Your guide to what's new in public health and social care locally and nationally
28 April 2017
This bulletin brings together the latest public health and social care news, publications and information
with direct links to full content. For more documents and previous issues of the Bulletin, go to
www.kpho.org.uk.
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Accident and Emergency
Arts and Health
Cancer/Stroke/Cardiovascular
Children/YoungPeople/Families
Commissioning and Economics
Communities & Local Govt
Drugs/Alcohol
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Health and Wellbeing Boards
Health Care
Health Protection/Emergencies
Hearing/Sight
Inequalities/Minorities
Information/Evidence/Research/Ethics
Legislation/Crime/Prisons
Long-term Conditions
Maternity/Infants
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Nutrition/Physical Activity/Obesity
Older People
Pharmacy/Prescribing
Safeguarding
Smoking/Tobacco Control
Workforce Development
Workplace
Accident and Emergency
HC report: NHS Ambulance Services (27/04/17)
Ambulance services provide a valuable, life-saving service that is held in high regard and plays a vital role in the entire
urgent and emergency care system.
In this report the Public Accounts Committee of the House of Commons recognises that ambulance services and national
bodies are inherently reliant on the rest of the health system to deliver new care models and services outside of hospital in
order to support a more sustainable ambulance service.
Action is being taken by NHS England, NHS Improvement and ambulance trusts to address the performance and longterm sustainability of the ambulance services but it has taken too long to begin addressing the issues identified by the
Committee in 2011.
QualityWatch report: Focus on: Emergency hospital care for children and young people
(24/04/17)
As the NHS emerges from its toughest winter yet, attention has been focused on the impact of older people on the health
system. But younger people (up to the age of 24) are also frequent users of emergency care and, like older people,
require specialist care.
This QualityWatch report, from the Health Foundation and the Nuffield Trust, shows changes in patterns of use over time
and provides the basis for discussion about the quality of care for children and young people.
The report analyses Hospital Episode Statistics from 2006/07 to 2015/16, giving a picture of how children and young
people used emergency care at NHS hospitals over the past 10 years, what conditions they needed care for, and what
may be happening to care quality in some areas.
It finds that some age groups saw significant rises in emergency admissions, and many children were hospitalised for
conditions that could be treated in other settings. The report, therefore, also raises questions about where children and
young people can access high quality treatment outside the hospital emergency care setting.
Violence in England and Wales in 2016: An Accident and Emergency Perspective (26/04/17)
The number of people injured in serious violence dropped by 10% in 2016 compared to 2015, according to a national
report published by Cardiff University.
The report on serious violence in England and Wales 2016 is based on data from a structured sample of 152 Emergency
Departments (EDs), Minor Injury Units (MIUs) and Walk-in Centres.
Overall, an estimated 188,803 people attended EDs in England and Wales for treatment following violence in 2016,
21,437 fewer than in 2015; a 10% decrease. This continues the overall steady reductions seen since 2002.
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Arts and Health
Wellcome Book Prize 2017 winner (24/04/17)
‘Mend the Living’ is the first novel in translation to be awarded the Wellcome book prize, translated from French into
English by the Canadian translator Jessica Moore. It is the second time a novel has been recognised in the prize’s history.
The judging panel praised Maylis de Kerangal’s beautiful style in this exploration of the emotional, physical and practical
complexities of organ donation, reflecting the fragility and fluidity of life.
Concentrated across the span of a single day, ‘Mend the Living’ is a heart-breaking and gripping story of life-saving
medical science: a 24-hour whirlwind of trauma and death, life and hope. It tells the story of Simon Limbeau’s heart, from
the car accident that leaves him brain-dead and on life support, to the moment when Simon’s heart begins to beat again in
the body of someone else.
The Guardian review
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Cancer/Stroke/Cardiovascular
Lessons from the NHS Cancer Drugs Fund (28/04/17)
Analysis into the drugs that were approved for use by the NHS Cancer Drugs Fund (CDF) in England has shown that the
fund was not good value for patients and society and may have resulted in patients suffering unnecessarily from toxic side
effects of the drugs.
In a study published in the cancer journal Annals of Oncology, researchers led by Professor Richard Sullivan, director of
the Institute of Cancer Policy at King’s College London, and Dr Ajay Aggarwal, academic clinical oncologist at London
School of Hygiene and Tropical Medicine, looked at 29 drugs that had been approved for use through the CDF in January
2015 for 47 specific cancer conditions (or indications). Of these indications, only 18 (38%) were based on clinical trials
that reported a statistically significant benefit from the drugs in terms of patients’ overall survival; the (median) average
overall survival benefit was 3.2 months, ranging from 1.4 months to 15.7 months.
When other factors such as quality of life and toxic side effects of the drugs were considered as part of criteria developed
by oncologists to measure value to patients, the majority of the drugs failed to show any evidence of meaningful clinical
benefit.
See also Investigation into the Cancer Drugs Fund, National Audit Office, September 2015
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Children/Young People/Families
Special guardianship orders: are they being used safely? (27/04/17)
Recent serious case reviews have renewed concern about the use of special guardianship orders, which have risen
steadily since 2010.
An alternative to adoption, special guardianship became a legal order in 2005. One or more individuals become a child’s
‘special guardian’, giving them parental responsibility, without severing the child’s legal relationship with their birth
parents.
Luke Stevenson writing in Community Care explores the topic.
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Commissioning and Economics
NHSCC launch new report on excellence in diabetes care commissioning (27/04/17)
Since 1996 the number of people living with diabetes in the UK has more than doubled. The NHS is now spending more
than £9.8bn each year on treating the condition and its complications.
NHS Clinical Commissioners has launched a new publication showcasing examples of where clinically led commissioning
is changing the way diabetes care is commissioned and improving people’s lives. The document draws out lessons from
those involved in the projects to share and embed for the future.
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Communities and Local Government
General Election 2017: status of Government policies (28/04/17)
This briefing, from the Local Government Association, identifies Government policy initiatives and projects relevant to
local government, providing an assessment of their status given the General Election. It includes items of interest to social
care, environmental health, and education.
Local government priorities, general election manifestos, April 2017 (28/04/17)
This briefing, from the Local Government Association, sets out the policy priorities councils would want adopted by each
of the political parties in their manifestos in order to help local government better support their communities and deliver on
the challenges facing the nation. It includes items of interest to social care and health, education, housing, and the
environment.
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Consumer Participation
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Drugs/Alcohol
Central Alerting System: Evidence of harm from fentanyl contaminated heroin (27/04/17)
This central alert, from Professor Paul Cosford Director for Health Protection & Medical Director, advises of the availability
of, and harms from, heroin that has been mixed with fentanyl or carfentanyl, both unusually potent synthetic opioids.
There is significant evidence from a small number of post-mortem results of recent drug user deaths and from police
seizures that some heroin may contain fentanyl or carfentanyl added by dealers. These are highly potent synthetic opioids
and very small amounts can cause severe or even fatal toxicity.
Those in contact with heroin users should be alert to the increased possibility of overdose arising from heroin cut with
these synthetic opioids, and be able to recognise possible symptoms of overdose and respond appropriately.
The fentanyls are a group of synthetic opioids; some have legitimate uses while others are illicit drugs. Fentanyl is about
100 times more potent than morphine and is a licensed medicine used to treat severe and terminal pain. Carfentanyl is
4,000 - 10,000 times more potent than morphine and principally used as an animal tranquilliser.
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Health and Wellbeing Boards
Health and Wellbeing Board Bulletin
The King's Fund, 24 April 2017
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Health Care
HC report: Access to general practice: progress review (27/04/17)
In March 2016 the Public Accounts Committee of the House of Commons, reported concerns that patients' experience of
contacting and accessing their general practices varied significantly between different groups of patients and between
different practices.
The Department of Health and NHS England have objectives to improve and extend access, and have made some effort
to understand the demand for this extended access.
But they are moving ahead in rolling out extended hours without really understanding the level of access currently being
provided or how to get the best from existing resources. This progress review reports that concerns persist.
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Health Protection/Emergencies
Avian Flu measures to be relaxed in England from 15 May (28/04/17)
The Avian Flu Prevention Zone and ban on poultry gatherings are set to be lifted across England from 15 May 2017,
following the latest risk assessment from Defra, the UK Chief Veterinary Officer.
From this date, keepers will no longer be required by law to follow specific disease prevention measures to reduce the risk
of infection from wild birds. They should continue to follow industry standard best practice on biosecurity, including
minimising movement in and out of bird enclosures, cleaning footwear, keeping areas where birds live clean and tidy and
feeding birds indoors. Bird gatherings can also then resume, subject to some additional identity and health checks and
biosecurity measures.
Public Health England advises the risk to public health is very low and the Food Standards Agency has said there is no
food safety risk for UK consumers.
The future of HIV services in England (25/04/17)
Care for people with HIV is now highly effective, and increasing numbers of people are living with HIV into older age with
normal life expectancy, so there are now more old people living with HIV who may have other care needs associated with
ageing.
Reforms introduced in 2012 divided up and distributed responsibilities for commissioning HIV services which has created
difficulties for coordinating and planning the future development of services.
This report, from The King's Fund, explores the challenges and opportunities facing HIV services in four areas in England,
and makes recommendations on future development to those in national and local leadership roles .
World Immunization Week 2017
World Immunization Week – celebrated in the last week of April – aims to promote the use of vaccines to protect people of
all ages against disease. Immunization saves millions of lives and is widely recognized as one of the world’s most
successful and cost-effective health interventions. Today, there are still 19.4 million unvaccinated and under-vaccinated
children in the world.
The World Health Organization (WHO) details the work being done, the Global Vaccination Action Plan, and offers
infographics and fact sheets on the topic. See also WHO Europe
Nearer to home, the Green Book has the latest information on vaccines and vaccination procedures, for vaccine
preventable infectious diseases in the UK.
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Hearing/Sight
New eye test detects the earliest signs of glaucoma (27/04/17)
Researchers at the Western Eye Hospital, part of Imperial College Healthcare NHS Trust, and University College London
(UCL) have developed a new diagnostic tool to detect the earliest signs of glaucoma.
In clinical trials the pioneering new eye test allowed doctors to see individual nerve cell death in the back of the eye for the
first time, using routine hospital eye examination equipment.
Glaucoma affects 60 million people in the world, with 1 in 10 suffering total sight loss in both eyes. Early detection means
doctors can start treatments before sight loss begins.
The researchers hope that eventually it may be possible for opticians to do the tests, enabling even earlier detection of the
disease. The test also has potential for early diagnosis of other degenerative neurological conditions, including
Parkinson’s, Alzheimer’s and Multiple Sclerosis.
NHS Choices Behind the Headlines
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Inequalities/Minorities
APPG report: Hungry Holidays (25/04/17)
The All-Party Parliamentary Group (APPG) on Hunger has published a report on hunger amongst children during school
holidays. The report said those at risk of hunger over the summer include more than 1 million children who receive free
school meals during term time, and 2 million more with working parents who are still in poverty.
The group also said that ministers should channel £41.5m raised as part of the planned tax on sugary drinks to help each
UK council set up support schemes with local churches and charities aimed at feeding hungry children when school
canteens are shut.
The views expressed in this report are those of Members of Parliament and Peers who serve as officers to the All-Party
Parliamentary Group on Hunger.
Hungry Holidays report
The Guardian
Trussell Trust: UK foodbank use continues to rise (25/04/17)
UK foodbank use continues to rise according to new data from anti-poverty charity, The Trussell Trust. Between 1st April
2016 and 31st March 2017, The Trussell Trust’s Foodbank Network provided 1,182,954 three day emergency food
supplies to people in crisis compared to 1,109,309 in 2015-16. Of this number, 436,938 went to children. This is a
measure of volume rather than unique users, and on average, people needed two foodbank referrals in the last year.
End of year statistics
Early Warnings report
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Information/Evidence/Research/Ethics
Confidentiality: good practice in handling patient information (25/04/17)
The General Medical Council revised guidance on confidentiality issued in January 2017 comes into effect for all doctors
practising in the UK from 25 April 2017.
National Data Guardian, Dame Fiona Caldicott, welcomes the revised guidance and believes it will play an important role
in helping doctors to protect the relationship based on trust that is cherished by both clinicians and patients.
Mapping human health: Project Baseline (19/04/17)
We used to think the world was flat, until teams of pioneers discovered new lands and pushed the boundaries of
knowledge. We're at a similar turning point with health and disease: we now have the advanced tools and technologies to
explore health in greater depth and detail than previously imaginable.
Project Baseline is the quest to collect comprehensive health data and use it as a map and compass, pointing the way to
disease prevention.
The first initiative of Project Baseline is a study led by Verily, Duke University School of Medicine, Stanford Medicine, and
Google. The project is seeking around 10,000 volunteers to represent different ages, backgrounds, and medical histories
on behalf of humanity over four years, starting in the USA.
MIT Technology review
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Legislation/Crime/Prisons
ONS: Crime in England and Wales: year ending Dec 2016 (27/04/17)
The Office for National Statistics (ONS) has published a bulletin and data for the year ending 2016, on crime against
households and adults, also including data on crime experienced by children, and crimes against businesses and society.
Main points include:
Most main offence groups covered by the Crime Survey for England and Wales (CSEW) showed no statistically
significant change compared with the previous year’s survey. Theft offences were the only exception and these fell by
10%.
The police recorded a total of 4.8 million offences in the year ending December 2016, an annual rise of 9%. However, the
large volume increases driving this trend are thought to reflect changes in recording processes and practices rather than
crime.
However, there appeared to be smaller but genuine increases in some of the lower volume but higher harm categories of
police recorded violence, including homicide and knife crime.
Safety in Custody Statistics Bulletin, England and Wales, Deaths in prison custody to March
2017 (27/04/17)
The Ministry for Justice has published the latest safety in custody statistics. There were 344 deaths in prison custody in
the 12 months to March 2017, up 54 from the previous year. Three of these were homicides, down from 6. There were
113 self-inflicted deaths, up 11, 10 of which were in the female estate. The rate of self-inflicted
deaths has more than doubled since 2013.
Other figures include: self-harm incidents up 24%, assault incidents up 27%, prisoner-on-prisoner assaults up 23%,
assaults on staff up 38%.
Howard League for Penal Reform
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Long-term Conditions
Analysis of non-diabetic hyperglycaemia prevalence in England (28/04/17)
Public Health England has published estimates and analysis of the number of people with non-diabetic hyperglycaemia in
local authority and clinical commissioning group (CCG) areas.
Healthcare professionals can use the estimates to understand the estimated number of people aged 16 years and over
with non-diabetic hyperglycaemia in their area. This can help with planning and commissioning local services.
The analysis was carried out using Health Survey for England (HSE) data and includes:
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analysis of the characteristics of people with non-diabetic hyperglycaemia. Characteristics include age, sex,
ethnicity and body mass index
analysis of four commonly used risk assessment tools that can help identify people at high risk of developing
diabetes
Osteoporosis, QS149 (4/17)
This quality standard, from the National Institute for Health and Care Excellence (NICE), covers managing osteoporosis in
adults (aged 18 and over), including assessing risk and preventing fragility fractures. It describes high-quality care in
priority areas for improvement.
See also Commissioning and Economics
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Maternity/Infants
Breastfeeding at 6 to 8 weeks after birth: 2016 to 2017 quarterly data (26/04/17)
Public Health England has published the latest quarterly data, with statistical commentary, on the number and proportion
of infants who have been fully, partially or not at all breastfed at 6 to 8 weeks after birth.
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Nutrition/Physical Activity/Obesity
Study finds primary school children get less active with age (28/04/17)
There is an age-related decline in children’s physical activity levels as they progress through primary school, according to
a British Heart Foundation-funded study. Researchers at the University of Bristol found that children spent less time doing
physical activity and spent more time sedentary from Year 1 (aged 5-6) to Year 4 (aged 8-9).
Additionally, by the time they got to Year 4, around a third of boys and two thirds of girls aged eight to nine years old in the
study were failing to meet Chief Medical Officer's (CMO) recommended physical activity guidelines of an hour of physical
activity per day. Previous research has shown that low levels of physical activity in childhood can track into adulthood,
suggesting that we should be doing more to ensure children keep active throughout their younger lives.
In the study, published in the International Journal of Behavioral Nutrition and Physical Activity (open access article), the
researchers tracked the physical activity levels of 1,300 children in Year 1, aged 5-6, over a week.
Child obesity and excess weight: small area level data (26/04/17)
Public Health England has published trend data from the National Child Measurement Programme (NCMP) showing
prevalence of excess weight and obesity in children at small area level.
he spreadsheets present 3 years of aggregated data for these 4 different geographies separately:
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middle super output areas (MSOA): 2011
electoral wards: 2015
clinical commissioning groups (CCG): 2015
local authorities (LA) and England: 2013
Tackling salt and sugar intake (25/04/17)
Graham MacGregor is Professor of Cardiovascular Medicine at the Wolfson Institute of Preventive Medicine. He has
spent much of his career campaigning tirelessly to persuade the food industry to do just that - to reduce these demons in
our diet - firstly salt, and now sugar.
As a nation we now eat thirty thousand tonnes less salt each year than we did fifteen years ago, saving the NHS a
staggering £1.5 billion per year.
Blood pressure lies at the heart of this huge saving and, as Graham explains to Jim al-Khalili in this week's episode of The
Life Scientific on BBC Radio 4, blood pressure is not a natural consequence of ageing. High blood pressure is simply a
consequence of too much salt.
Graham MacGregor research history
Walk your way to health
A regular 10 minute brisk walk can make you feel better in so many ways. It can boost your energy, clear your head and
lift your mood.
It can help people with lower back pain and those at risk of high blood pressure. It is also seriously good for your longterm health – it can reduce your risk of serious illnesses like heart disease and type 2 diabetes.
Each 10 minute burst of exercise is known as an “Active 10”.
Brisk walking is simply walking faster than usual, at a pace that gets your heart pumping. Start with a 10 minute brisk walk
a day and then see if you can gradually build up to more.
It’s the easy way to improve your health and wellbeing. No gym memberships, no Lycra. Just 10 minutes and you!
Get started with the One You Active 10 walk tracker app, free to download Public Health England.
Donate - Borrow - Ride: bike libraries
The concept of a Bike Library is simple - a location or mobile unit with a fleet of bikes which are available for loan to
children and families. These bikes can be used to partake in a range of activities to promote healthy living, social inclusion
and to have fun! Activities may be as specific as a guided ride in the local community, a basic bike skills or maintenance
course or simply just to give the freedom to ride on a safe route with family and friends.
The scheme has been pioneered in Yorkshire, and relies on donated bikes, which are then repaired and re-cycled. There
are now 44 bike libraries and 51 donation stations in the county.
The website includes three sample case studies.
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Older People
State Pension age independent review: final report (27/04/17)
This is the final report by John Cridland CBE following his independent review of State Pension age arrangements after
2028. It is for the Secretary of State for Work and Pensions.
The report recommends the timetable for increasing State Pension age to 68 and reports on the wider factors that need to
be taken into account when setting State Pension age such as:
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affordability in the long term
fairness to current and future generations of pensioners
consistency with supporting fuller working lives
Exercise interventions for cognitive function in adults older than 50: a systematic review with
meta-analysis (25/04/17)
In this analysis of previous studies, researchers from the University of Canberra looked at the effects of at least four
weeks of structured physical exercise on the brain function of adults.
The meta-analysis showed that physical exercise interventions are effective at improving the cognitive function of older
adults, regardless of baseline cognitive status. Interventions of aerobic, resistance training, multicomponent training and
tai chi were similarly effective. The findings suggest that an exercise programme with components of both aerobic and
resistance-type training, of at least moderate intensity and at least 45 min per session, on as many days of the week as
possible, is beneficial to cognitive function in adults aged over 50 years.
The results have been published in the British Journal of Sports Medicine.
University of Canberra
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Pharmacy/Prescribing
See Cancer/Stroke/Cardiovascular
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Safeguarding
Social media sites failing to protect children (27/04/17)
The NSPCC is calling for minimum standards that internet companies must meet to safeguard children. These standards
must include:
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age-ratings in line with those for films set by the British Board of Film Classification
safe accounts automatically offered to under 18's – with default privacy settings, proactive filtering of harmful
content and mechanisms to guard against grooming
fines for companies who fail to protect children
Out of 1,696 children and young people who took part in the charity's Net Aware research, 1,380 thought social media
sites needed to do more to protect them from inappropriate or harmful content. When asked about what they were coming
across on social media sites, children reported seeing:
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pornography
self-harm
bullying and hatred
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Smoking/Tobacco Control
Statistics on NHS Stop Smoking Services: England, April 2016 to December 2016 (27/04/17)
This quarterly report, from NHS Digital, presents results from the monitoring of the NHS Stop Smoking Services in
England during the period April 2016 to December 2016. NHS Stop Smoking Services offer support to help people quit
smoking. This can include intensive support through group therapy or one-to-one support. The support is designed to be
widely accessible within the local community and is provided by trained personnel, such as specialist smoking cessation
advisors and trained nurses and pharmacists.
This report includes information on the number of people setting a quit date and the number who successfully quit at the 4
week follow-up. It also presents in depth analyses of the key measures of the service including pregnant women,
breakdowns by ethnic group and type of pharmacotherapy received. The results are provided at national, regional and
local authority levels.
Tobacco packaging design for reducing tobacco use (27/04/17)
Tobacco use is the largest single preventable cause of death and disease worldwide. Standardised tobacco packaging is
an intervention intended to reduce the promotional appeal of packs.
It can be defined as packaging with a uniform colour (and in some cases shape and size) with no logos or branding, apart
from health warnings and other government-mandated information, and the brand name in a prescribed uniform font,
colour and size.
Australia was the first country to implement standardised tobacco packaging between October and December 2012,
France implemented standardised tobacco packaging on 1 January 2017 and several other countries are implementing,
or intending to implement, standardised tobacco packaging.
This Cochrane review set out to assess the effect of standardised tobacco packaging on tobacco use uptake, cessation
and reduction. The available evidence suggests that it may reduce the reduce smoking prevalence. Only one country,
Australia, had implemented standardised packaging at the time of this review, so evidence comes from one large
observational study that provides evidence for this effect.
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Workforce Development
A Teaching Care Home pilot (25/04/17)
The Teaching Care Home, above all else, aimed to champion, empower and inspire the sector and create a legacy of
learning for future care homes and nursing in the sector.
The pilot is a Department of Health funded programme of work, led by Care England (the leading representative body for
independent care services in England). It was conceived after the Care Sector Nursing Taskforce called for a programme
of work to respond to some of the most prescient challenges facing the sector. Namely, to empower and embolden the
workforce in care home nursing, with a desire to harness and promote care, knowledge and skills development.
The pilot set out to change and challenge prevailing perceptions: recognising that the key to sustainability in the sector is
through workforce training and development and through this delivering improved health and care outcomes for residents.
It aimed to ensure that people who are training to be the next generation of health and social care professionals, could
learn from the experience of the care home sector, and would be better equipped to manage the health complexities and
social care needs of an ageing population.
A series of reports and booklets from the pilot have been published by International Longevity Centre-UK.
Spot the Signs: resources to help reduce domestic slavery in the UK (21/04/17)
Domestic slavery refers to the practice of exploiting and exercising undue control over another to coerce them into
performing services of a domestic nature in unacceptable conditions.
With home visits as part of their responsibility, health visitors are well-placed to see what goes on behind closed doors
and spot the signs of someone living in domestic slavery.
The Institute of Health Visiting (iHV) has announced the publication of new Good Practice Points and a new e-learning
module aimed at helping health visitors to spot the signs.
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Workplace
HC report: Brexit and health and social care - people and process (28/04/17)
Over sixty thousand people from EU countries work in the English NHS and around ninety thousand in adult social care.
Post-Brexit the UK will continue to need, and benefit from the presence of EU staff in health and social care.
The UK's withdrawal from the European Union—"Brexit"—will affect many aspects of the provision of health and social
care in the United Kingdom.
Given the range and complexity of the questions involved, the House of Commons Health Committee took evidence in
advance of the triggering of Article 50 of the Treaty on European Union (TEU). This report was intended to be the first
phase of an inquiry. Further phases have necessarily been cut short by the general election but it is hoped that the
successor committee will return to this issue.
Nuffield Trust
see also Status of EU nationals in the UK, Home Office, 07 April 2017
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If you would like more details about any of the information included in this bulletin, please contact:
Pam White, Library and Knowledge Services Manager
 Tel: 03000 418444
 Email: [email protected]
 Web: www.kpho.org.uk
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Betty O’Callaghan, Knowledge Services Assistant
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