The healthmatters blog; commentary, observation and review
On November 9th the CQC (Care Quality Commission) warned that 40 per cent of care homes for older people are below standard. Andrea Sutcliffe, the CQC’s chief inspector for adult social care, said that a third of social care facilities required improvement, with as many as seven per cent providing “inadequate” services.
Stephen Burke, Director of ‘Good Care Guide’, the TripAdvisor style website for the care industry, argues that the government must react to the care crisis, and suggests the following steps:
1) The government should commission an independent review to establish ‘fair care funding’ and ensure that local authorities pay at least the minimum rate required for both care home places and home care services. Alongside this review the government must fund councils properly to ensure that care providers are paid at or above the agreed minimum rate.
2) Care providers for their part must also commit to greater transparency, for example, of the wages they pay, staffing levels, profit margins and shareholder dividends. As private companies funded by public money, they should be accountable not just for the quality of care they provide but also for the way they run their businesses.
3) The investment in integration of care and health must be stepped up several gears, with one integrated budget at local level. Local authorities and CCGs(Clinical Commissioning Groups) must be required to demonstrate how effectively they are using this funding, for example to keep people out of hospital and residential care.
4) Following what is in essence the scrapping of the cap on care costs, the government should look at better ways to protect families from catastrophic care bills. One such measure would be to raise the threshold for paying for care from £23,250 to £250,000 (the average cost of a home in the UK). It is estimated that such a move would cost the same as the postponed cap and it would be a lot easier to administer.
He added: “Providing quality residential care is becoming unsustainable, especially if a care home relies on local authority income. That challenge will become even tougher next year with the much heralded increase in the national minimum wage. All the above should be seen as steps on the way to the long term sustainability of care funding. That will also require a new way of paying for care that is fair and effective.”
ORAL CANCER is now the tenth most common cancer in men according to new figures* released by Cancer Research UK today (Tuesday).
This latest data shows around 7,300 people were diagnosed with oral cancer in the UK in 2012** and twice as many men than women diagnosed with the disease –around 4,900 males and 2,400 females.
It is the fifteenth most common cancer in women.
Over the last decade, cases of oral cancer have risen from around 4,500 back in 2002. The incidence rate of the disease has increased by a third over ten years, rising from 9 per 100,000 people in 2002 to 12 per 100,000 in 2012.
Because of this sharp rise in oral cancer cases, Cancer Research UK has partnered with the British Dental Association and the British Dental Health Foundation to raise awareness of oral cancer during Mouth Cancer Action Month. They are launching a new oral cancer toolkit*** for dental professionals and GPs to help try and spot the disease earlier.
The free toolkit for health professional features images of signs and symptoms and outlines how GPs and dentists should refer patients for further tests. Health professionals also accrue credit for their continued professional development by completing the toolkit.
There are around 2,300 people who die from oral cancer in the UK every year, around 1,500 men and around 770 women.
Oral cancers include cancer of the lips, tongue, mouth (gums and palate), tonsils and the middle part of the throat (oropharynx).
Around nine out of 10 oral cancer cases in the UK are linked to major lifestyle and other risk factors. For example, an estimated 65 per cent of oral cancers in the UK are linked to tobacco smoking. The human papilloma virus (HPV), drinking alcohol and having a diet low in fruit and vegetables have also been linked to oral cancer.
Higher smoking rates in men are largely responsible for the greater number of cases in men and an estimated 70 per cent of oral and pharyngeal cancers in males in the UK are linked to tobacco smoking.
Dr Richard Roope, Cancer Research UK’s lead GP, said: “It’s a real concern that oral cancer cases continue to climb and has now broken into the top ten most common cancers in men, especially as the majority of cases are preventable. The combination of tobacco, drinking alcohol and HPV provides a toxic cocktail that has led to this rising tide of cancers, so it’s vital that people are aware of how to reduce their risk. If oral cancer is found at a late stage treatment options are more likely to be limited with long-lasting side effects and the chances of survival are poor. It’s because of this that we’re working to raise awareness of the risk factors of the disease as well as helping doctors and GPs spot the signs and symptoms and have the knowledge they need to act.”
Professor Richard Shaw, a head and neck surgeon based at the University of Liverpool involved in developing the GP and dentist toolkit, said: “We know that the vast majority of oral cancer cases could be prevented, so it’s important that people know how to reduce the risk of the disease through lifestyle factors. Alongside this, it’s vital that GPs and dentists can spot signs and symptoms of the disease to help catch it early and that they feel confident in knowing the next steps they should take in referring patients for further tests. Having seen the devastating impact that oral cancers can have, I hope this toolkit will help more cancers being detected at an earlier stage, when treatment is more likely to be successful. I can only see a limited number of patients every week, but this toolkit means more people will have the knowledge to spot the disease early.”
Professor Damien Walmsley, chief scientific advisor to the British Dental Association, said: “If oral cancer is spotted early survival rates can reach 90 per cent. Delay is costing lives, so it’s vital that front line health professionals have the tools and the information to reduce the risk of the disease and get patients diagnosed as quickly as possible. We are proud to team up with Cancer Research UK, and we urge all those who work in the oral health field to make use of this toolkit.”
Access the dental professionals toolkit here or the GPs toolkit here.
As a recent user of the NHS at one step removed, the inadequacy of current funding is all too apparent. Now the NHS Confederation has done the sums and worked out that by 2020 the Service will require £30 billions more than at present because of changes in medical technology, the growing population base, and the ageing of that population.
The attached info-graphic from the NHS confederation sets out visually the strategic impact this NHS funding chasm could have and indicates the broad areas where health and care services may need to change to meet this crisis.
The Confederation suggests that in order the fill this funding gap a transformation of services across both the NHS and the care sector is required which needs to be planned now to stop this becoming true by 2020.
Annual admission rates 2% lower than expected in areas with more restrictive policies.
Tighter local alcohol licensing curbs are linked to fewer drink-related hospital admissions in these areas, reveals research published online in the Journal of Epidemiology & Community Health.
In areas with the most restrictive licensing policies, annual drink-related admissions were 2% lower than would have been expected if no active policies had been in place, the findings show.
Alcohol misuse costs the NHS in England alone an estimated £3.5 billion every year. But that excludes the additional annual costs of drink-fuelled crime of £11 billion, and a further £7.3 billion in lost productivity.
The proportion of regular drinkers has fallen since 2005. But around a third of women and more than four out of 10 men exceed recommended weekly alcohol limits, while regular drinking is become more common among middle aged and older adults.
The researchers assessed the alcohol licensing policies and responses to alcohol licensing applications made to 326 local authorities (councils) between 2007-8 and 2011-12.
Council licensing policies allow for the creation of designated cumulative impact zones, or CIZ for short. These aim to regulate the number of new alcohol outlets in areas where the addition of more would undermine crime prevention and public safety, create a public nuisance or potentially expose children to harm.
The research team generated a ‘cumulative licensing intensity score’ for each council, based on whether they deployed CIZ and/or whether they refused to grant licenses for new premises. The score was divided into four categories: no activity; low; medium; and high.
In 2007-8, 118 out of 319 (37%) local councils operated some form of active alcohol licensing policy, one in five of which also included CIZ for new premises.
The cumulative intensity licensing score was classified as medium or high in around a third (35%) of councils; 43% were classified as no activity; while 21% were classified as low.
By 2014, a further 63 councils had adopted active alcohol licensing policies.
The researchers also looked at the number of drink-related hospital admissions, standardised for age, in each of the local areas from 2009 up to the first quarter of 2015.
After taking account of influential factors, such as deprivation and drink-fuelled crime, the analysis showed that the intensity of alcohol licensing policies was associated with a reduction in drink-related hospital admissions between 2009 and 2015.
The largest effects were seen in those local authority areas operating the most comprehensive policies.
Drink-related hospital admissions fell by an average of 0.6% every year in those local authorities with a medium score—twice as large as the fall in the average admission rate between 2009 and 2015 in those local authorities without an active alcohol policy.
In the local authorities classified as high, drink-related hospital admissions fell by 2% every year, or around 8 fewer drink-related admissions per 100,000 of the population in 2015, compared with what would have been expected in the absence of any active policy.
The researchers emphasise that this is an observational study, so no firm conclusions can be drawn about cause and effect. And they point out that the findings could also be the result of other additional alcohol policies, such as late night levies, or alcohol screening, which they did not investigate.
But they conclude: “These analyses contribute to the available evidence on the effectiveness of population level alcohol licensing policies specifically for England, and are the first to demonstrate that the intensity with which selected alcohol licensing policies are implemented and scrutinised is related to measurable reductions in alcohol attributable hospital admissions.”
The increasing numbers of older people with dementia and older people from minority ethnic groups in the UK present new challenges for many housing services according to Gearing Up: Housing, Ethnicity and Dementia, a report jointly published today by Age UK. Researchers, Valerie Lipman and Jill Manthorpe from the Social Care Workforce Research Unit at the Policy Institute at King’s examined the ways in which Housing Associations in England and Scotland are preparing themselves for tenants who develop dementia especially those who are from minority ethnic groups. The increasing numbers of older people with dementia and from minority ethnic backgrounds is challenging many parts of society, but the true impact on housing services is often overlooked.
The study asked if the older people’s social housing sector is prepared for the growing numbers of older people from minority ethnic groups who may wish to move to older people’s housing in later life (or who are already social housing tenants) and who may have dementia or develop it later. It found that while most Housing Associations had already planned how to meet the needs of their tenants from diverse ethnic groups, there was little awareness that many of these tenants might already have dementia. Similarly those Housing Associations that were making preparations for higher numbers of tenants with dementia were not always considering matters of ethnicity, religion and culture.
Not all training on dementia for housing workers covers cultural and ethnicity matters that are relevant to dementia care, and not all training on race equalities covers dementia – this really needs to be addressed concluded the researchers. One of the most interesting discoveries was that Housing Associations rely so heavily on healthcare professionals when making adaptations; and did not feel confident in co-ordination such support. Overall good practice in meeting the housing and care needs of people who develop dementia needs to be matched by good practice in meeting their cultural, religious and ethnic-related needs. These all need to be considered together when it comes to providing good housing care and support. Existing good practice in this sector needs sharing and other services such as primary care should pay more attention to housing matters.
The report was funded by Age UK with finance from the Department of Health as part of its Health & Care Voluntary Sector Strategic Partner Programme.
Michael Meacher MP, who died earlier this year at the age of 75, was a junior minister in Health & Social Security before Thatcher’s victory in 1979, and subsequently was opposition spokesman on health (among other posts). He had a homely approach to political thinking about the NHS. In opposition he drew on the knowledge and experience of three unofficial advisors – a social scientist, and epidemiologist and a general practitioner – to develop health policy for Labour. The trio would be invited to meet Mr Meacher in a room in the House of Commons, or sometimes (when he forgot to book the room) in the nearby gardens, for a brief review of changes in the NHS and a discussion of policy options. There was no agenda and no minutes, nor was it ever clear that the discussions shaped Labour’s responses to Thatcher’s claim that the NHS was “safe” with her.
Mr Meacher’s successors as health spokesman – especially Frank Dobson and Robin Cook – developed wider and more formal consultation networks, including the British Medical Association, which upset those in the Socialist Health Association at the time who saw the BMA as the enemy. It is not clear that the wider approach to policy making made much difference, except perhaps to the relationships between the BMA and Blair’s governments, at least initially. There is a PhD thesis in there somewhere.
Another recent obituary, of Professor Giovanni Berlinguer, reminds News from Nowhere moles of the pleasure this Communist stalwart of Public Health Medicine experienced when explaining to leftists worried about privatisation that markets had existed before capitalism, existed within capitalism and would exist after capitalism. Even in health care.
Five headline indicators of national success: Good Jobs, Wellbeing, Environment, Fairness and Health
NEF’s major new report, Five headline indicators of national success: A clearer picture of how the UK is performing is published today. You can read the report at http://www.neweconomics.org/headlineindicators
The report proposes five headline indicators of the UK’s overall success, measuring Good Jobs, Wellbeing, Environment, Fairness and Health. The indicators have been developed using evidence of what matters most to British people.
The most recent data and trends in the five indicators show that even when things are going well according to standard measures, the public’s priorities are not sufficiently addressed by current economic and social policy-making.
For example, while the headline employment rate has increased over recent years, our Good Jobs indicator shows a decline in the proportion of the labour force in secure, decently paid jobs.
The report calls on the Office for National Statistics to adopt the five indicators as headline measures – a call which is backed by 25 organisations from across British society, including businesses, trades unions, charities and community organisations. The endorsing organisations are listed here.
Rob Webster, Chief Executive, NHS Confederation said:
“There is an unprecedented consensus that we can only address the problems facing the NHS if we invest in the future of our nation’s health by helping people to stay well. Open any report from any director of public health in any part of the country and you can see health inequalities and poor health putting pressure on NHS services and blighting people’s lives.
“From our 2015 challenge to the Five Year Forward View, there is agreement that public health has a vital role to play, alongside care in people’s homes, in hospitals, and in the community. Investment in public health is critical for achieving a sustainable NHS and for addressing inequalities across society.
“We need the upcoming spending review to protect public health budgets, reflecting the Government’s commitment to transform and improve the way care is delivered to patients.”
BMA urge Government to give real and urgent consideration to Public Health England’s recommendations in delayed sugar report
Professor Sheila Hollins, BMA board of science chair, said:
“Doctors are increasingly concerned about the impact of poor diet, which is responsible for up to 70,000 deaths a year, and has the greatest impact on the NHS budget, costing £6bn annually.
“We urge the Government to give real and urgent consideration to Public Health England’s recommendations including restricting the marketing of high-sugar products, reducing promotions of sugary food and drink, and introducing a 10-20 per cent sugar tax.
“While sugar-sweetened drinks are very high in calories they are of limited nutritional value and when people in the UK are already consuming far too much sugar, we are increasingly concerned about how they contribute towards conditions like diabetes.
“It is concerning that a decision was made to delay publication at the same time as the BMA published its own report into the impact of sugar on children and young people, which included calls for a 20 per cent tax on sugary drinks alongside action to restrict the pervasive marketing strategies used by the food and drink industry. It is vital that the government takes on board the concerns already raised by doctors, and now echoed by Public Health England.”
The 2015 Community Mental Health Survey results, published today, reflect troubling and sizeable declines in service user experiences. The fact that many of these incidences are occurring in the areas that matter most to patients is even more so.
The Care Quality Commission Survey, developed and co-ordinated by Picker Institute Europe, was completed by over 13,000 people and found delivering effective person-centred care to be a key concern, with involvement, or the evident lack of it, to be particularly eye opening. More than two in every five (44%) respondents said that they were not involved as much as they wanted to be in agreeing the care they would receive, while a similar proportion were not fully involved in discussions about their care at care review meetings.
Support of people’s wider wellbeing and quality of life could also be significantly better with only two in five people responding that mental health professionals “always understood what is important to you in your life” (41%) or “always help you with what is important to you.” (41%)
Commenting on the results, Dr Andrew McCulloch, Chief Executive at the Picker Institute said; “We welcome today’s publication, and call on all mental health providers across the country to absorb the results and act accordingly. Communication, active involvement and effective co-ordination are known to be core to quality person-centred care provision, but the survey results show declines or stagnation in all of these areas, between 2014-2015. Although we recognise that services are facing the dual challenges of rising demand and increasing financial pressures, meeting these cannot be at the cost of delivering quality care.”
The results also suggest that more could be done to ensure that services match users’ personal circumstances.
Commenting further Dr McCulloch said; “When mental health services are effective, they can support people’s wider wellbeing, but when they aren’t they can also undermine it. Mental health is a long term struggle, many people need to and want to live everyday lives despite their condition, services need to be co-designed and structured in a way that supports them to do this. Focused action on understanding and responding to users experiences is needed urgently to arrest these declines.”