NHS staff "quitting to work in supermarkets because of poor pay"

NHS staff are quitting to stack shelves in supermarkets instead of caring for patients because they are so demoralised by years of getting pay rises of only 1% or nothing, hospital bosses have warned.

The health service is now so understaffed that patient safety is being put at risk and people with mental health problems are experiencing delays and setbacks as a result, NHS leaders say.

The intervention in the general election campaign comes from NHS Providers, which represents almost all of England’s 240 NHS hospital, mental health and ambulance trusts. They told ministers bluntly on Monday that the government’s longstanding policy of holding down NHS staff pay is wrong and is damaging the service by deepening its already severe staff shortages.

“Years of pay restraint and stressful working conditions are taking their toll,” said Chris Hopson, NHS Providers’ chief executive. “Pay is becoming uncompetitive. Significant numbers of trusts say lower paid staff are leaving to stack shelves in supermarkets rather than carry on with the NHS.”

He urged Theresa May to abandon her plan to limit NHS staff’s pay increases to 1% a year until 2020 and not pursue it during the next parliament as a way of making the NHS’s books balance.

He added: “Trust leaders tell us that seven years of NHS pay restraint is now preventing them from recruiting and retaining the staff they need to provide safe, high-quality patient care. The NHS can’t carry on failing to reflect the contribution of our staff through fair and competitive pay for five more years.

“Pay restraint must end and politicians must therefore be clear about when during the lifetime of the next parliament it will happen and how.” He repeated the organisation’s demand for £25bn in extra funding to help the NHS in England get through until 2020 and warned that staff are also leaving because they are exhausted from having to work so constantly to keep up with the unprecedented demand for care.

Hopson added: “We are getting consistent reports of retention problems because of working pressures in the health service causing stress and burnout.”

Medical royal colleges, health trade unions and health charities such as Cancer Research UK have been highlighting in recent months the damaging effects on patient care of widespread shortages of doctors, nurses, GPs, paramedics and many other NHS staff groups.

Norman Lamb, a former coalition government health minister, said NHS pay restraint – which had operated since 2010 – was “stupid” and had gone on so long that it was proving counterproductive.

“The Conservatives expect NHS staff to take year-on-year real-terms pay cuts in order to try to stave off financial disaster in the NHS,” said the Liberal Democrat health spokesman. “You can’t possibly justify this over such a long period. It is also stupid because great staff will vote with their feet and leave.” s

He contrasted his party’s plan for a 1p increase in income tax to generate extra funds for health and social care with May’s refusal to commit to any tax increases for that purpose. With the Tory majority set to increase, “this guarantees a bleak future for the NHS and for its staff under the Conservatives”, claimed Lamb.

Jeremy Hunt, the health secretary, repeated his pledge of more money for the NHS if the Tories are re-elected and said that nurses’ pay should go up. Responding to a question from the BBC interviewer Andrew Marr about some nurses going to food banks, Hunt replied that average nurse’s pay is £31,000.

“Is that enough considering the brilliant work that they do? I think many people would say they want to pay them more. I think they do an incredible job. If you want more money to go into the NHS – and this government recognises we will need to put more money into the NHS and the social care system because of the pressures we face – then the question is how you get there,” said Hunt.

He also insisted that key NHS waiting time standards, such as the four-hour target in A&E and 18-week wait for planned hospital care, were not particularly useful measures of true NHS performance. Lives saved from cancer and heart disease as a result of better care showed the service was doing well, he added.

Jonathan Ashworth, Labour’s health spokesman, said Hunt’s agreement that it was unacceptable that the A&E target had not been met in England for more than two years was “an admission of failure straight from the horse’s mouth: the Tory-made A&E crisis is simply ‘not acceptable’”.

Responding to Hopson’s comments on NHS pay, Ashworth added: “This is a stark warning from NHS Providers about the Conservatives’ catastrophic management of the NHS workforce. It is incredible and disgraceful that NHS staff are leaving to work in supermarkets instead because NHS pay has been squeezed so far. The country’s shortage of paramedics, nurses and consultants now threatens a raft of NHS strategies to provide better services for patients.”

NHS Providers are also warning that understaffing is so serious in mental health services that patients are now suffering delays in receiving treatment, taking longer to recover and having a bad experience of NHS care. “We are particularly worried about the pressures in the mental health workforce,” said Hopson. “These are resulting in delays in treatment, people are taking longer to recover, and as a result their care is more expensive and their experience is worse.”

A Conservative spokesman declined to respond directly to Hopson’s warning. He said only that: “As NHS England say, outcomes for every major disease in this country are now better than they’ve ever been. But the truth is that in order to continue to invest in the NHS, grow staff numbers and pay, and improve patient care, we need to secure the economic progress we’ve made and get a good Brexit deal. That is only on offer at this election with the strong and stable leadership of Theresa May.”

NHS staff "quitting to work in supermarkets because of poor pay"

Rich Americans live up to 15 years longer than poor peers, studies find

You can’t buy time – except, it seems, in America.

Increasing inequality means wealthy Americans can now expect to live up to 15 years longer than their poor counterparts, reports in the British medical journal the Lancet have found.

Researchers said these disparities appear to be worsened by the American health system itself, which relies on for-profit insurance companies, and is the most expensive in the world.

Their conclusion? Treat healthcare as a human right.

“Healthcare is not a commodity,” wrote US Senator Bernie Sanders in an opinion article introducing the issue of the journal, whichis devoted to inequality in American healthcare.“The goal of a healthcare system should be to keep people well, not to make stockholders rich. The USA has the most expensive, bureaucratic, wasteful, and ineffective healthcare system in the world.”

Sanders, like authors of the lead report, called for single-payer health insurance or what Americans might know as “Medicare for all”, a reference to an existing public health program for older Americans.

“Making sure that every citizen has the right to childcare, healthcare, a college education, and secure retirement is not a radical idea. It is as American as apple pie,” he said.

The Lancet studies looked at how the American health system affects inequality and structural racism, and how mass incarceration and the Affordable Care Act (ACA), also known as Obamacare, have changed public health.

Among the studies’ key findings: the richest 1% live up to 15 years longer than the poorest 1%; the same gap in life expectancy widened in recent decades, making poverty a powerful indicator for death; more than one-third of low-income Americans avoid medical care because of costs (compared to 7% in Canada and 1% in the UK); the poorest fifth of Americans pay twice as much for healthcare as a share of income (6% for the poor, versus 3.2% for the rich); and life expectancy would have grown 51.1% more from 1983 to 2005had mass incarceration not accelerated in the mid-1980s.

The poorest Americans have suffered in particular, with life expectancies falling in some groups even while medicine has advanced. For example, researchers reported that the poorest fifth of women born between 1930 and 1960 statistically lived four years less than Americans in the top fifth of the socioeconomic spectrum.

All of these health outcomes arrive in the context of widening general inequality. The share of total income going to the top 1% of earners has more than doubled since 1970,making the US more unequal than all but three developed countries: Chile, Mexico and Turkey.

At the same time, the ACA brought relief to many. The number of Americans without insurance dropped from 48.6 million in 2010 to 28.6 million in 2015. The number of Americans who struggle with medical bills dropped from 41% to 35% in 2014.

Further, accounting for current public health insurance programs, military healthcare, the portion of local and state budgets used to purchase private health insurance for workers, and subsidies to employers to buy workers health insurance, researchers believe as much as 65% of health insurance nationally is already paid for by taxpayers.

The conclusions come at a tumultuous time for American healthcare.

Donald Trump’s election threw his predecessor’s market-based health laws into question. Trump promised multiple times on the campaign trail to repeal the ACA and replace it with “something terrific”.

Though Barack Obama’s signature health law insured more Americans than ever before, problems remain.

Insurance companies have increasingly passed costs on to consumers through “cost-sharing”, or asking Americans to pay more for doctor’s visits, prescription drugs and procedures before insurance kicks in. Sky-high prescription drug prices have prompted public outrage. And a requirement that Americans purchase insurance, even with government subsidies, was politically toxic.

Though Republicans promised for more than seven years to repeal the ACA – if they could only gain control of the federal government – once Trump took office, they offered a plan not conservative enough for conservatives, and not moderate enough for moderates. With an abysmal public approval rating of just 17%, the plan combusted weeks after it was introduced. Failure to pass the bill became a major loss for the Trump administration.

That has left a vacuum of ideas. Republicans tried and failed to resurrect a version of the hated plan this week. Progressives have expressed hope that single-payer reform could move into the forefront.

“I, like many others, was deeply concerned with Republican proposals that went down in flames,” said Dr David Himmelstein, a New York City doctor and co-founder of Physicians for a National Health Program, a group that lobbies for single-payer health reform. Himmelstein was also the author of one Lancet report, America: Equity and Equality in Health.

“It would have been tremendously damaging to large numbers of people in our country. So the defeat of that proposal was encouraging,” he said.

“It’s opened up much more room for debate about what there should be, so in that way, I think it’s an encouraging time that has perils but also opportunities.”

However, single-payer healthcare remains unpopular with American conservatives, who still control the government.

Robert Moffit, a researcher at the conservative thinktank the Heritage Foundation, argued that Americans would use healthcare willy-nilly if it were provided by the government.

“I mean look – you can save money with a single-payer system, don’t misunderstand me, but the quality and supply of medical services is going to be determined by government officials,” he said.

“You’re going to have inequalities in any state,” he said, calling it it “naive” to believe a “government-run system that is going to ultimately be highly politicized” would be better than a private one.

Rich Americans live up to 15 years longer than poor peers, studies find

America rose to defend healthcare. But Trump’s attack on the poor is not over | Mary O’Hara

Obamacare will be the law of the land for the “foreseeable future”, the speaker of the US House of Representatives, Paul Ryan, admitted in the aftermath of the abject failure of Donald Trump or the Republican party to “repeal or replace” Obama’s flagship Affordable Care Act (ACA) after seven years of bleating about it. The colossal and humiliating collapse of the proposals was met with jubilation last Friday by millions of people, especially the poorest and disabled, who were in line to lose access to healthcare if the American Health Care Act had been successful.

Watching the events unfold I wondered: what if there had been a similar sudden downfall of the austerity programme in the UK in those early days when the dire warnings of the harm it would unleash were being shouted from the rooftops? How many people would not now be turning to food banks or battling to access social care if austerity had been stopped in its tracks?

The political rollercoaster in the US as the new health bill failed to garner the necessary votes to be passed in the house (partly because rightwing hardliners wanted an even harsher version) was stunning. The debacle came against a backdrop of months of anxiety and fear at what would unfold if it were passed and, the closer the vote deadline got, the more it hit home how much ordinary citizens would suffer. Across the country, individuals and groups rose to oppose it, highlighting the potentially devastating consequences for access to reproductive health services and the disproportionate impact on low-income women and children. Disabled campaigners worked tirelessly to draw attention to the particular injustices they would face if the law passed. Last Wednesday, more than 50 disability rights activists were arrested in Washington DC for protesting against it.

As longtime campaigner Bruce Darling from the disability rights organisation Adapt explained, many people risked being placed in institutions rather than supported in their own homes if proposed cuts of $ 880bn (£705bn) to Medicaid, the government-funded programme that assists the very poorest and disabled people, went ahead. “Disabled people will die,” Darling told me.

Leading up to the healthcare vote I talked to people who were terrified about the impact of the new act. One of these was Marta Conner, a charity consultant from Virginia whose seven-year-old daughter, Caroline, has Rett syndrome, a neurological condition that severely limits her control over her body and means she needs round-the-clock care, expensive medication and specialist equipment. Conner was like many of those speaking out. She told me she felt “it was important to have our voices heard” because children like Caroline and millions more disabled and seriously ill people could lose a lifeline.

Paul Ryan on failed healthcare bill: ‘This is a disappointing day’

According to independent analysis from the non-partisan Congressional Budget Office, the AHCA would have seen 24 million people lose health cover in the next decade – and sent insurance premiums for older people rocketing. And, just to rub salt in the wounds, it would have meant a doling out of tax breaks to the rich.

Nevertheless, despite the healthcare reprieve, if you are poor or disabled in the US right now, the fight for rights to support and quality care is far from over. For a start, the healthcare debate isn’t going to disappear: health insurance remains prohibitively expensive for many and even with the advances of Obamacare, it is not a universal system.

But there are other reasons why complacency is not an option. The attack on the poorest is coming on multiple fronts. Trump’s “blueprint” budget, which was also published this month, is a source of widespread anxiety. It has been overshadowed somewhat by the healthcare issue, but with clear echoes of cuts in Britain, initiatives that help the most vulnerable could be decimated if Trump gets his way.

In a similarly absurd vein to Tory claims of “compassionate Conservatism” while they slash budgets, preside over soaring levels of child poverty and pummel the NHS, Republicans have had the gall to argue that culling anti-poverty programmes such as after-school nutrition initiatives and Meals on Wheels are acts of compassion towards taxpayers. The question now is, can these radical proposals come crashing down as the healthcare bill did? For the sake of the most vulnerable, let’s hope so.

America rose to defend healthcare. But Trump’s attack on the poor is not over | Mary O’Hara

Pay poor countries for NHS staff they train | Letters

Recruiting NHS staff from other countries saves the British taxpayer the very substantial costs of training them.

However, the proportional financial cost to poorer source countries is much greater than our saving. John Holme (Letters, 21 March) mentions Malawi as one source for NHS staff: six years ago a study published in the BMJ estimated the loss of returns to Malawi just for doctors then working in rich, predominantly white countries, at $ 1.41bn. Of those countries, it was the UK that benefited most, with a net transfer of wealth from nine sub-Saharan countries struggling with HIV/Aids of $ 2.7bn.

Getting poorer countries to pay for our medical training appears to be a deliberate UK policy rather than just the mighty free market, given the cuts in training places and funding.

Rather than selfishly celebrate this neocolonial asset-stripping, we should insist that countries of origin should be fully compensated for the loss. And that the UK should pay its own way in future.
Peter McKenna
Liverpool

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Pay poor countries for NHS staff they train | Letters

UK second only to Japan for young people"s poor mental wellbeing

Young people in the UK have the poorest mental wellbeing in the world – with the exception of Japan – and list money, getting on in life and the rise of terrorism among their greatest concerns, according to an international survey of 20,000 youngsters.

The study ranks the UK 19th out of 20 countries in its survey of wellbeing, with young people in the UK aged 15-21 lagging behind comparable cohorts in France and Germany, as well as those in countries such as Israel, Turkey, Russia and China.

Indonesia, India and Nigeria scored highest on the wellbeing scale, with scores of 56.2, 54.4 and 53.9 respectively (the highest possible score being 70), whereas Japan scored the lowest at 41.3, followed by the UK (47.3), New Zealand (47.6), and Australia (47.9).

Mental wellbeing graphic

Just 15% of UK youngsters surveyed felt they had good physical wellbeing, measured by regular exercise, sufficient sleep and time for rest and reflection – which was comparable with France (14%) but lower than most countries including Germany (21%), Italy (21%), and Nigeria which scored highest at 41%.

The report was compiled by the Varkey Foundation education charity and used the Warwick-Edinburgh Mental Wellbeing measure, which asks respondents whether they feel optimistic, confident, loved, and interested in other people. The results found a significantly greater sense of wellbeing among young people in emerging economies compared to those in Europe, North America and Australasia.

Extremism and the rise of global terrorism was the issue which made young people in the UK more fearful for the future than any other factor (83%) – a position shared by young people in 13 of the 20 countries, though young Chinese people who took part in the survey identified climate change as their greatest concern.

Moral outlook graphic

Vikas Pota, chief executive of the Varkey Foundation, said: “At a time of nationalist and populist movements that focus on the differences between people, the evidence shows that young people – whatever their nationality or religion – share a strikingly similar view of the world.

“Teenagers in Nigeria, New Delhi and New York share many of same priorities, fears, ambitions and opinions. There is far more unity among young people than a glance at the headlines would suggest. Young people are passionate believers in the right to live the life that they choose, whatever their background, free of prejudice of all kinds.

“However, they are a generation that is deeply pessimistic about the future of the world. They are not strongly influenced by politicians and think that governments are doing far too little to solve the refugee crisis – one of the greatest challenges of our age.”

On global challenges facing the world, nearly half of young people (48%) in the UK said they thought the government was doing too little to solve the international refugee crisis – compared to 72% in Brazil and 16% in Turkey, which scored the lowest on this measure of any country surveyed.

There were mixed responses to questions about immigration, with 31% of British youngsters in favour of the government making it easier for immigrants to live and work in the UK, while 26% thought it should be more difficult. There was greater support for legal migration in Germany (37%), Italy (38%) and the US (38%), but less in France (27%).

More than half of young people in the UK (54%) said money worries were among their top three causes of anxiety. And asked about their most important value, more UK youngsters chose “working hard and getting on in life”, rather than honesty, tolerance, kindness to others, helping their family, or looking after the world beyond their community.

Fears for the future graphic

Young people in the UK are however noticeably enthusiastic about their country, with more than two-thirds (67%) agreeing it is a good place to live, compared to just 4% who think it is a bad place to live. In France the comparable positive figure was 51%, in Germany 75%, and in Canada 87%.

Nevertheless the report suggests a strong sense of pessimism about the future among young people worldwide with 37% overall convinced that the world is getting worse, compared to 20% who think it is getting better. Young people were at their most pessimistic in France, Italy and Turkey where more than half (53%) feared the world was deteriorating.

In contrast, the most optimistic youngsters are to be found once again in emerging economies – 53% of young people who took part in the survey in China and 49% in India believe that the world is becoming a better place.

And on a positive note, the survey, conducted by Populus, showed widespread support from young people around the world for liberal values of tolerance and equality – 63% support legal same-sex marriage; 89% support equal treatment for men and women and 74% are in favour of equal rights for transgender people.

The report, called What the World’s Young People Think and Feel, compares the experiences of teenagers and adults known as Generation Z, who were born around the turn of the millennium in Argentina, Australia, Brazil, Canada, China, France, Germany, India, Indonesia, Israel, Italy, Japan, New Zealand, Nigeria, Russia, South Africa, South Korea, Turkey and the US, as well as the UK. It is thought to be the first international comparative study of the attitudes of young people on this scale.

UK second only to Japan for young people"s poor mental wellbeing

Poor people are allowed to be fat – video

Last year, author Kathleen Kerridge was fat-shamed by some commenters on social media after we published a video about her experience of poverty. Here, she argues that people should not judge a person’s need based on the size of their jeans. Getting fat is often a byproduct of being poor, she says, because a lot of cheap food that is filling is also unhealthy

• WARNING: strong language
  

Poor people are allowed to be fat – video

Fat people can be poor, too – video

Last year, author Kathleen Kerridge was fat-shamed by some Guardian commenters after we published a video about her experience of poverty. Here, she argues that people should not judge a person’s need based on the size of their jeans. Getting fat is often a byproduct of being poor, she says, because a lot of cheap food that is filling is also unhealthy

• WARNING: strong language
  

Fat people can be poor, too – video

Mentally ill patients face "double whammy" of poor hospital care

More than half of people with mental health problems receive a “double whammy” of poor care in general hospitals which increases patients’ risk of dying, according to a major new NHS inquiry.

Only 46% of patients with serious mental health conditions were well looked after when they attended hospital with a physical ailment such as heart trouble, a group of independent experts found.

Many A&E unit staff lack the knowledge or confidence to care properly for mentally ill people, according to a report by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD).

Substandard care that mentally ill patients receive for physical health problems results in many of them repeatedly returning to A&E , the NCEPOD team found when they analysed the medical records of 552 patients who sought help at an acute or general hospital.

“Good care was only provided to 46% of patients in this study, showing patients who had a mental health condition suffered the double-whammy of both poor physical and mental healthcare,” said co-author Dr Vivek Srivastava, who is the NCEPOD clinical coordinator and a consultant in acute medicine.

“The systems don’t exist to train hospital staff appropriately in the care of patients who also happen to have a mental health condition, so immediately there is an issue with having the confidence to care for this group of patients.

“Once someone is admitted to hospital it is likely to expose any underlying issue such as a mental health problem, and staff need to have the confidence to deal with this, and have access to and know how to refer to mental health services,” he added.

Poor physical health care leads directly to patients with a mental health condition staying longer in hospital, Srivastava added. “They are often discharged into the community inappropriately and then bounce back in and out of hospital if the underlying health condition is not treated properly.”

Inadequate treatment of such patients matters because they are already more likely to die than other people, the report says. “It is well established that patients with severe mental illness develop co-morbid physical health conditions, like heart disease, about a decade earlier in their life. They are also more likely to die more than a decade earlier than those without mental health conditions.”

Prof Sally Davies, the government’s chief medical officer, has estimated that 60% of the excess mortality among people with a mental health condition could be avoided if they received better care.

Prof Lesley Regan, the ex-president of the Royal College of Psychiatrists and chair of NCEPOD, said: “For many years mental healthcare in the NHS has been underfunded, and you may rightly conclude from this new NCEPOD report that patients with mental health conditions are seriously disadvantaged when treated for physical disorders in hospital. I fear that the patients we studied could well be only the tip of the iceberg.”

The Department of Health said it was improving how A&E services cared for people with mental illnesses. “We have invested £247m to make sure support will be available for people who come to A&E needing mental health care. The NHS is also working to develop the mental health skills of all staff so that issues are identified earlier and patients receive the care they need,” a spokeswoman said.

Mentally ill patients face "double whammy" of poor hospital care

Delicious roast spuds are part of the good life. Poor cancer advice isn’t | Suzanne Moore

There wasn’t exactly a muted reaction today to the news that your breakfast may kill you. Trump may start a war on facts, a missile may go astray, but it turns out that the final straw is telling people that their toast is bad for them. According to the Food Standards Agency (FSA), burnt toast is potentially bad, as are crisps, and well-browned roast potatoes. With this news, something has stirred deep within us. You will only take away our delicious crispiness by prising it from our cold dead hands. We will fight for the right to fluff: that is, to increase the surface area of potatoes before roasting them in order to maximise the brown, crispy bits. Isn’t that Jamie Oliver’s contribution to humanity? We don’t want warm bread, we want actual toast, toasted. Don’t even start me on crisps.

But the latest abomination, according to the FSA, is that we are consuming too much acrylamide. This has been shown to increase the risk of cancer in mice and therefore is likely to have the same affect on us. It is a chemical produced by cooking starchy foods at high temperatures. Which is, of course, the miracle of deliciousness that we must now shun, or moderate – if not give up altogether.

Actually, none of this information is new. We knew in 2002 that burnt foods suspected of being carcinogenic, and we’ve since learned that the process of curing is considered risky. We are now told that sugars – basically, what carbs turn into – are the work of the devil, so we shouldn’t be eating them crisped to perfection anyway. But hey, life too short and all that …

Or we could be making it so. The problem with all this is partly to do with our understanding of risk, which is extremely poor, and partly to do with the message everywhere now that cancer is reducible to lifestyle. Scientists have to give us the information they have. But we need more context, or otherwise their studies just become a list of things that are bad for us, because … rat studies. The mature response would be to eat less of the bad things and give up all that is lovely. Live a life of vegetables and the odd nut. Clearly most of us never reach this level of maturity. And anyway, I don’t buy this whole “you are what you eat” argument.

Cancer is not a choice or simply a result of diet. This is a vast over-simplification. We can say that two-thirds of cancers are related to lifestyle “choices”: obesity, smoking and drinking primarily, but a third aren’t. We have to take in genetic and environmental factors. What Susan Sontag described as “disease-producing lifestyles” we could now say is basically modern life. There are carcinogens in the environment as well as those we choose to put into our bodies. Pinning cancer to environmental factors is extremely difficult because epidemiologists rarely get the chance to link individual cancers to specific pollutants.

Here are a few other things that increase your risk: paint, Chinese salted fish, contraceptive pills and wood dust

So the lay person has to wade through this advice on eating without comparative studies, and without fully understanding the risks. Yes, burnt toast might up your risk of cancer. (How much would you have to eat, and for how long though?) Here are a few other things that will also increase your risk: paint, vinyl, Chinese salted fish, contraceptive pills and wood dust. We have to navigate our way through this minefield as best we can.

All those crappy alternative health books that somehow blame people for their own illness – attributing it to their repressed-anger “cancer personalities” – are now being rewritten from the perspective of clean living. The proponents of this talk as if we are all only individually responsible for our own health. They hold up the myth of the ever well, pure, toxin-free body. Obviously they live in a different environment to the rest of us. Planet Denial.

Of course we can all take better care of ourselves. Eat more veg and steam more stuff. Moderation and all that. Crisped-up carbs may indeed be the opium of the masses, and the masses will hold on to them. We may seek to extend, life but someone also has to talk about the point of living. If roast potatoes aren’t part of that, I don’t know what is.

Delicious roast spuds are part of the good life. Poor cancer advice isn’t | Suzanne Moore

The poor must not be left to pick up the tab for everyone’s social care | Letters

Theresa May’s decision to single out Ealing for attack on adult social care at prime minister’s questions is bizarre and unfair (Councils can get social care cash early, says PM, 15 December). Despite significant funding pressures, Ealing council has one of the best re-ablement services in the country, with 93% of older people who use this service still at home three months after hospital discharge, a record we are proud of. Ealing works closely with our local NHS to provide a seamless discharge service: our rate of delays to discharge due to social care issues is average, not the worst.

Since 2010, government cuts have led to a reduction in Ealing’s adult social care budget of nearly 20%. The council tax precepts the government has allowed us are sticking plasters by comparison. I’m proud that, rather than levying a precept on Ealing residents, as the prime minister seems to want us to do, our success in growing Ealing’s economy and building homes has provided us with the resources to provide extra social care funding that more than matches what a precept would raise. We’ve allocated £2.3m extra for social care this year, rising to £4m by 2019, along with a £5m transformation fund to redesign services so fewer people need intensive help in future.

Councils, like Ealing, that are innovating, redesigning and delivering high-quality social care in very difficult financial conditions, while not demanding extra money from just about managing local families, deserve Theresa May’s praise, not her censure.
Cllr Julian Bell
Labour leader of Ealing council

• My Labour-controlled local authority recently announced cuts to its budget of £82m up to 2020 and more than 400 job losses. These are on top of the cuts already implemented of £250m and 2,000 redundancies since 2010. In real terms, the council’s budget will have been cut by 50%. Any small increase to social care funding through higher council tax has to be set in this overall context (Council tax hike considered to cover social care costs, theguardian.com, 12 December).

All over the country, local authorities are facing a similar funding crisis, with accumulating evidence of how vital local services have been decimated and the serious consequences for local communities. No amount of Orwellian double-speak about efficiency savings, partnership working and smart delivery should be allowed to disguise the fact that the loss of skilled workers, the closure of facilities and cutbacks to services are leading to the biggest crisis of local provision ever seen in this country.

It’s time for councillors to reject the logic of imposed austerity. There should be a coordinated campaign by all Labour-led authorities not to set another round of cuts budgets. To the predictable response that the government will threaten to suspend councillors and impose administrators – so what? Nothing could be worse than meekly accepting what is, effectively, the destruction of local government in any recognisable form. They should be leading a campaign to restore real local democracy and funding to provide decent local services. Get up off your knees and fight for the working-class communities you are supposed to represent.
Steven Schofield
Bradford

• Changes to council tax and the social care precept will seem to many nothing more than a temporary fix. There is real concern about the postcode lottery nature of these tax-raising powers intended to fund our ailing social care system.

While the changes to the social care council tax precept from 2% to 3% over the next two years are welcome, they do not provide additional funding. The government has missed the opportunity to bring forward some of the £1.5bn additional funding for social care through the Better Care Fund already announced for 2019/20.

The most deprived areas in the UK derive the lowest proportion of their income from council tax. The government’s intention in allowing councils to increase council tax is to spread the financial burden of the nation’s rising social care bill. But council tax payers in deprived areas may be less likely to be able to afford the increase, and many of these who are on low incomes will already be paying reduced rates.

The UK has a long tradition of providing care to those who need it most. If that is to continue, the government must invest in a robust social care system that can cater for all based on needs and not on geography. From a taxpayer’s perspective this is a zero-sum game. For every £1 not invested in social care, the cost to the NHS is considerably more.
Paul Dossett
Head of Public Sector, Grant Thornton UK LLP

• Gaby Hinsliff is right (Do-it-yourself social care only works for the very rich, 16 December). Grown children’s ability to step in where the state fails to care for their elderly parents becomes increasingly decisive. But with the proposed increase in council tax the state is forcing the unemployed to step in. Since April 2013 the unemployment benefits of grown children have been taxed by 259 councils out of 326 in England. Taxation of the weekly £73.10 jobseeker’s allowance/income support/employment and support allowance of single mothers and vulnerable citizens deemed fit for work by the Department for Work and Pensions will now be increased to require the least able to step in to pay for the care of anyone’s elderly parents.

Tenants are also forced to step in by paying not only the increase in council tax but also increases in rent out of their unemployment benefits since April 2013; that is due to the cuts in housing benefit called “local housing allowance”, “single room supplement” or “benefit cap”. Some of them are struggling to pay off rent, council tax, utility and fines arrears that accumulate during the three-month absence of income caused by a benefits sanction.

The supreme court has noted the injustice of taxing benefits in Mosley v Haringey. “Their income was already at a basic level and the effect of Haringey’s proposed scheme would be to reduce it even below that level and thus in all likelihood to cause real hardship, while sparing its more prosperous residents from making any contribution to the shortfall in government funding.”
Rev Paul Nicolson
Taxpayers Against Poverty

• I have cancer (non-Hodgkin’s lymphoma) and I was recently taken by ambulance to Plymouth’s Derriford hospital with a pulmonary embolism (a blood clot on the lung). I was admitted to A&E around 1am but spent more than 12 hours on a trolley until a bed could be found for me on the medical assessment unit (MAU). I was one of many patients – most were elderly and frail – waiting on trolleys where there was very little spare room for any more. Nursing staff told me that the delay was because the MAU could not find beds on other wards for patients ready for transfer. I was also told this problem was caused by these wards struggling to discharge medically fit older people because these patients needed social care that is not available.  

My experience is just one example of the crisis facing hospital services around the country. Patient care is suffering as a direct result of the economically misguided and unjust consequences of this government’s austerity programme. This policy should be reversed by central government providing immediate funds directly to local government to enable an equitable and adequate provision of social care services to free up beds in NHS hospitals and relieve the pressures on A&E services.
Nigel Charles
South Brent, Devon

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The poor must not be left to pick up the tab for everyone’s social care | Letters

"Poor decisions and lack of compassion" reported at NHS trust

A secret medical review showed mothers and babies died at an NHS trust in the Manchester area where clinical errors, bad staff attitudes and chronic shortages were commonplace.

The review, carried out by new maternity director Deborah Carter at Pennine Acute Hospital NHS trust which operates North Manchester General and the Royal Oldham hospitals, outlines a string of avoidable deaths and long-term injuries caused by failures over many years.

The report details how a premature baby was left to die alone in a sluice room rather than its mother’s arms, another woman who died of a catastrophic haemorrhage after her symptoms were put down to mental illness and a baby who died because staff failed to identify its mother’s rare blood type.

Long-term failures led to “high levels of harm for babies in particular” and repeated warnings over years had not led to improvements.

The internal review only came to light following a freedom of information request by the Manchester Evening News. The paper said the trust tried to suppress the report and even claimed it did not exist.

On Wednesday night the trust said more staff had been taken on and progress was being made to improve care.

The report identifies “clear evidence of poor decision-making which has resulted in significant harm to women” and “real issues” on maternity wards resulting in “high levels of harm for babies in particular, which has significant life-long impact”.

Staff shortages are linked to a series of deaths, including one baby who died because antenatal staff had failed to spot its mother’s blood type. But bad attitudes and a lack of compassion among staff were also cited.

In one case a mother died from a “catastrophic haemorrhage” after staff ignored the symptoms of hypoxia, a condition caused by lack of oxygen, while medics believed the woman had mental health issues.

Another incident involved the birth of a 22-week-old baby. The report states: “When the baby was born alive and went on to live for almost another two hours, the staff members involved in the care did not find a quiet place to sit with her to nurse her as she died, but instead placed her in a moses basket and left her in the sluice room to die alone.”

The report cites “worrying repetitive themes” across the department, including failures to monitor basic vital signs, poor documentation, lab results left unchecked, critical information left off patient records, a “rigid mindset” among staff who tended to view patients’ conditions as “uncomplicated”, repeated breaches of safety procedures and little performance monitoring of the high numbers of agency staff on the trust’s books.

The trust received more legal claims and paid out more in damages than any other between 2010 and 2015, nearly half the claims relating to mothers and babies – payouts that totalled more than £25m.

Prof Matthew Makin, medical director at Pennine, said: “The priority is for all of the trust’s services to meet the high standards that patients expect and deserve. We are steadily making the necessary improvements so that patients can receive reliable, high quality care across all of our services.

“In addition to the appointment of a new head of midwifery, 31 new midwives started … across our two maternity units at north Manchester and Oldham last month.

“In addition to 58 new midwives joining us since April, the new management team is being supported by Central Manchester NHS foundation trust, who are providing supplementary clinical leadership support in order to stabilise and strengthen services on the north Manchester site.

“We have fully reviewed our risk and governance arrangements including learning from incidents and complaints, and are making progress in improving the way we listen and involve our staff to address the longstanding problems and challenges facing our teams.”

"Poor decisions and lack of compassion" reported at NHS trust

Teething problems: why dental records are a poor way of checking age for migrants

The media furore over dental checks to establish the ages of child migrants arriving from Calais has raised the question of how we define – and prove – adulthood. Dentists have said the checks would likely be inaccurate, not to mention unethical. Brain imaging wouldn’t be much use either, as recent research has shown the brain continues developing right up until the mid-20s and beyond.

Growth of grey matter is very rapid from around the age of 12, but peaks a few years later. What follows in later adolescence is a pruning and sculpting of the many connections that have sprouted during puberty. It could be argued that experiences in this period are as important as earlier ones, and in some ways more significant, as they affect the brain’s frontal lobe which deals with the development of character and morality.

Insurance companies seem to have realised this, as car insurance premiums change depending on your age right into your 20s. And since 2013, child psychologists have worked with under 25s, not just under 18s. It’s just a shame that this is not currently reflected by our asylum policy.

Dr Daniel Glaser is director of Science Gallery at King’s College London

Teething problems: why dental records are a poor way of checking age for migrants

Britain’s poor record on health spending | Letters

For a rich nation, we are asking our NHS doctors and nurses to provide excellent care with comparatively limited levels of support, and it is hardly surprising that standards of delivery in particular areas of care appear low (Nine out of 10 NHS groups failing on cancer care, ratings show, 4 October).

OECD figures for 2014-15 show that the UK ranks 15th out of 42 countries surveyed in public spending on health provision. The 14 countries ranked above the UK spend, on average, 25% more per capita than the UK. With 2.8 doctors per 1,000 inhabitants, the UK ranks 24th out of 39 countries surveyed by the OECD; and with 8.2 nurses per 1,000 inhabitants, the country ranks 17th out of 38.

It is in levels of bed provision, however, that the figures appear most disturbing. With 2.7 beds per 1,000 inhabitants, the UK ranks joint 27th of 35 countries surveyed. Thirteen countries have more than twice this number of beds per patient and four – Japan, Korea, Russia and Germany – have three times as many.

These figures reflect the relatively low priority that successive governments have given to public health provision over several decades.
David Wilcock
Dalston, Cumbria

• I am dismayed to see the Guardian persisting with the popular conception that suffering from cancer somehow equates to having a fight (Actor Ben Stiller discloses prostate cancer fight, 5 October). Can we please remember that cancer is just one of a list of serious diseases, and that it does a profound disservice to cancer sufferers to infer that it is some sort of battle that you can either win or lose? As with all diseases, whether you get better or not is very often not in your control.

I, like Ben Stiller, had prostate cancer which was detected by a blood test and then treated by a radical prostatectomy. It was bad luck on me to have contracted the disease but I was fortunate to have been diagnosed at an early stage and to then receive the correct treatment with a successful outcome. I was not a winner. I had not won any fight but merely been well treated for a serious disease. If I had been less fortunate with my treatment would I be seen as a loser, one who had not fought hard enough?
Peter Clark
Nottingham

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Britain’s poor record on health spending | Letters

Statins: Patients are allowed to make poor choices but the media shouldn’t help them | Ranjana Srivastava

It’s clear that her symptoms are advancing and that she was right on the futility of further chemotherapy. She is having trouble staying awake, her appetite is deteriorating, and she is weaker by the day. This may well be our last appointment.

“We can get rid of a number of your medications,” I say, frowning at the long list that her daughter says is proving increasingly difficult to administer.

“Let’s do that,” she says joyfully.

So in one of my favourite acts, I slash half her list, explaining why as I go along.

But she stops me at the statin, an anti-cholesterol drug she was prescribed 20 years ago for a barely elevated cholesterol detected on an insurance test.

“I need that so I don’t die from a heart attack.”

“Not quite,” I say soothingly. “Statins exert their benefit over many years and we agree that now, it’s more important to maintain comfort.”

“I can’t imagine my day without my statin,” she declares, leaving me to wonder somewhat enviously how her cardiologist managed to evince such devout compliance for a questionable cause.

Just then her husband pipes up. He is a sprightly 74, still working, and unlike his wife, detests medications, including the statin he was prescribed after a serious heart attack some years ago.

“Well, I’ve decided that at 75, I am swapping the statin for sausages. From what I hear, the two are as bad as each other.”

She has heard this before because the wife adds with a smile, “At 75 or when I die, whichever happens sooner.”

I urge the husband to discuss his decision with his doctor before stopping treatment, I tell my patient to stop her statin and I bid them both a fond goodbye.

As they leave, I find myself thinking about many recent conversations I have had with patients about statins. With cancer patients who have a limited life expectancy, stopping the statin is both safe and right. But during my stints in general medicine, where we treat heart attacks, strokes and dementia, the answer is more nuanced.

Does everyone need a high-dose statin? How many will experience side effects? Is lifestyle modification a reasonable starting point or should every patient be commenced on a statin? The reality of most hospital management is that a drug is prescribed and the patient finds out as an afterthought. But if a statin, once started, is likely to become a lifelong drug, what considerations are important beforehand?

Many patients have heard of statins but awareness does not mean familiarity and it certainly does not mean being informed. For every person who trusts a doctor’s recommendation to take a statin, someone else suspects a conspiracy theory fuelling the prescription of the world’s highest-selling drug.

For the patient who wants to know more, things can get complicated. A cursory internet search warns that statins make women (but not men) more aggressive, accelerate ageing, damage stem cells, worsen heart disease, cause dementia and are “unhealthy and unethical” to prescribe.

Alongside are studies asserting that statins significantly reduce the incidence of heart attacks and strokes and improve mortality. Their benefits are evident within the first year of intake and accumulate over time, making them among the few drugs to have a dramatic impact on health outcomes. Considering that heart disease is the number one killer in many parts of the world, this is no ambit claim. But pity the hapless patient trying to make an informed choice – it’s hard to know which “expert” advice to heed because everyone sounds knowledgeable.

Very few patients needed to stop statins due to adverse effects.

When I recently prescribed a statin to a young woman with a heart attack and a host of coronary risk factors, she expressed concern. I explained that no drug was without side effects but a new, rigorous, non-industry funded, meta-analysis by the clinical trial service unit of Oxford University, shows that the benefits of statins have been underestimated and harms exaggerated. The results were published in the Lancet medical journal.

Treating 10,000 high-risk patients with a low-cost, generic statin for five years prevented 1,000 strokes and heart attacks and treating 10,000 lower-risk patients prevented 500. Of 10,000 patients, five might suffer muscle aches, up to 100 may develop diabetes and five to 10 may suffer a brain haemorrhage but these side-effects have been included in the estimate of the absolute benefit.

Very few patients needed to stop statins due to adverse effects. It may not be the absolute final word but the meta-analysis concludes that many problems have been misattributed to statins, therefore planting fear in the minds of those at high cardiovascular risk and dissuading them from taking a potentially life-saving drug.

But how did these rare toxicities garner so much attention in the first place?

In October 2013, the British Medical Journal, as part of its mission to promote rational prescribing, published a paper quoting the incidence of statin-related side effects being as high as 18% and thus concluding that statins did not provide an overall health benefit to those patients deemed at low risk. But the 18% figure was based on flawed research and it was apparent that even in the quoted research, the figure was closer to 9%, but without the inclusion of a placebo-controlled group, which meant even the 9% could not be genuinely attributed to statins. (The meta-analysis says that statins are “no less well-tolerated than placebo”).

Seven months later the BMJ corrected the erroneous statements but did not retract the entire paper. Sir Rory Collins, the lead author of the Oxford meta-analysis, warned at the time that without full retraction, doctors and patients would continue to be misinformed. It turns out he was prescient.

Medical journal editors … owe it to society to publish papers that “first do no harm”.

Misleading media reports followed and led to increased reticence among doctors to prescribe or even discuss statins and increased unwillingness among patients to take them. Statins were already being under-used but a new wave of adverse media meant a further reduction in use.

In the UK, 200,000 patients stopped taking statins. 60,000 fewer statin prescriptions were dispensed in Australia following a now-withdrawn television program. If those patients avoided statins for the next five years, researchers estimated that a few thousand would suffer a fatal heart attack or stroke. For a disease that kills 17 million people around the world each year, an ounce of prevention is not to be sniffed at.

So what does the statin saga teach us? For one, it underlines the power of the media and in turn, the responsibility of health reporters and newspaper editors to think twice before exploiting health news to suit their audience.

“Beloved grandma loses mind to cholesterol drug” and “How statins ruined my life” might be guaranteed click-bait but responsible reporting might instead discuss the dreadful statistic of one Australian dying of cardiovascular disease every 12 minutes and how to prevent it. Statins are no panacea but combined with diet, exercise and curbing cigarettes and alcohol, they have a role.

Second, it reminds medical journal editors that they owe it to society to publish papers that “first do no harm”. If Big Pharma can’t be trusted to provide unbiased data and to base advice on sensational tabloid fare makes a mockery of medicine, doctors must put their faith in someone to provide credible information.

There is an old joke that the majority of academic papers are read only by the author and the editor – this may be a little harsh but busy clinicians mostly flick through abstracts and note key points rather than read even a fraction of the million scientific papers published annually with an interrogating mind. It is up to journal editors to simplify the task and spell out the difference between interesting research and findings that transform patient care.

Finally, better health arises from better health literacy. In a free society, patients are allowed to make poor choices but the media shouldn’t facilitate it. Just this week an acquaintance asked me what I thought of her daughter’s “courageous” bid to not vaccinate her child for fear of “giving her autism”. I reminded her that the fraudulent data had long been exposed and retracted but she said she had seen it on the net and that was that. Dashing my hopes, she next took on statins.

“What do you make of the controversy?”

“There is no controversy,” I replied. “Read the report.”

“You would say that, wouldn’t you?”

Then, after a pause, “But seriously, did you see the story about the old lady who went mad on her statin?”

No, I didn’t. But newspaper editors, please take note!

Statins: Patients are allowed to make poor choices but the media shouldn’t help them | Ranjana Srivastava

MPs say cuts are "false economy" in drive to improve poor people"s health

MPs are calling on the prime minister to fulfil her pledge to end the “burning injustice” of shorter lifespans for the poor by boosting public health, after the missed opportunity of the childhood obesity strategy.

But the health select committee is saying in a hard-hitting report that cuts to public health funding since responsibility was handed to local authorities in 2013 will make this more difficult. Cuts are “a false economy”, because keeping people healthy in their communities protects the NHS from the expensive consequences of treating diabetes, heart disease and other chronic illnesses in times to come.

Dr Sarah Wollaston, Tory chair of the committee, said people were rightly scathing about the government’s recent watered-down childhood obesity strategy, which “demonstrates the gap in joined-up evidence-based policy to improve health and wellbeing”.

“Government must match the rhetoric on reducing health inequality with a resolve to take on big industry interests and will need to be prepared to go further if it is serious about achieving its stated aims.”

Speaking to the Guardian, she said people were “hugely disappointed because it was the opportunity to signal intent that this wasn’t going to be business as usual”.

Wollaston added: “People were hugely encouraged by Theresa May’s words and determination. I don’t doubt her intent. What I feel is now at risk is that the people who are going to be tasked with making a difference won’t have the tools to do the job, and at a time of shrinking health budgets it’s even more difficult for them to narrow health inequality.”

Although the childhood obesity figures appear to be levelling off – with about a third of kids overweight or obese by the time they leave primary school – the truth is that the change is in the children of affluent families. The gap between rich and poor children is widening.

“Childhood obesity is this huge future growing disaster not only for these individual children but for the NHS in terms of costs from managing type 2 diabetes,” Wollaston said.

She urged the government to listen to the criticism and act. Linking public health to planning and licensing applications, thereby allowing local authorities to say no to more fast food outlets and off-licences, “would send a very strong signal”, Wollaston said.

She believes the government should also rethink the absence of restrictions on advertising and marketing junk food to children. “There’s nothing there about advergames – the deliberate targeting of children where they think they are playing a game when they are actually having stuff flogged to them. And [it’s] particularly disappointing that there was nothing about the saturation advertising to children and the use of cartoon characters,” she said.

“There was very clear evidence that Public Health England presented about impulse purchases and pester power and end of aisle displays and checkout displays. Everyone recognised that it wasn’t just a single hit here. You had to look at it across the board, yet whole tranches of public health messaging are going to be undermined by the fact that advertising hasn’t been touched at all.”

Funds to local authorities for public health were slashed by £200m last year and more cuts are to come. The report says this is short-sighted and talks of “a growing mismatch” between spending on public health and the significance attached to prevention in NHS chief executive Simon Stevens’s plan. Keeping people well and out of hospital is fundamental to the sustainability of the NHS in his plan.

The report calls for a Cabinet Office minister to be given responsibility for embedding the interests of health in every government department, a proposal welcomed by the Royal Society for Public Health. “A ‘health in all policies’ approach is key to addressing wider determinants of health and health inequalities, such as housing, education and employment, and enhanced cross-departmental working at a national level will help enable this,” said Shirley Cramer, its chief executive.

The Kings Fund agreed. “The government’s weak plan on childhood obesity underlines the need for a minister at the centre of government to coordinate public health policy across departments but, more importantly, to hold departments strongly to account for their actions. Funding reductions are already resulting in significant cuts to key services such as sexual health services and support for people who want to stop smoking,” said David Buck, senior fellow, public health and health inequalities.

Prof John Middleton, president of the Faculty of Public Health, said the report “demonstrates the false economy of cutting local authority public health budgets because of the added pressures this puts on NHS resources. Councils in England have worked extremely hard for many years to maintain the services they offer their communities with reduced funding. Nevertheless, sexual health services, drug treatment clinics and other health services funded by councils have been hit hard by these cuts.”

MPs say cuts are "false economy" in drive to improve poor people"s health

Poor healthcare leading to hospital admissions "shows no social divide"

People living in affluent areas of England are just as likely to end up in hospital because of inadequate healthcare as those living in impoverished areas, statistics have shown.

Data compiled by the University of York for NHS England revealed that the wealth or poverty of an area makes little difference to how well the local NHS treats its patients.

Liverpool clinical commissioning group, which appears on the worst performers list, and Tower Hamlets and Portsmouth CCGs, which appear on the best performers list, each serve some of the most deprived neighbourhoods in the country.

At the wealthy end of the scale, South Cheshire performs badly on inequalities, while East Surrey CCG performs well, appearing in the top 10.

Prof Richard Cookson, of the Centre for Health Economics (CHE) at York, led the team that helped devise the indicators for NHS England. “For the first time, you can now find out how fair your local NHS is, compared with similar local areas, in terms of tackling health inequalities between rich and poor,” he said.

“It’s not simply that Brexit-voting deprived areas do badly, and posh southern suburbs do well. Some deprived areas do well at tackling local health inequalities – such as Tower Hamlets, Stoke-on-Trent, Portsmouth – and some affluent areas do badly – such as South Cheshire and Windsor.” The information is available on a CCG website.

The indicators show how well a CCG is doing in reducing the inequalities that exist between the rich and poor in an area. Although poorer people are likely to have worse health than richer ones, local NHS efforts can reduce this.

The indicators measure the proportion of people from rich and poor backgrounds who have long-term conditions, from dementia to diabetes and heart disease, which are not properly managed at the GP level or in out-patient departments. These are people who end up being admitted to hospital as an emergency because their condition has unnecessarily worsened.

“These emergency admissions are not just a barometer of wider social ills, but also an indicator of how well the NHS is succeeding in delivering out-of-hospital services to deprived patients with complex long-term conditions,” Cookson said. “This is important for NHS managers to know, because social inequalities in potentially avoidable emergency hospitalisation impose large and rising costs on the NHS, as well as raising important concerns about social justice.”

The work was funded by the National Institute of Health Research. Between April 2015 and April 2016, the York team found there were 264,000 preventable hospital admissions in England associated with socioeconomic inequality.

The best performing CCG was City and Hackney in London, followed by Fareham and Gosport, East Surrey, Crawley and the Isle of Wight. Tower Hamlets in London was seventh.

The worst performer was Central Manchester. North Manchester and South Manchester CCGs were also in the bottom five, as were Blackburn,Darwen and Islington.

Miqdad Asaria, the CHE’s lead analyst, said: “There is a social gradient in preventable emergencies meaning everyone, not just the poorest, is affected. The further down the gradient a person is, the greater the chances of suffering a preventable emergency hospitalisation.

“The NHS can now start producing our equity indicators on an up-to-date, annual basis to help improve the coordination of care and reduce preventable hospitalisation and mortality arising from social inequality.”

Ruth Passman, the deputy director for equality and heath inequalities for NHS England, said being able to compare the performance of the NHS around the country on the issue was of major importance.

“For the first time, NHS managers can now find out how well their local CCG area is doing in tackling these inequalities, compared with similar CCG areas, and see how these inequalities are responding to local healthcare initiatives,” she said. “This will help NHS managers learn about the best ways of reducing costly health emergencies associated with social deprivation.”

Islington CCG, which was the fifth most deprived borough in London, said: “There are areas of great and increasing affluence next door to neighbourhoods experiencing some of the most significant deprivation in the capital.”

It said it was working to improve the diagnosis and management of long-term conditions, keeping people in or close to their homes, and had set up programmes to identify people with complex needs who were at risk of ending up in A&E. It had made “significant and sustained progress on reducing inequalities in cardiovascular disease in recent years”, it said in a statement.

A statement from Manchester’s CCGs said: “Manchester has a lot of high-intensity pockets of deprivation. Other ‘norm’ areas, for example Trafford, will have extremes, ie, areas of affluence against areas of deprivation, which is normally shown in findings like this.
“The NHS results are not performance indicators – and the rankings are
based on values. Manchester CCGs see that the tool is useful in highlighting inequality and will see it as an indicator of variables of the current picture – and will continue with their work, especially via the neighbourhood teams, to reduce health inequalities across Manchester.”

Poor healthcare leading to hospital admissions "shows no social divide"

Poor Habits That Can Price You Your Task

Misrepresenting your credentials or intentionally plagiarizing, lying on time sheets or billable hrs, misusing cost accounts or abusing company credit cards, stealing the kudos for a co-workers’ accomplishments, or otherwise robbing your employers blind can all value you your occupation.

“The surest way for any of us to bring our career to a sudden and miserable finish is to have the habit of hedging the truth and lying in techniques small and large,” says Ann Kaiser Stearns, Ph.D., psychologist and very best-promoting author of Living By means of Private Crisis (Idyll Arbor Press, 2010). “Dishonesty is a slippery slope with a devastating crash waiting at the end,” she adds. “Whether we function in business or banking, academia or the army, publishing or philanthropy, housing or overall health care, the marketplace or the ministry, if we lack integrity and betray our employer, we don’t deserve to keep our jobs.”

Poor Habits That Can Price You Your Task

Far more Evidence That Sugar May Be Poor For The Brain

A new study suggests that sugar-sweetened beverages could be dangerous to the brain – especially the establishing brain. The thought itself is not a shock: Earlier research have surely hinted that sugar may have a detrimental result on brain cells, in the way of memory impairment and cognitive difficulties. The new research finds that, at least if you are an adolescent rat, consuming drinks sweetened with higher-fructose corn syrup (HFCS) might impede maze-studying, which is a good check of cognitive perform for rats. No matter whether the findings hold accurate for human youngsters is nevertheless up for debate, but the researchers say there’s convincing evidence that it is.

“It’s no secret that refined carbohydrates, particularly when consumed in soft drinks and other beverages, can lead to metabolic disturbances,” mentioned study author Scott Kanoski, of the University of Southern California. “However, our findings reveal that consuming sugar-sweetened drinks is also interfering with our brain’s capability to perform generally and bear in mind crucial data about our atmosphere, at least when consumed in extra ahead of adulthood.”

(Photograph credit score: Bev Goodwin)

It’s essential to stage out that the review has not but been published in a peer-reviewed journal, so it should be regarded preliminarily. It will be presented at the Yearly Meeting of the Society for the Examine of Ingestive Habits this week.

In their examine, the researchers fed adolescent and adult mice lower-fat lab chow, water, and yet another beverage, consisting of both eleven% sucrose or eleven% high-fructose corn syrup (a control group just got a lot more water) for 30 days. They examined the rats’ memory by possessing them do a Barne’s maze task, which issues them to uncover a aim by remembering exactly where they’ve already been.

The adult rats faired Ok, irrespective of what variety of beverage they’d been drinking. But the adolescent rats carried out worse on the process when they’d been offered the HFCS-sweetened drinks, in contrast to the sucrose-sweetened drinks.

If HFCS truly influences brain function, what mechanism may be behind the effect? Inflammation in the brain’s extended-term memory center, the hippocampus, might be accountable, the authors propose. They found higher ranges of pro-inflammatory cytokines IL-six and IL1-b in the adolescent rats who’d consumed HFCS-sweetened beverages, but did not locate the same increase in other groups of rats.

“This could,” explained Kanoski, “result from peripheral insulin resistance, which was existing in the adolescent rats that consumed SSB [sugar-sweetened beverages], and has been previously linked with neuroinflammation.” He adds that it is attainable that sugary drink consumption might also degrade the blood-brain barrier, which has been hinted at in previous scientific studies, but wants to be confirmed.

Possibly an equally critical question is whether or not the findings are applicable to human teenagers who could be taking in a whole lot of sugar in the way of soda, juice, and power drinks. Kanoski says they completely are. “The relevance to human teens, in my opinion, is based on the truth that one) in our research we utilised sugar-sweetened drinks with sugar concentrations that are comparable to those commonly consumed by people, and two) sugar-sweetened beverages consumption in the U.S. has risen dramatically in the previous 30 many years (specifically in kids), and three) rodents are an exceptional model for human feeding behavior.”

There is tons of evidence, he says, that not only are our metabolisms equivalent, but the same memory circuits in rodents also exist in the human brain. The hippocampus is an spot of the brain that is delicate to numerous different chemical substances – sugar, apparently, amongst them – in both species. It is identified to govern finding out and memory, and plays roles in depression, cognitive decline, and Alzheimer’s illness. “In several approaches this region is a canary in the coal mine,” says Kanoski, “as it is specifically sensitive to insult by numerous environmental aspects, which includes consuming meals that are higher in saturated body fat and processed sugar.”

A lot more investigation will be needed to tease it all apart, but you may well want to lower back on the sugary stuff, especially if you’re a teenager. Diet soda may not be a lot healthier for the brain, of course, so select your poison. Or at least drink soda as you would consume something else with an eye toward overall health — in moderation.

Adhere to me @alicewalton or locate me on Facebook.

Far more Evidence That Sugar May Be Poor For The Brain

Poor hospital foods is not just a issue for sufferers it has an effect on NHS employees also

An audit of NHS trusts in London discovered only 19% reported obtaining healthful consuming policies, writes Na’eem Ahmed. Photograph: Rui Vieira/PA

In his very first media interview Simon Stevens, the chief executive of NHS England, stated that employers must get an lively interest in personnel wellness and wellbeing. Stevens’ earlier organisation UnitedHealth offered all workers economic incentives for well being improvement, which includes reductions in body mass index for individuals with a higher-than-excellent BMI. As the purveyor of overall health and wellbeing, how is the NHS carrying out in marketing a healthier life-style between its own?

In 2009, the Division of Wellness estimated that of the one.two million personnel in the NHS, about 300,000 would be classified as obese and a more 400,000 as obese. Obesity, even though induced by many aspects, is greatly influenced by our choice of diet. Individuals functioning inside of the NHS would agree that food in hospitals is limited in selection, reasonably pricey and primarily unhealthy.

The issue of the quality of meals in hospitals is not a new one particular. In 1963, a report from the Nuffield Believe in discovered that hospital meals were overcooked and cold, with minor assortment and bad dietary material. Far more latest press coverage reiterates some of these concerns. The campaign for far better hospital food has centred on patients, with significantly less interest offered to bettering provision for NHS staff. Despite the looming burden of weight problems amid workers, an audit of NHS trusts in London found that only 19% reported getting wholesome consuming policies and 8% particular policies for bodily activity for workers.

Failure to tackle the problem of personnel wellbeing might translate into poorer outcomes for patients. For the duration of the latest Keogh evaluation, Sir Bruce said: “All NHS organisations will realize the constructive affect that content and engaged personnel have on patient outcomes, which includes mortality prices, and will be producing this a essential component of their high quality improvement technique.”

In an ambiance of fiscal constraint, there is a powerful monetary case for bettering NHS employees wellbeing too it is estimated that if current prices of sickness have been diminished by a third, it could translate into an yearly direct cost conserving of £555m.

So what can be completed? The Royal University of Physicians’ Action on Obesity report outlines suggestions for minimizing weight problems between employees including implementation of Good recommendations for weight problems in the workplace and better labeling of meals in hospitals. However diktats from policymakers on hospital catering reform appear to have acquired tiny or no traction.

Locally led initiatives are starting to challenge the standing quo. The pioneering Hitchingbrooke hospital lately won the prize for meals excellence from the Soil Association. Their site claims that patient satisfaction jumped to 92% just two months right after new menus have been introduced. The new menus, set by a Michelin-trained head chef, included changing frozen vegetables with fresh, locally sourced veggies and sourcing all meat from regional farms.

Hospital trusts and commissioners can play a top role in reform firstly by reviewing present provision and setting much more stringent nutritional criteria within contracts. They need to encourage more healthy options and increase competitors amongst suppliers to drive up high quality. Atriums and foyers within hospitals could be transformed by social enterprises to provide healthful food in the type of versatile pop-up retailers, which are getting to be more and more well-known within purchasing centres and on high streets.

Patient and staff wellbeing are our most powerful drivers for alter. As Dr Dan Poulter prepares to announce his suggestions for hospital catering companies it is evident that urgent reform is essential each to avert NHS colleagues inadvertently including to the chronic ailment burden on the well being service and to make certain that we accomplish and sustain large-good quality care for our patients.

Dr Na’eem Ahmed is clinical fellow to Prof Sir Bruce Keogh at NHS England 

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Poor hospital foods is not just a issue for sufferers it has an effect on NHS employees also

Dwell Q&A, 26 June: generating well being programs perform in poor countries

How can we help well being techniques to deliver service outcomes? Photograph: Issouf Sanogo/AFP

On Tuesday 24 June the Global Growth Committee begins an inquiry into well being technique strengthening, and if the Globe Health Organisation (WHO) is to be believed, this couldn’t come soon enough.

According to WHO, the lack of powerful healthcare infrastructure in components of the developing planet is currently one particular of the most significant barriers to growing essential healthcare accessibility. Of the millennium improvement goals, the wellness-relevant goals are the least most likely to be met, and regardless of a increasing availability of medication, vaccines and overall health-relevant resources, there is a disconnect in between innovation and the power of worldwide overall health methods to provide them.

So how can we assist shut this gap? As all wellness programs are context-particular, there is no single set of rules that can be put forward to enhance efficiency. But analysis demonstrates that wellness methods with the highest well being outcomes have specified shared traits. To start, they have procurement and distribution techniques that really supply interventions to those in require. Their overall health staff have the correct skills and motivation, and they operate inside monetary processes that are sustainable, inclusive, and honest.

Partnership is also important as Frank Anderson, member of the Institute for Healthcare Policy and Innovation explains: “Worldwide academic partnerships have the potential to make monumental breakthroughs in the wellness of poorer countries. Nonetheless, issues like distance, communication and cultural dfferences usually turn into barriers that stop us from creating the best affect.”

Similarly the size of the job can be daunting. Strengthening health programs requires investments in accessibility, coverage, top quality, or efficiency – the place will minimal and middle revenue nations find the funds amid all the other pressures on the budget? As developing countries face the double burden of disease, quickly-developing populations that are both really young or more and more old, it is important that the backbone that supports overall health delivery is strengthened. Join our expert panel on Thursday 26 June from one-3pm BST to go over how this can be sustainably accomplished.

The live chat is not video or audio-enabled but will consider place in the comments section (under). Get in touch via globaldevpros@theguardian.com or @GuardianGDP on Twitter to advise someone for our expert panel. Follow the discussion employing the hashtag #globaldevlive.

Dwell Q&A, 26 June: generating well being programs perform in poor countries