society including class, gender, sexual orientation, disability, race and faith?
Responding to the news that the prime minister has called a general election on 8 June, Dr Mark Porter, BMA council chair, has called on politicians of all parties not to duck the crisis in the NHS any longer. Dr Porter said:
“Health is always one of the most important issues for the people of this country and with the NHS at breaking point, having been put through one of the worst winters on record, it must be a central issue in the upcoming election. The NHS must not be pushed to the margins in the focus on Brexit.
“Staff have ensured that we still have one of the best health services in the world, but years of underinvestment while patient demand has been rising means that it is now failing too many people, too often. Our hospitals and GP surgeries are full and social care is on its knees, with staff working under impossible conditions. There are crippling funding and staffing shortages undermining the delivery of safe care, and serious question marks over the future of thousands of EU citizens who are a vital part of the NHS.
“Consecutive governments have been in denial about the state of the NHS and when it comes to elections have chosen to use it as a political football. Our health and social care systems can no longer cope without urgent action. We call on politicians of all parties not to duck this crisis any longer, and instead to outline credible and sustainable plans that will safeguard the future of the fully funded and supported NHS that staff want and patients deserve.”
Too big to succeed?
A bid worth £687m by a privately-led consortium to run cancer services for 10 years in Staffordshire has collapsed. The consortium – which included University Hospitals North Midlands Trust and The Royal Wolverhampton Trust as well as ‘Interserve’ – did not convince commissioners that its offer was economically viable. The tender process had started in 2013 but was paused in 2016 for review. A senior figure in one of the commissioning CCGs said that the focus of the NHS had switched from procurement to integration as the best way to change local services. The HSJ reported that the drawn out bidding process had cost more than £840,000.
This is the second recent commissioning mega-failure. In December 2015 ‘UnitingCare Partnership’ handed an £800m, five-year contract for older people’s care in Cambridgeshire and Peterborough back to the commissioning CCG, after only eight months’ running. The company was a limited liability partnership established by Cambridgeshire and Peterborough Foundation Trust, and Cambridge University Hospitals FT.
Funny old market
Earlier this year the independent provider Circle (remember them?) won a five year contract worth £73 million for musculo-skeletal services, beating the local NHS provider, Lewisham and Greenwich Trust. Auditors PwC reported that the loss of the MSK services could, potentially, push the Trust into financial special measures. So Circle signed an agreement with the CCG and the Trust to reduce the financial impact of the contract loss on the Trust. Circle agreed to include a specified minimum activity level in MSK services for the Trust for the duration of the contract, and a termination clause (for Circle) if planned activity levels in orthopaedics at the Trust fall below a threshold. It looks as if Circle is being drawn into the public domain as a contractor, with a tight contract that meets the needs of the local health economy. So much for the disruptive dynamism of the market.
UK patients are the most sceptical in Europe, the Middle East and Africa (EMEA) when it comes to having robotics and AI involved in their healthcare. New research from PwC shows that just 39% of UK patients (and 41% of German patients) say they are willing to engage with artificial intelligence/robotics for healthcare, in sharp contrast with other countries in the EMEA region, such as Nigeria where 94% of patients are willing.
Even though UK patients are more sceptical, the fact that nearly four in 10 would be willing to engage with technology in their healthcare experience signals a huge opportunity to transform healthcare delivery for the benefit of patients.
In the UK, men are significantly more willing than women – 47% compared to 32% – to engage with AI and robots for their healthcare. And perhaps unsurprisingly, the older generation are much more sceptical than the young – 33% compared to 55%.
PwC’s report – What doctor? Why AI and robotics will define New Health – is based on a survey of over 11,000 people from 12 countries across Europe, the Middle East and Africa. More than half of the respondents (55%) say they would be willing to use advanced computer technology or robots with AI that can answer health questions, perform tests, make a diagnosis and recommend treatment. This has the potential to transform healthcare delivery to make it better, faster and more accessible for all.
This report follows PwC’s recent Economic Outlook, published in March 2017, which predicts that 17% of healthcare jobs in the UK are likely to be impacted by AI.
Brian Pomering, PwC healthcare partner, commented:
“The younger the demographic group, the more likely they are to see new health technologies in a positive light. Well over half of 18 to 24 year olds would be willing to engage with AI and robotics to take care of some of their health. If only a proportion start to use more services delivered through technology, that could begin to make big savings. This could, in turn, make a serious contribution to addressing the huge financial challenges facing the health system in the UK.”
The survey found that even in the operating theatre, respondents would be willing for a robot to perform a minor surgical procedure instead of a doctor. Respondents in Nigeria, Turkey and South Africa are the most willing to undergo minor surgery performed by robots (73%, 66% and 62% respectively), with the UK the least willing (36%).
Perhaps unsurprisingly, the situation changes dramatically when it comes to major surgery, such as replacement of a knee or hip joint, removal of a tumour, or heart surgery. Even so, a significant percentage of respondents are willing to undergo major surgery performed by a robot: ranging from 69% in Nigeria to 40% in the Netherlands and 27% in the UK.
The survey also explores the key drivers for a person’s willingness or unwillingness to use an AI-enabled or robotic health procedure or service. Easier and quicker access to healthcare services (36%) and speed and accuracy of diagnoses (33%) are the primary motivators for willingness, with lack of trust in robots being able to make decisions (47%) and lack of the human touch (41%) as the primary reasons for their reluctance. Although percentages vary across countries, these top two advantages and disadvantages are cited in this order across all countries with the exception of Saudi Arabia and Qatar, where respondents feel the lack of ‘human touch’ was the biggest disadvantage.
The survey was conducted in November 2016 by YouGov, the world’s premier qualitative and quantitative research suppliers. 11,086 people from 12 countries participated in an online survey, including: nationally representative samples for Belgium, Germany, the Netherlands, Norway, Sweden, Turkey and the UK, and urban representative samples for Nigeria, Qatar, Saudi Arabia, South Africa, and the UAE.
The NHS is involved in a standoff with many of its locum staff – doctors, nursing and non clinical staff such as IT contractors.
There has been a change to tax rules, -IR 35 -which means that staff who are not regularly employed but are contacted with “off payroll” , – have to now pay the same tax and national insurance contributions as employed workers. this means there take home pay will drop -though most are still paid far more than the regular salary for that job, if they work as Agency staff. The NHS didn’t make the tax rules but is having to deal with the consequences.
A number of staff, notably doctors, have abruptly withdrawn their availability for shifts, some at very short notice – less than 24 hours -unless the employer pays an increased rate to make up for the tax changes. This has meant that hospitals have had great difficulty in covering those rota gaps at short notice. and some departments such as A and E have been threatened with closure. In my own Trust, we have a heavy reliance on locum doctors to staff A and E as we have not been able to recruit permanent staff, so our A and E has been badly affected.
it was hoped that all employers would” hold the line,” but some Trusts have agreed to pay the higher rate. So staff have moved to work with them, rather than the employer to which they had committed.
So is this reasonable action by locum staff , who can sell their services to the highest bidder? The law of supply and demand is working well, one could say.
However, the medical regulator makes it clear that reasonable notice should be given if doctors are not available for agreed shifts.
The General Medical Council has warned that any locum doctors engaging in “unreasonable withdrawal” from work could exacerbate pressure on health services and potentially risk patient safety. This is against the professional code of conduct.
It remains to be seen if the action of some doctors will be judged to be “unprofessional” -i t depends on what you think is” reasonable notice”. It is worth noting that some of these doctors have a long term relationship with certain Trusts -they may be employed on an ongoing basis. What price loyalty?
My hunch is that the Trusts will cave in and pay the higher rates, as they have to have continuity of safe services (with more strain on the budgets) . But it is an unedifying tale -and I personally would say we are seeing “unprofessional behaviour”
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