Official figures indicate that the 2015-16 financial year was the busiest in NHS history.
Nearly 23 million people visited A&E in the 12 months to March 2016; an increase of over 500,000 from the previous fiscal year.
Under the circumstances, it was perhaps not surprising that the NHS missed several performance targets.
And NHS England also indicated that the ongoing junior doctors dispute had exerted a significant negative influence over the performance of the health service.
Commenting on the issue of the under-performing NHS, a spokesman defended the figures achieved by the health service.
It was pointed out that the proportion of people dealt with in four hours in A&E – 91.9% – was “almost certainly one of the best performances in the Western world” despite falling short of the 95% target set by the government.
While the percentages were not as strong as hoped for by regulators and government officials, the figures were not altogether negative.
The more patients that the NHS has to deal with, the less likely it is to meet percentage targets.
And what can be said for certain is that the health service is actually dealing with more people successfully in pure volume than at any point in its history.
Figures acquired by the NHS indicated that over 2 million patients visited an accident and emergency department in March, which is the single highest monthly figure ever recorded.
However, delays discharging patients reached record levels, with nearly 170,000 days of delays experienced by patients unable to leave because of a lack of support available in the community
The ambulance service also missed its targets for responding to the most serious calls expediently, and this was the tenth consecutive month in which ambulances have failed to meet this target.
Figures also indicated that there is something of a backlog in the NHS for operations, and that the situation is not likely to improve in the foreseeable future.
The number of patients undergoing routine operations jumped by 4% year-on-year, and by March 8.5% of patients on the waiting list had been waiting for more than 18 weeks; the worst level since record-keeping began in 2012
Commenting on the issue, Royal College of Surgeons president Clare Marx suggested that the figures should be considered worrying, and called on the government to produce a legitimate long-term plan to address the problems in the health service.
“Dedicated frontline doctors and nurses are treating more patients than ever before. We welcome the extra money the government promised, but we still need a long-term plan to address the growing number of patients.”
Marx also suggested that social care being underfunded was of massive concern, and this is equally something that needs to be addressed due to the lack of community services now available.
In a move that could indicate the direction of future legislation in the UK, the United States government has unveiled a new federal rules which include a ban on the sale of e-cigarettes to those aged under 18.
Vaping technology has already become relatively widespread in the United Kingdom, with many arguing that it has health benefits over smoking, and can contribute to smokers quitting the habit completely.
However, e-cigarettes are also controversial, as some evidence suggests that they can be almost as harmful as regular cigarettes, and that the technology is ultimately having a limited impact over the number of people who stop smoking.
As part of the new legislation, the Food and Drug Administration will require manufacturers of e-cigarettes to submit products to the agency for review.
California has also recently passed anti-smoking legislation which regulates e-cigarettes, ironically at a time that the smoking of marijuana is becoming more socially acceptable In that United States.
US secretary of health and human services Sylvia Burwell believes that the announcement could have a significant impact on the health of young Americans.
Burwell suggested that the decision is “an important step in the fight for a tobacco-free generation”.
The health secretary also asserted that the new legislation will enable the US government to create a more sophisticated generation of children that are in a better place to make responsible decisions about e-cigarette products.
“This bill will help us catch up with changes in the marketplace, put into place rules that protect our kids and give adults information they need to make informed decisions.”
The Food and Drug Administration has asserted, based on statistics collated by the organisation, that the level of e-cigarette usage among high school students has risen more than ten-fold in just four years.
Government legislators believe that unscrupulous e-cigarette manufacturers can target children and capture their attention, involving them in a physical practice which seems to be benign, but which ultimately could be as dangerous as traditional smoking.
Public health advocates in the United States welcomed the news, with Harold Wimmer, president of the American Lung Association, particularly prominently commenting on the legislation.
“Ending the tobacco epidemic is more urgent than ever, and can only happen if the FDA acts aggressively and broadly to protect all Americans from all tobacco products,” Wimmer asserted.
Electronic cigarettes will also be banned in public spaces across California, in common with existing tobacco products.
While the United States tends to take a prohibitive attitude towards smoking and tobacco-related products, there has been a more mild and liberal approach in the UK.
It has even been recommended for GPs to prescribe e-cigarettes, but it seems increasingly that the jury is out on the efficacy and appropriateness of this particular policy.
A major charity has suggested that unpaid carers in England are not receiving sufficient support, despite new laws introduced with the intention of helping them.
Carers UK states that the Care Act – introduced in England last year – has failed to achieve its modus operandi.
The government legislation was passed in order to provide better support for those needing care and those who provide it unpaid.
But the charity believes that many unpaid carers are still forced to wait far too long in order to receive adequate assessment of their particular needs.
However, the government defended the new policy, suggesting that it is still bedding in and has already delivered tangible improvements.
Social care minister Alistair Burt acknowledged the contribution that unpaid carers made to society, and signalled his intention to work closely with counsellors in order to ensure that good practice was adopted more commonly on a nationwide basis.
Yet a report by Carers UK suggests that the new law has not yet delivered the promised improvements.
A total of 6,149 carers and former carers responded to Carers UK’s annual survey earlier this year, but only responses from the 3,076 people currently caring for a family member or friend in England were included in the final report.
And the statistical results collated in the survey can be considered rather worrying.
Despite the legal right for carers to have to an assessment of their needs, many believe that this had not been properly conducted.
The majority of those who responded expected their standard of living to decrease in the coming year, and this was actually an increase over the 50% that had asserted this before they Care Act was even passed.
Of carers who received an assessment in the past year:
– 68% felt their need to have regular breaks from caring was either not considered or not thoroughly considered
– 35% felt support to look after their own health was thoroughly considered
– 74% did not feel the support needed to juggle care with work was sufficiently considered
– 21% said they received little or no helpful information or advice, and felt they did not know where to go for support with caring
Helena Herklots, chief executive of Carers UK, offered tacit tacit support for the Care Act by suggesting that it is a valuable and ultimately welcome piece of legislation, but also suggested that it is not entirely fulfilling its remit at present.
“If the Care Act is to deliver on its promise to improve support for carers, the government must set-out a clear expectation of when carer’s assessments should be carried out, alongside investment in the care and support services that are desperately needed to backup families. Caring is not an issue that we, as a society, can afford to ignore. After all, caring will touch each and every one of our lives – whether we provide care for a loved one or need care ourselves.”
The aforementioned Burt, however, the minister for community and social care, stated that the new rights for carers introduced by the Care Act legislation have yet to become fully embedded in the culture of the UK.
Burt furthermore offered his support to carers, and insisted that the government is doing everything possible to improve the situation.
“That is why we are working hard with the sector to support and challenge Local Authorities and share the great practice that already exists. We want to do all we can to support carers through our new Carers Strategy and I urge everyone with caring responsibilities to respond to our call for evidence.”
While oral steroids are frequently prescribed for a range of conditions, including rheumatoid arthritis, recent research suggests that there could be downsides to this particular form of medication.
Patients taking oral steroids for rheumatoid arthritis may have a ten-fold increased risk of diabetes, According to estimates recently published by researchers.
A joint team from Canadian universities and the University of Manchester in the UK conducted research on a group of patients taking 5mg per day of prednisolone equivalent dose.
Various groups received this dosage for one, three and six months, and these individuals had a 20%, 43% and 48% increased risk of diabetes respectively, when compared with non-users of glucocorticoids.
Not only are steroids associated with an increased risk of diabetes, but it seems that the level of dosage also has a significant influence over this phenomenon.
Increasing the dose of oral glucocorticoids to 30mg per day saw patients at one, three and six months have a three-fold, eight-fold and ten-fold increased risk of diabetes respectively.
In fact, such is the strength of this particular piece of research that the scientists involved suggested that treating individuals at this dosage will result in an extra case of diabetes for every seven patients on corticosteroids.
But the results were not seen in those who had stopped taking oral glucocorticoids more than six months ago, with their risk being comparable to those that had never taken the therapy.
And the sample size involved involved in the research is certainly significant, with over 20,000 UK patients with rheumatoid arthritis involved in the study.
And the conclusions of the research where then validated by examining over 12,000 patient records from the US; establishing that the results of the survey were rather sound.
Researchers were cautious about the results of the study, ensuring to emphasise that treatment with oral steroids should not be ruled out completely, but rather that the research will enable “clinicians and patients to make informed decisions about their treatment, balancing benefits and harms.”
Writing in the paper, the authors assert that “glucocorticoid use is a clinically important and quantifiable risk factor for diabetes. Risk is influenced by the dosage and treatment duration, although only for glucocorticoid use within the last six months.”
Dr Will Dixon, honorary consultant rheumatologist and lead author of the research will certainly provide food for thought for clinicians, and that oral steroids perhaps it shouldn’t be diagnosed quite as glibly as is the case currently.
“Doctors treating people with arthritis have to make a decision how best to prescribe glucocorticoids by balancing the benefits against the risks. This research provides important evidence for doctors to make this decision.”
The study was published in Arthritis and Rheumatology; a monthly peer-reviewed medical journal covering the natural history, pathophysiology, treatment, and outcome of the rheumatic diseases. It is an official journal of the American College of Rheumatology.
Rheumatoid arthritis is the second most common form of arthritis in the UK and the most common inflammatory joint disorder.
Women are three times more likely to be affected than men.
After researchers at Oxford University suggested that less people proportionately die in hospital at the weekend than during the week, further research has backed up the impression that Jeremy Hunt’s NHS policy is ill-founded.
This is particularly important, as the Health Secretary Hunt has repeatedly cited evidence related to the vulnerability of patients at weekends as central to his desire to create a seven-day NHS culture.
Yet a study from Manchester University has seemingly identified a simple cause of the statistical anomaly of death rate rises at the weekend among NHS patients.
Analysis conducted by researchers at the university examined people arriving in accident and emergency departments, and found that although there is a so-called ‘weekend effect’, few people are admitted at this time, and they are often the sickest patients.
Ultimately, the supposed phenomenon on which Jeremy Hunt has based large swathes of NHS policy is simply a resource that anyone would reasonably expect to see based on the data.
Prof Matt Sutton led the research, which looked at deaths in hospital within 30 days of admission, and concluded that the severity of the conditions which are treated at weekends has a bigger impact than any other factor.
“Hospitals apply a higher severity threshold when choosing which patients to admit to hospital at weekends – patients with non-serious illnesses are not admitted, so those who are admitted at the weekend are on average sicker than during the week and more likely to die regardless of the quality of care they receive. As a result, the figures comparing death rates at weekends and weekdays are skewed. The NHS has rushed to fix a perceived problem that further research shows does not exist.”
The research has already been published in the Journal of Health Services Research and Policy, as the policy and assertions of Jeremy Hunt and the Conservative government continued to unravel.
Rachel Meacock, lead author, indicated that researchers involved in the study were actually surprised about the results.
Research had been conducted following suggestions that the seven-day working culture would ultimately not be cost-effective for the NHS, although previous papers published on this subject have been largely ignored.
The latest study conducted at Manchester University “was just trying to understand it a bit more” according to Meacock. “We had this weekend effect and nobody understands the cause of it.”
While Meacock acknowledged the existence of a weekend effect, she also indicated that the existing NHS policy which Hunt intends to introduce will simply have absolutely no impact on the number of weekend deaths.
“The so-called ‘weekend effect’ is a statistical artefact and extending services will not reduce the number of deaths. Instead, the most likely impact of the planned service extensions will be an increase in the number of less severely ill patients who are admitted at the weekend, further pushing up NHS costs.”
NHS England predictably defended its position in the light of the new information, suggesting that the policy had been vindicated.
“This analysis confirms the fundamental point that patients admitted to hospital at weekends are sicker, and need to have the right medical cover available, ensuring patients can see a senior doctor as soon as possible.”
Liverpool City Council has indicated its intention to begin naming and shaming the most heavily sugared drinks on the market, as public sector bodies step up their opposition to the fizzy drinks industry.
Chancellor George Osborne has already signalled its intention to consider the possibility of a sugar tax in its most recent budget, and it is clear that heavily sugared drinks are being particularly targeted.
The new move from Liverpool Council means that it is the first in the UK to campaign against what is often described as the unbelievable levels of sugar in many commonly available brands of fizzy drink.
Public officials have particularly blamed these products for the high level of obesity and tooth decay in Liverpool, although it is not entirely clear why these should be higher than other regions of the country considering that these drinks are available on a nationwide basis.
Central to this new initiative is the principle of ensuring that people are better informed on the content of sugary consumer products.
Thus, displays in GPs’ surgeries, children’s centres and hospitals featuring seven popular makes of soft drinks will highlight how much sugar each contains.
Ironically, a drink which was once promoted as ideal for athletes will be recognised as being the worst offender.
Lucozade features 15.5 cubes of sugar, or 62g, in a 500ml bottle. It is closely followed by the 13.5 cubes in a bottle of Coca-Cola.
Dr Sandra Davies, the city’s director of public health, stated that she was “astounded when we found out quite how much sugar was in some of these drinks. Some of the sugar levels are…astounding.”
Yet while the dangers of drinks such as Coca-Cola are widely known, it is surprising how many seemingly benign products in fact contain sugar.
For instance, 300ml of Tropicana orange juice had 7.5 cubes, or 30 grammes, while even a 500ml bottle of Volvic flavoured water contained 5.75 cubes of sugar.
“You can consume as much as your daily maximum recommended amount of sugar, or even double that, even if you have just one of these drinks,” the aforementioned Davies noted.
Council officials took advice from health professionals when drafting the new policy.
And Sondos Albadri, a consultant in paediatric dentistry at Liverpool University, indicated a particular opposition to sugary drinks, outlining the negative impact that they have on the oral hygiene and health of children.
“I had to remove 15 adult teeth for a 14-year-old recently. While that is an extreme case, it is not a rare occurrence. All this is largely preventable by reducing sugar intake and keeping teeth clean by brushing twice a day.”
Public Health England did not specifically offer its backing to the campaign, but it also acknowledged that sugary drinks can be extremely damaging for young children in particular.
Dr Alison Tedstone, its chief nutritionist, recommended water or lower-fat milk instead.
“It is deeply concerning that children consume three times the official recommendations for sugar, their main source being sugary drinks. That is why our report on how to help people cut down on sugar proposed a levy on sugary drinks as well as controls on marketing, advertising and promotions of high-sugar products and reducing the sugar in food and drink.”
Fresh talks are underway over the junior doctors’ contract disputes, with both sides indicating their willingness to find an eventual solution.
The British Medical Association is representing doctors across the UK.
Meanwhile, the government continues to insist that it is willing to impose contractual conditions on junior doctors if is a compromise is not identified.
The government has put on hold, for five days, its plans to impose the contract, but remains intransigent in his position that it will indeed force doctors to accept the contractual provisions proposed.
This latest round of talks will be mediated once again by conciliation service Acas.
Junior doctors have concerns over the contract proposed by Health Secretary Jeremy Hunt, both from a personal and patient perspective.
The medical professionals believe that the imposition of the contract is completely unreasonable, as the pay and conditions included in the terms of the Hunt-approved document are unfair.
There is particular concern over the fact that normal working hours are to be redefined under the terms of the contract, meaning that most doctors will lose some pay, and some will see their salary plummet by as much as 30%.
Additionally, it is believed both by medical practitioners and the British Medical Association – and supported by many of other groups as well – that the so-called seven-day NHS culture which Hunt wishes to impose will compromise patient safety.
Experts argue that the NHS is already overstretched currently, and that attempting to deliver more services, while also asking for the health service to identify over £20 billion of efficiency savings, is tantamount to organisational suicide.
And in recent days, a new study published by researchers at Oxford University suggests that the evidence that Jeremy Hunt has utilised regarding the danger of weekend care is actually fundamentally inaccurate.
NHS England has already offered its response to this piece of research, attempting to defend the position of the government and Department of Health on this topic.
“This report about data collection covering one condition from nine GP practices in no way alters the wider issue that sick patients rightly should expect to be seen by a consultant within a few hours, have prompt access to tests and treatments and receive joined-up care, whatever day of the week they fall ill, as recommended by the Academy of Medical Royal Colleges.”
It seems that the position of the government is completely unravelling, yet Hunt remains defiant on the contract, indicating that he will be imposed regardless of any further industrial action.
The British Medical Association has stated previously that many options remain on the table for junior doctors, and there have also been reports that many are considering either leaving the profession completely, or moving abroad in order to practice in more favourable locations.
Overall, the whole issue as to what could be described as a complete disaster for the NHS, and it is therefore of paramount importance that talks produce an agreement acceptable to both sides in the dispute.
Researchers believe that patients that self-diagnose to a certain extent, and utilise websites in order to check and self-manage respiratory tract infections (RTIs), are less likely to need GP attention.
A team of researchers, who studied the effects of using Internet-based information in patients aged 18 or older who had RTIs, found that there was a significant difference between those who used websites and those who did not.
It was concluded that those who accessed the Internet ahead of GP visits were 30% less likely to need the attention of doctors.
Presenting patients with NHS Direct details on the website also led more website users to contact the service, compared to non-users.
This is an interesting phenomena that gives a real insight into the power of information, and suggests that many GP visits could ultimately be prevented.
While RTIs are unquestionably debilitating conditions, avoiding clogging up the NHS system with needless visits is obviously an extremely valuable prospect for an already over-burdened health service.
However, while this notion is an interesting one, and something that could benefit the treatment of RTI in the future, the phenomenon was not entirely one-sided.
People who accessed and took guidance from the website also experienced slightly longer illness duration.
However, researchers concluded that this did not deviate massively between groups, and ultimately attributed this to patients being recommended to utilise ibuprofens in order to treat their specific condition.
Despite this, there was no significant increase in hospital admissions in the website users, compared to non-users.
This does suggest that providing information to RTI sufferers ahead of doctors’ visits can ultimately effectively had off the need for attention at the pass.
Patients involved in the study visited a website on a four-weekly basis, and subsequently completed a series of questions about the symptoms and medical history, with individual advice tailored to their particular needs to be offered depending on the answers given.
Researchers involved in the study hailed from the University of Southampton, and the scientist believes that this could have a significant impact on NHS clogging.
The authors of the research believe that their findings support using internet-based interventions to reduce GP visits, and that this could be an effective way to more efficiently utilise the NHS services in a very demanding climate.
Professor Paul Little, lead author and a GP in Southampton, offered his belief in the paper that Internet-delivered interventions can have a very positive impact.
“An internet-delivered intervention for managing RTIs helps participants appropriately manage their symptoms and contacts with NHS staff. The estimated 25% reduction in GP consultations, even if only over a period of a few months, would provide very considerable relief in terms of pressure on services during the winter months. The study was published in the journal the BMJ Open, And is widely available for viewing and reading online.”
NHS England has announced that it intends to recommission the flu vaccine scheme from last year for the season that will overlap the end of 2016 and beginning of 2017.
This is despite the fact that many believe that the scheme has contributed to a fall in vaccinations, and has ultimately cost of general practice millions of pounds with limited return.
A national contract, introduced last September, paid community pharmacists across the whole of England to give flu jabs as part of the annual NHS flu vaccination campaign.
Yet official figures indicate that the number of people signing up for the flu vaccination has fallen across every single demographic of the target population since the scheme was introduced.
Furthermore, the General Practitioners Committee has warned the NHS that the vaccination program has disrupted established flu clinics.
It may also have ost practices as much as £4 million in vaccine payments that were ultimately lost.
On balance, there seems to be substantial evidence that the existing vaccination program is not particularly effective, not least because it had rather poor return in terms of dealing with flu cases last year.
Yet Alastair Buxton, PSNC director of NHS Services, defended the decision to renew the project, suggesting that it could have a positive impact on influenza in the forthcoming months.
“This early announcement of recommissioning will help pharmacy contractors prepare for provision of this important service and is to be welcomed.”
But this view was not echoed by Dr Richard Vautrey, deputy chair of the GPC, with the clinician suggesting that NHS England is effectively ignoring ample evidence which has been provided by doctors and doctors’ groups.
“Practices will be frustrated that NHS England is ignoring the evidence that the extension of the flu immunisation scheme this year failed to deliver significant improvements and in fact led to a drop in overall uptake, fragmentation of a previously good service to patients, wasted vaccine that had been pre-ordered by practices and in some cases undermined previously good relationships between practices and pharmacies.”
Indeed, GP leaders have already warned that the practice risks diminishing the amount of funds made available to general practices across the country, while the established flu vaccination campaign has already been disturbed by the new process.
And the existing evidence would certainly seem to support the view of GPs.
Indeed, coverage has fallen in all at-risk groups, while it is estimated that practices have lost in excess of £4 million in lost vaccine payments.
There are also concerns that the programme is adding to practices’ administrative workload in order to keep track of who has been vaccinated.
Critics of the flu vaccination also suggest that while certain cohorts of the population which are particularly at risk are targeted by the flu vaccination, this message is poorly communicated to the general public.
Some suggest that manufacturers of the flu vaccination ultimately benefit from this approach as opposed to the general population whom it is intended to assist.
The high-street chemist chain Boots is considering offering a range of complex treatments in-store which will help ease the cancer burden on the NHS.
The Chief pharmacist of Boots has indicated that the chain is indeed ready to offer more profound health treatments, and this could help reduce the scope of organisational problems that the NHS faces.
Post-diagnosis treatments for skin cancer and diabetes could soon be offered at local branches, if indeed the Boots scheme goes ahead as planned.
The chief pharmacist of Boots, Mark Donovan, believes that the services it is proposing to offer will be extremely valuable to the public and NHS alike.
“The NHS needs us to change to meet some of the challenges it is facing”, Donovan asserted, and the chemist also indicated that several treatments could be undertaken by community pharmacists as a possible alternative.
However, despite the practical benefits of Boots becoming involved in more advanced treatments, not all observers are convinced by the validity of the scheme.
Patient advocacy groups suggest that the proposals need to be assessed carefully, as there is a massive profit incentive for a huge private company such as Boots.
Katherine Murphy, chief executive of the Patients Association, believes that the plan could have positive benefits, but is also concerned about the motivation for Boots to be involved in the first place.
“I agree that pharmacists are an under-utilised resource but we’ve got to be careful and scrutinise private providers creeping into the NHS. When they see an opportunity, is the opportunity for the patient or for their own gain?”
Boots strongly opposes the views of Murphy and instead indicates that the NHS simply requires help in order to tackle some of the challenges it is confronted with currently.
The aforementioned Donovan outlined his view that the partnership between Boots and the NHS will simply help organisational problems in the health service be addressed.
“The NHS needs us to change to meet some of the challenges it is facing. The treatment of minor ailments and the management of long-term conditions, once they had been diagnosed, could be done effectively by community pharmacists, and the NHS needs this assistance”.
Yet the timing of this announcement will be considered strange by many.
Boots has already been criticised for apparently profiting from the prescription scheme that it already runs for the NHS, and this will obviously heighten concerns that the High Street chemist chain will indeed profit inappropriately from this new arrangement.
The investigation into the potential of £30 million profit that Boots may have made from prescriptions is ongoing.