The healthmatters blog; commentary, observation and review
New one-year cancer survival rate figures for England out today, released by the Public Health England National Cancer Registration and Analysis Service (NCRAS) in partnership with the Office for National Statistics, show that for many common cancers more than one in three people will survive their cancer for at least a year despite being diagnosed at a later stage.1 Dr Fran Woodard, Executive Director of Policy and Impact at Macmillan Cancer Support says:
“It is really heartening that cancer survival rate of people living at least one year after a cancer diagnosis have increased2 and these new results are further proof that cancer is no longer the death sentence it once was. But with thousands more people surviving cancer, this also means more are dealing with the significant impact it has on their lives. They may be grappling with potential long-term debilitating side effects such as heart problems, incontinence and chronic pain or having money worries, a result of giving up work or cutting down their hours because of their illness.
“While we want people to be diagnosed early as it gives them the best chance of survival, it’s important to remember that even those with potentially incurable cancer can survive for many months or years. For example more than four in five men (85%) with advanced prostate cancer survive at least a year after diagnosis2. There must be the right support available for those who are trying to get on with their lives while coping with the inevitable effect that cancer has had on them. Support needs to be personalised and might include advice on how to manage the side effects of treatment, get back to work, or become physically active.
“We’ve seen the Government commit to a package of care to support the recovery of people with cancer and we’d urge NHS England to put this in place as soon as possible. To address the complex needs of cancer patients, everyone from health and social care professionals, to employers to the friends and family of people with cancer needs to work together to ensure no one faces cancer alone.”
- Office for National Statistics. One–year net cancer survival for Bladder, Breast, Colorectal, Kidney, Lung, Melanoma, Ovary, Prostate and Uterus, by stage at diagnosis. June 2016.
- Office for National Statistics. Table 10 to 16: 1-year cancer survival by clinical commissioning group in England, with 95% confidence intervals. February 2016.
- One–year age-standardised net cancer survival rate for men (aged 15 to 99 years) diagnosed with stage 4 prostate cancer in England in 2014. See reference 1 for further details.
Ending Discrimination in Mental Health, Conference and Live Broadcast “Turning the Crisis Tap Off”,
Thursday 13th October 2016, Amba Hotel Marble Arch, Bryanston Street, London, W1H 7EH.
Black African Caribbean Men are up to 6.6 times as likely to be admitted as inpatients or detained under the Mental Health Act as the average population. It is one of the deepest and most discriminatory social failures of our education, social, health and criminal justice services.
- Early Intervention for Prevention – through schools
- Ending CRISIS management of BME mental health
- Education and awareness of culture and mental health among staff
- Education to avoid staff stereotypes and presumptions of what behaviours mean
- Prevention and diversion through reskilling the workforce – Attitude Shift
- Make this a priority (create an imperative not to ignore and to embrace change)
- Influencing the community, creating a user voice, reducing fear in BME groups of statutory services
- Reducing Police involvement in a health issue
- Influencing national policy through budget oversight, monitoring and creating an observatory correlating evidence and data
- Influencing through first adopter programmes in pilot authority areas
- Creating funding incentives and key budget pools in commissioning to cross sectors from public and third sector, and reduce duplication and improve effective use of resources
- Creating specialist skills services for high level forensic support
- Reducing dependency of “bed” and “pharma” containment
- Building transformation capacity and knowledge – a professional centre – of what works
- Provide evidence of the “social value” return on investment and the impact on cost base for commissioners
- Develop personalised services and budget options
The NHS Inpatient Survey 2015 results show small but vital improvements have been made in key areas such as communication, involvement, and personal care. However, discharge planning and at-home support are lacking by comparison. In general, people’s experiences of care in hospital are markedly more positive than their feedback on the discharge process and at-home support.
The NHS Inpatient Survey 2015 of over 83,000 inpatients has revealed statistically significant improvements in a number of important questions designed to reflect the aspects of care that matter most to patients. Improvements included:
- 84% (up from 81% in 2014) reported that they were “always” treated with respect and dignity in hospital.
- A growing majority said that they “always” had confidence and trust in doctors (82%; up from 80% in 2014) and nurses (79%; up from 78% in 2014).
- 71% (up from 69% in 2014) said that when they had important questions for doctors or nurses they “always” got answers that they could understand.
- 60% (up from 57%) said that they were “definitely” involved as much as they wanted to be in decisions about their care and treatment – a big improvement on the 57% in 2014.
By contrast, results around people’s experiences of post-treatment discharge planning were less encouraging. 41% of people responded that they were not told about medication side effects to watch for when they went home, and 62% felt that hospital staff did not completely take their family or home situation into account when planning their discharge process.
The survey results also flag self-management, an area integral to person centred care, as needing urgent improvement, with only 56% of people who needed it agreeing that they received enough support from health and social care professionals to help them manage their condition after leaving hospital.
Taken together, these results underline the need for continuity of care, and for enough time and attention to be given to the care delivered both within and beyond the hospital wards. Sustained effort must be made and given to both understand the potential impact of improving care quality and deliver on the critical aspects of person centred care.
Commenting on the NHS Inpatient Survey 2015 results, Dr Andrew McCulloch, Chief Executive of the Picker Institute, who developed and coordinated the survey on behalf of the Care Quality Commission, said: “It is fantastic to see so many improvements in people’s experiences of hospital care. It is particularly encouraging that some of the most notable improvements are in areas that are of particular importance to patients, including communication, involvement, and respect for people as individuals. NHS staff work tirelessly and these improvements are not only testament to their commitment but a reflection of the efforts made in the last year to understand and improve on 2014 findings.
Nevertheless, the survey highlights areas that still need improvement. An effective person centred service is streamlined and continuous, and while strides have been made in hospital treatment, the results around discharge planning and self-management are cause for concern. For patients to have the best chance of recovery – and for providers to minimise the risk of readmissions – patients need to leave hospital with good, clear information and understanding about their ongoing care and medicines. Too often this is not happening, and improvement is needed to benefit patients and the NHS alike.”
Public Health Minister, Jane Ellison, has confirmed today (Tuesday) that a new, simpler, bowel cancer home testing kit known as FIT (Faecal Immonochemical Test) will be rolled out across England.
The new home testing kit is simpler – only one stool sample is required instead of two samples from three separate stools with the current test.
Sara Hiom, Cancer Research UK’s director of early diagnosis, said: “The news that the Government will introduce a new home testing kit that is more accurate as well as being simpler and easier for people to use could potentially transform the effectiveness of bowel cancer screening and early diagnosis of the disease.
“It’s hugely positive news that the Faecal Immunochemical Test (FIT) will replace the older test so now people will only need to take a single sample when using the screening kit delivered to their homes making it easier for people to do the test.
“The bowel screening programme is crucial in reducing deaths from bowel cancer, and research shows that this change will make the test even more effective. Bringing in the new test in England will save more lives by detecting the disease early when it is more likely to be treated successfully.
“The need for improvements to the bowel screening programme was set out in the new cancer strategy for England last year so it’s good to see progress being made.”
Today, the NSPCC launches its ‘Case for Change’ to highlight the importance of infant mental health and the need to do more to support that of babies and young children in care.
The charity has revealed that the impact of infant mental health has been vastly under-estimated across the wider care system, despite the fact that children in care are four times more likely than their peers to experience mental health problems and behavioural issues in later life.
Infant mental health refers to the healthy social and emotional development of babies and children under five, through the formation of secure and stable relationships with their parents and care-givers. Research shows that children who experience maltreatment and grow up without positive and stable relationships are at greater risk of mental health problems throughout their lives. Those in care are particularly vulnerable. Twenty per cent of children in care are under five years old, however, at present, mental health services for babies and young children in care are virtually non-existent.
The NSPCC’s Case for Change brings together a wide range of evidence from research and practice, from the UK and internationally, and lays out a series of solutions to how we can all rethink our approach to infant mental health in the care system. These include;
- Developing interventions that focus on the attachment-relationship between the child and their caregiver;
- Combining both health and social care expertise to create a consistent team of multi-disciplinary professionals;
- Offering a bespoke treatment model tailored to the individual needs of each case;
- Full liaison with other services that can support the needs of parents and/or children.
For the first time in the UK, the NSPCC is currently exploring a new approach to help improve the mental health of babies and young children in care who have been abused or neglected. Developed in America, the New Orleans Intervention Model puts a child’s attachment relationships at the heart of decision-making so they can experience a positive and nurturing care setting as early in life as possible and the model is now being tested by the NSPCC at two sites in Glasgow and London.
The NSPCC’s ‘Case for Change’ report is being launched during the UK’s first Infant Mental Health Awareness Week, organised by the Parent Infant Partnership (PIP UK).
Peter Wanless, NSPCC CEO said:
“The wider system has vastly under-estimated the importance of looking after infant mental health. Acting early can have significant benefits to future life outcomes. Yet public money is mostly spent on ‘late intervention’, rather than preventing problems occurring in the first place. It is time to rethink the way we work together across agencies to better identify and address the mental health and well-being needs of infants and young children.”
Claire Rees, Executive Director, PIP UK said:
“Good mental health begins in early childhood. When a baby has the opportunity to form a secure bond with their caregiver, it can support their ability to form healthy relationships throughout life. The first 1001 days of life, from conception to age two, provide a crucial opportunity to influence this development. We are really pleased that the NSPCC has chosen to launch its Case for Change during Infant Mental Health Awareness Week.”
Providers within the U.S. healthcare system continually work to improve the quality of community health, but nurses can often be relegated to support roles. The newly revised Healthy Places, Healthy People, Third Edition, published by The Honor Society of Nursing, Sigma Theta Tau International (STTI), builds a compelling case that nurses can lead the change to providing the highest quality of patient care by working with their communities to understand specific cultures and healthcare needs.
The newest edition of this popular book offers a detailed look at the differences and complementarities of ethnography and epidemiology, as well as updates on the national agenda and Joint Commission requirements that help nurses provide culturally sensitive care. Authors Lisa E. Skemp, Melanie C. Dreher, and Susan P. Lehmann provide updated information on community and public health as they guide students and experienced nurses alike through the core public health leadership competencies.
A well-crafted strategy enables public health workers to mobilize citizen action, working with groups and individuals to build capacity for health equity and, ultimately, a healthier future. Healthy Places, Healthy People, Third Edition provides realistic strategies and practical advice — everything current and future nurses need to prepare, gather, organize, and analyze the basic community information needed to create an effective public health strategy.
“Healthy places are the building blocks for healthy people,” Skemp said. “The capacity of communities to assure a robust physical and social environment will promote and protect the health of their citizens.”
The book is available at http://www.nursingknowledge.org/sttibooks
To mark the five-year anniversary of the BBC documentary which exposed the abuse suffered by people with a learning disability at Winterbourne View Hospital on Tuesday May 31st, the families of those abused along with charities have signed an open letter outlining their anger at the ‘painfully slow’ rate of change in improving care for people with a learning disability.
There has been little change since the Panorama, with 3,500 people with a learning disability still stuck in inpatient units, despite Government and NHS commitments to move people with a learning disability in back in to their communities.
Further figures from the Learning Disability Census 2015 revealed that of the 3000* patients receiving inpatient care who were included in the Census:
72% had received antipsychotic medication, yet only 28.5% were recorded as having a psychotic disorder
1,670 had experienced one or more incidents (self-harm, accidents, physical assault, restraint or seclusion) in the 3 months prior to census
Average length of stay in an institution is 4.9 years
670 people are 100km or more from home, an increase of 17% on last year
The families of those abused, along with Mencap and The Challenging Behaviour Foundation, have been campaigning for better care for people with a learning disability since the documentary was shown, but these figures show that very little has changed.
Ann Earley’s son Simon was one of residents who faced abuse at Winterbourne View. Simon is now living back in his local community receiving good care which is tailored to him. Ann said: “It was only when we were visited by two of the Panorama team that I learned of what had happened to Simon and fellow residents of Winterbourne View. They told us Simon had been subjected to abuse and they had footage and documentary evidence to prove it. I’ll always remember seeing the footage – the disbelief. I was utterly speechless to see the cruelty, the physical abuse, the mental torture and the systematic nature of it all.
“5 years on Simon is thankfully doing a lot better. He is living in his own house and has become a central part of his community. Simon is now safe and living a full and happy life. All this, and his package of care now costs about half as much as it did when he was at Winterbourne View. I am devastated that 5 years on from Winterbourne View people with a learning disability are still stuck in inpatient units like Simon was, and families are still forced to battle a system of care that is outdated. It breaks my heart every time I see a photo of someone who is shut away, far from home or hear the distressed voice of a parent. After everything that Simon went through, after all the things that have been said by those in power, it is unforgivable that things have not changed for so many people.”
Jan Tregelles, chief executive of Mencap, and Vivien Cooper, chief executive of The Challenging Behaviour Foundation, said:
“Five years on, despite all the promises, reports and action plans since Winterbourne View, the number of people with a learning disability in inpatient units has not changed, and it is appalling that the number of children in these places has increased over the last year.
“People with a learning disability and their families have endured nearly five years of failure by national and local government, and the NHS, to bring about meaningful change for the 3,500 people in in-patient units. Many of these are far from home at increased risk of abuse and neglect, with their families still fighting to bring loved ones home. NHS England recently announced a 3-year closure programme. This means that the right community-based support should be being developed for people with a learning disability and behaviour that challenges. But it means nothing until families see change on the ground.
“It is vital there is action now for the people currently stuck in these units, and those who are being inappropriately medicated and restrained. There must be independent checking put in place to make sure that change is real and rapid. The Panorama expose of Winterbourne View created a rare opportunity to focus attention on tackling these outdated services, which are failing people with a learning disability and their families, and to get care right. We cannot, must not, waste any more time.”
Rt Hon Norman Lamb MP, Former Minister of State for Care and Support in the Department of Health from September 2012 to May 2015, said:
“When I was Care Minister I was always deeply shocked by stories of families whose loved ones were stuck in places like Winterbourne View. I spent much of my time trying to make a difference, trying to get the system to work better and to get the right support in local communities. In March 2015, we also published proposals in a green paper to give new powers to people with learning disabilities and their families to decide where they were cared for, and power to challenge decisions about their care. Sadly, the Government has still not legislated to introduce those powers, and there seem to be no plans to do so in the near future.
“It is deeply frustrating that five years on from Winterbourne View we are still yet to see the change needed for this group of vulnerable people. What is clear to me is that hospital settings like Winterbourne View mean people with a learning disability and behaviour that can be described as challenging are too far from home, for too long, at an increased risk of abuse. It is a shocking indictment of our health and social care system that there has been such a failure to action change. People need to be moved out of these places and into more appropriate care in community settings, where they will be able to live in the way them and their families choose.”
Open letter from the families of former residents of Winterbourne View:
“Dear Prime Minister,
“We the families of people abused at Winterbourne View hospital write to express our anger at the lack of change five years on from the day that Panorama exposed what happened to our loved ones.
“Despite clear commitments and plans from government and the NHS, today, around 3,500 people, including over 160 children, are still stuck in places like Winterbourne View; often hundreds of miles from home, and at risk of abuse. Lives have even been lost.
“The rate of change has been painfully slow, and people with a learning disability and their families continue to suffer as a result. Government and the NHS must end this outdated model of hospital care and tackle the inappropriate use of restraint, seclusion and anti-psychotic medication, which is devastating lives.”
Families: Steve Sollars, Ann Earley, Wendy Fiander, Claire and Emma Garrod
Supported by: Dr Margaret Flynn, Author, Winterbourne View Serious Case Review; Jan Tregelles, Chief Executive, Mencap; Vivien Cooper, Chief Executive, The Challenging Behaviour Foundation
For the Mencap infogram on learning disability go to here.
Absenteeism and presenteeism* is costing UK employers up to £23 billion per year, according to the British Dietetic Association’s Work Ready Programme Whitepaper.
The British Dietetic Association (BDA), founded in 1936, is the professional association and trade union for dietitians in Great Britain and Northern Ireland. It is the nation’s largest organisation of food and nutrition professionals with over 8,500 members.
To emphasise the importance of workplace health, the BDA is this year theming their annual Dietitians Week around the value of good nutrition and hydration practices at work. Dietitians Week 2016 is taking place from Monday 6 June to Friday 10 June.
Maintaining a healthy weight has been shown to reduce productivity losses – the National Institute for Health and Care Excellence estimated that an average London business lost £126,000 per year on weight-related issues like back problems. Positive steps such as protecting lunch hours and ensuring employees are well hydrated throughout the working day has been shown to improve productivity and reduce the number of days lost to sickness.
The Dietitians Week event will see the BDA visit the House of Lords in Westminster and a trip to County Hall in Cardiff to encourage decision makers to promote healthier workplaces. The public will also be encouraged to take part through social media activities focusing on various aspects of workplace health including protecting your lunch hour, healthy meetings, hydration, food and mood, and physical activity.
“Dietitians Week has been a great tool to promote important public health messages and the work that dietitians do in relation to these issues,” said Andy Burman, BDA Chief Executive Officer.
“With so many barriers for workers to a healthy life including working irregular shifts, poor options for food within canteens/vending machines, and feeling stressed, it is important that employers take the time to consider their employees’ health, which is why this year’s Dietitians Week focuses on workplace health.
“Full time workers spend as much as 60% of their waking hours at work, so it is extremely important for employers to support their employees in a healthy life, to ensure overall health for the public, which can also benefit the organisation in terms of productivity.”
In November 2015, the BDA launched their Work Ready Programme (WRP). The programme offers bespoke nutritional and wellness services tailored to employers’ needs, to be delivered by dietitians to the organisation and its employees. The aim of the programme is to help improve the health of UK workers whilst assisting in a reduction of absenteeism and presenteeism related to health problems.
The BDA’s Work Ready Programme Whitepaper outlined that organisations have previously benefited from work-based health programmes like this. For example in 2012, Merseyrail invested in a dietitian-led tailored intervention for 50 staff which saved £11,000 in sickness absence costs.
“A ‘pick and mix approach’ affords businesses the opportunity to choose the level of support that they need as required,” said Fiona McCullough, BDA Honorary Chairman.
“Whether it is a full dietitian-led intervention or elements of the Work Ready Programme to be combined with existing services, employers can be sure that they are receiving a quality assured service, soundly based in scientific research and principles, provided by dietitians, specifically trained in workplace nutrition.
“Over half of people with a long-term condition say that their health is a barrier to the type or amount of work they can do, rising to over 80% when someone has three or more conditions, so experts who commission employee wellbeing programmes are increasingly looking for solutions which target this issue, and this WRP does just that.”
The full programme includes a workplace health needs assessment, and many useful tools and resources for employees to use.
Find out more about Dietitians Week on the BDA website
For more information about the programme, visit:
See the full BDA Work Ready Programme Whitepaper:
*Presenteeism refers to workers attending their place of employment whilst unwell which can lead to productivity losses.
The combined year end deficit of small hospitals in England has more than doubled from £114.6m in 2014/15 to £301.3 in 2015/16, an increase of 161% (£186.7m), according to analysis published by EY today. Only one trust has seen an improvement in its finances since last year and has broken even with a small surplus of £0.02m.
- 95% of hospitals with a turnover of less than £200m running a deficit in 15/16
- Small hospitals now account for 12% of the overall NHS deficit
According to EY’s analysis, the average small hospital deficit is £15.1m or 10.1% of its revenue. The majority of small hospitals (70%) has seen an increase in their deficit of between 0.1 and 10% a year. However, four small hospitals (20%) have increased their deficit by as much as 31%. Small hospitals now account for 12% of the overall NHS forecast deficit of £2.4bn, down from 14% last year.
EY’s analysis is based on a study of all 20 small acute hospital trusts across England, which had a turnover of less than £200m, using publicly available information from the relevant Trust’s websites. The most recent in year deficit / forecast position has been used where Trusts do not publish their 2015/16 surplus / deficit forecast.
Gill Cooksley, Executive Director in EY’s Healthcare team, said: “Never before has there been as much focus on alleviating the NHS deficit. 2015/16 year-end figures show that the majority of NHS trusts are in the red and running at a combined deficit of £2.45bn. This is £461m worse than planned.
“While other provider’s deficits are increasing at a faster rate, small hospitals are still over represented in their share of the overall NHS deficit and are bearing the brunt of unsustainable finances.
The south continues to outperform the rest of England
The research examined deficits in seven small hospitals in the North, nine in the Midlands & East and four in the South. Looking at the year as a whole, the total deficit for small hospitals in the North grew by 176% (£53.6m), while in the Midlands & East by 170% (£113.3m), and in the South by 114% (£19.7m).
Since the end of the last quarter, small hospitals in the North have fared the worst with their deficit increasing by 31%, followed by Midlands & East at 26%. Small hospitals in the South continue to perform better with an increase of their deficit of only 4%, according to EY’s research.
Gill Cooksley, added: “Small hospitals play an integral role within local communities and if they fail and the services they provide are put into question, the consequences will be more acutely felt by the local patient population.
“Beyond the numbers, small hospitals often provide services to population groups that can be disadvantaged or isolated. It is not just the financial, but also the societal impact that needs to be considered, if services are removed in an un-planned way and not replaced.”
Small hospitals analysed:
|Milton Keynes Hospital NHS FT|
|The Princess Alexandra Hospital NHS Trust|
|Hinchingbrooke Health Care NHS Trust|
|Burton Hospitals NHS FT|
|Wye Valley NHS Trust|
|George Eliot Hospital NHS Trust|
|Bedford Hospital NHS Trust|
|The Queen Elizabeth Hospital King’s Lynn NHS FT|
|James Paget University Hospitals NHS FT|
|Tameside Hospital NHS FT|
|Barnsley Hospital NHS FT|
|Southport and Ormskirk Hospital NHS Trust|
|East Cheshire NHS Trust|
|Mid Cheshire Hospitals NHS FT|
|Airedale NHS FT|
|Harrogate and District NHS FT|
|Yeovil District Hospital NHS FT|
|Weston Area Health NHS Trust|
|Isle of Wight NHS Trust|
|Dorset County Hospital NHS FT|
A not unexpected result bearing in mind that economies of scale exist in the NHS as elsewhere. As a former hospital service planner I recall planning district general hospitals to serve populations as low as 100,000 in the late 1960s and 1970s. In those early days of hospital planning we did not fully appreciate the impact of economies of scale; and more importantly we did not understand at all the impact of proficiencies of scale. So the NHS is left with a legacy of small inefficient hospitals which are also possibly not providing the highest quality of care across the board.
Paul Walker, June 2016
The Q initiative is led by the Health Foundation and supported and co-funded by NHS Improvement, that aims to connect people working in quality improvement across the healthcare system throughout the UK. During 2015, the first year of Q, the Health Foundation recruited 231 members to join a founding cohort to help design, refine and test the initiative before the wider recruitment process commenced in 2016. As part of this, the Health Foundation appointed RAND Europe to undertake an independent, embedded, real-time evaluation of Q to inform its future design and implementation.
Members of the founding cohort reported a range of views on what quality improvement is, what the barriers to its effectiveness are, and what they expect from Q. Members also expressed a series of benefits and challenges of the initiative.
- Members of the founding cohort were optimistic that there was benefit to be gained from the creation of a national initiative like Q.
- Members were positive about their involvement in Q’s founding cohort, especially its impact on connecting them with other participants and developing key aspects of the Initiative.
- The vast majority of participants who were interviewed stated that they would like to remain involved with Q in some capacity. Overall, the levels of commitment and loyalty expressed by those interviewed at the end were high.
- Members of the founding cohort reported that they face significant barriers in implementing quality improvement, which was mainly due to lack of time and financial constraints.
- The large size of the founding cohort made co-design of Q challenging, but did help members buy into it.
- Members agreed that Q was a promising but unproven initiative. Members of the funding cohort and project team members agreed that Q did not make as much progress during the first phase as might have been hoped.