Cannabidiol Gummy Bears, frosty relations and NHS money worries

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Not just an ordinary bear

For the first time, plant-based Cannabidiol (a legal extract of Cannabis, also known as CBD) is available in gummy bear form. London based Love Hemp sold through their initial stock of over 2,000 bears in under 48 hours of trading, seemingly to the surprise of their manufacturer. Designed as a food supplement, each fruit-flavoured bear contains 10mg Cannabidiol and is enriched with Vitamins B12 & D3. The CBD infused gummy bears do not contain yeast, wheat, gluten, dairy, eggs, or peanuts. The bears are sold in packs of 5, 10 or 25, priced at £5.99 for the smaller packs – except you cannot buy them at the moment; you have to join a waiting list.

Whilst this makes them arguably the most expensive gummy bears available in the UK, studies have linked Cannabidiol consumption with a range of benefits from reduced stress and anxiety, to heart health and muscle recovery. Combined with Vitamins often lacking from our diet, the bears are intended to support a healthy lifestyle, say the manufacturers.

Neuroimaging studies have shown that CBD can affect the limbic and paralimbic regions of the brain including the amygdala, which plays a key role in the fear response. When exposed to stressful situations, subjects who had been given CBD showed less activity in these parts of the brain and felt less anxiety. CBD has also been linked with relieving the symptoms of irritable bowel disease (IBS) — a common and sometimes painful condition. Worldwide, the UK ranks second in the number of web searches for CBD products online.

Sticking to the rules, or not.

The Chief Executive of NHS England, Simon Stevens does not seem too bothered by his frosty relationship with the Prime Minister, who did not warm to his public criticism of her claims on NHS funding. You have to give the man credit for his determination. He has announced new restrictions on hospital bed closures and prophesied the end of the purchaser-provider split. Biding his time (or not risking his position), he has also declined to seek more money for the NHS from the Government, for the moment.

First, the clamp-down on bed closures. NHS England has said that any planned bed cuts must:

  1. Demonstrate that sufficient alternative provision, such as increased GP or community services, is in place alongside or ahead of bed closures, and that the new workforce will be there to staff them, and/or;

  2. Show that specific new treatments or therapies – the example given is new anti-coagulation drugs used to treat strokes – will reduce hospital admissions and/or;

  3. Demonstrate that hospitals using beds less efficiently than the national average have a credible plan to improve performance without affecting patient care.

Perhaps predictably, BMA Council Chair Dr Mark Porter said in response: “While the principle of this move sounds sensible, it is astounding that NHS leaders are still talking about cutting the numbers of beds even though we know that patients are being already unfairly let down by a huge lack of beds in our hospitals”.

Second, speaking to the House of Commons public accounts committee hearing recently, Simon Stevens reported that between six and 10 of the 44 Sustainability and Transformation Plans were set to become “accountable care organisations or systems, which will for the first time since 1990 effectively end the purchaser provider split, bringing about integrated funding and delivery for a given geographical population. The response from private sector providers, as reported by the Health Service Journal, was that the implementation of STPs and the development of new care models should not lead to inflexible monopoly provision of health services and that patient choice, fair treatment of provider and a diversity of healthcare provision should be upheld.

Third, capital spending – mainly investment in buildings or equipment – will need to increase significantly in order to fulfil the ambitions set out in STPs. Capital reserves have been raided to keep hospital deficits down, but the NHSE Chief Executive is not pushing his luck, deferring a campaign to relax Treasury stringencies on capital funding until the Autmn financial statement.

Patient centred, us?

Earlier this year the Court of Appeal dismissed an application by NHS England to reverse a decision by a High Court judge last year who ruled a teenager with a severe form of narcolepsy should be prescribed with the drug sodium oxybate.

Since the 2016 ruling, NHS England has made the drug routinely available to children with narcolepsy. It pursued its appeal despite the fact that the teenager in the case was now receiving the drug and would continue to be treated with it regardless of the outcome of the appeal. NHS England was ordered to pay costs for the , anticipated as around £200,000. As the Health Service Journal pointed out, sodium oxybate costs £13,000 a year, meaning the legal fees paid by NHS England on the case could fund the teenager’s treatment for 15 years.

Money worries

It is not just capital accounts that are being raided by Trusts desperate to reduce their deficits. The NHS Sustainability and Transformation Fund (not to be confused with an STP) has also been broken into. The Sustainability and Transformation Fund was introduced to reward trusts that agreed to meet their financial targets, yet some 40 trusts have received up to two-thirds of their STF allocation, even though they are forecast to significantly miss their targets.

However, it is not all doom and gloom. It was always obvious to anyone working in the NHS that Trusts would be unable to keep the deficit down to last summer’s target of £250m. NHS England and NHS Improvement stopped referring talking about this target some time ago, and the crucial number is now £800m, the reserve that CCGs hold in case of overspending by hospitals. Although the predicted deficit has risen to £873m, it may well be possible to reduce this to around £800m with some creative accounting and some land sales. Then, hey presto! The NHS deficit is written off by the reserves, and everybody will give a sigh of relief, especially in the Cabinet.

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