Online event: Caring for people with learning disabilities: the importance of support in the right place

The King’s Fund, in partnership with Home Group,  will run an online event on Monday 16 April 2018.  The event will explore various models of care to support people with learning disabilities in the right setting. The session will cover a service set up in Hull (commissioned by the local authority) to support people with learning disabilities to live independently and as part of mainstream society.

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 Ray James, National Learning Disability Director from NHS England, and Gary Bourlet, Co-Founder of Learning Disability England, will  also discuss how to drive improvement across the country in services for people with learning disabilities, their families and carers (The King’s Fund).

Full details are available from The King’s Fund
You can register for the event here 

Health chiefs are failing to investigate a clear pattern of worsening health outcomes, according to BMJ editorial

BMJ| 2018 |  Rise in mortality in England and Wales in first seven weeks of 2018| 360 | doi: https://doi.org/10.1136/bmj.k1090

The BMJ has published an editorial on the rise in mortality rates in England and Wales in the first seven weeks of 2018. It is in response to the the publication of statistics that show in the first seven weeks of 2018, some 93 990 people died in England and Wales. Over the same period during in the last five years, an average of 83 615 people died. This increase of 12.4%, or 10 375 additional deaths, was not due to the ageing of the population. These figures show that one more person died every seven minutes during the first 49 days of 2018 compared with what had been usual in the previous five years. The editorial questions why this was the case (BMJ).

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The full editorial can be read at Rise in mortality in England and Wales in first seven weeks of 2018 it is available from the BMJ here 

UK trails behind its peers, reveals International comparisons of health and wellbeing data in early childhood

Nuffield Trust | International comparisons of health and wellbeing in early childhood |

According to the first ever international analysis looking at UK child health measures over time and across 14 other comparable countries, published today by the Nuffield Trust and Royal College of Paediatrics and Child Health (RCPCH). The indicators examined included a range of child health outcomes – spanning life expectancy, nutrition, immunisations, and  early childhood mortality. 

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The analysis looked at data from 14 OECD (Organisation for Economic Co-operation and Development) countries, it reveals that the UK is lagging behind Sweden, Spain, Germany and the Netherlands who all have much higher immunisation levels. It also trails behind its  peers on levels of infant mortality.

The UK also had one of the highest levels of overweight or obese children than the average amongst high-income countries  in 2013. It had the second highest incidence of overweight girls 2-19 (29%).

The president of the RCPCH Dr Russell Viner called on the government to create a focused, comprehensive cross-departmental child health strategy,

“Given that children and young people make up a quarter of the UK population, it’s a real failure of the system that child health gets so little political attention. Investing in child health makes both moral and economic sense – for every £1 you put in, you get an average of £10 back in terms of future productivity.”

The full press release is available from the Nuffield Trust

Related: Nuffield Trust blog Lagging behind: why we must do better on child health

The report can be downloaded here 

Dementia UK: ‘Together again’

Dementia UK have created a short animated film to show the differences Admiral nurses make in bringing families affected by dementia together again, even for the briefest of moments.

This animation explores those feelings of being lost in dementia – and how the support and guidance of an Admiral Nurse can help bring people back together again.

 

More about Dementia UK and the Admiral Nurse Service available here

New data shows NHS weight loss programme enables patients to lose half a stone

NHS England | Flagship NHS Type 2 Diabetes Prevention Programme exceeds expectations as patients shed the weight of 15 double cheese burgers |

A flagship diabetes prevention programme supporting overweight patients to lose weight has exceeded expectations with over half of the participants losing eight pounds. Results published from the first wave of the scheme show patients were half a stone lighter (3.17kg) if they completed the majority of sessions during the nine month programme. However, when those with a normal weight and BMI but on the programme due to other health and lifestyle risks associated with developing Type 2 diabetes, this increased to 3.7kg.

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Image source: NHS England

Since the programme began  three years ago, over 154,000 people have been referred, with around 66,000 of these taking up places. The programme has attracted a higher proportion of male patients than typically attend such weight loss programmes.

In addition, a further 5,000 people are also expected to benefit from a recently launched digital support to patients.  The pilot project comprises five companies and eight areas of the country are test driving a range of apps, gadgets, wristbands and other innovative digital products.

Professor Jonathan Valabhji, National Clinical Director for Diabetes and Obesity, at NHS England said: “While it is early days, this data from several thousand people is very promising. Not only is our prevention programme exceeding the initial targets set for referrals and equity of access, what we are now starting to see is the first set of encouraging weight loss results too. Type 2 diabetes is heavily linked to obesity and if those on our programme continue to lose weight, as this snapshot suggests, then it is a step in the right direction and this programme can be an effective part of the solution.”

The full news story is available from NHS England here 

More information on the Digital Prevention Programme can be found at NHS England 

Forward Thinking- NIHR research on support for people with severe mental illness (SMI)

NIHR | Forward Thinking- NIHR research on support for people with severe mental illness |

National Institute of Health Research (NIHR) has provided an overview of NIHR- funded recent research into support for individuals with a diagnosis of SMI. It supports early detection and intervention, crisis care, supporting recovery and managing physical and mental health.

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Image source: dc.nihr.ac.uk

The overview includes 30 published studies and 19 ongoing research projects to address particular uncertainties and evidence gaps identified by those working in and using these services. It also highlights research currently taking place to inform the support and care of people with SMI; and provides questions to ask about support for people living with SMI.

Full details are at the NIHR website 

The full overview can be accessed here 

The clinical and cost effectiveness of shorter duration prescriptions vs. longer term prescriptions

The National Institute of Health Research (NIHR) has synthesised research from four recent papers looking at shorter duration prescriptions (28 days) and comparing these with three month prescriptions.

One of these papers, the Impact of issuing longer- versus shorter- duration prescriptions: a systematic review published today in the British Journal of General Practice, says 28-day prescriptions should be reconsidered in favour of longer- duration prescriptions.  The study examined the impact of longer-duration (2–4 months) versus shorter-duration (28-day) prescriptions. The systematic review found that UK recommendations to provide shorter prescriptions are not substantiated by the current evidence base. 

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While other research  found that longer prescriptions were more cost-effective for the NHS, one of its authors, Dr Rupert Payne said that the evidence base for this was ‘poor’. Dr Payne also cautioned that “community pharmacies receive a fee for every prescription they dispense. So simply switching every repeat prescription item from, for example, one month to three months, could result in a large reduction in pharmacy income.” While this may reduce costs, a possible consequence could be loss of pharmacy services.  Therefore,  any “changes to policy around the length of repeat prescriptions should also consider how pharmacies are reimbursed.”

References:

 King, S.,  et al | Impact of issuing longer- versus shorter- duration prescriptions: a systematic review |British Journal of General  Practice

The full article can be downloaded from British Journal of General Practice here

Doble, B. et al | 2018 |Retrospective, multicohort analysis of the Clinical Practice Research Datalink (CPRD) to determine differences in the cost of medication wastage, dispensing fees and prescriber time of issuing either short (<60 days) or long (≥60 days)
prescription lengths in primary care for  common, chronic conditions in the UK |BMJ Open |Vol. 7| 12 | http://dx.doi.org/10.1136/bmjopen-2017-019382

This article can be downloaded from BMJ Open here 

Miani, C.et al. Clinical effectiveness and cost-effectiveness of issuing longer versus shorter duration (3-month vs. 28-day) prescriptions in patients with chronic conditions: systematic review and economic modelling. Health Technology Assessment |2017 | Vol. 21 |78| https://doi.org/10.3310/hta21780

This can be accessed from NIHR 

Martin, A., Payne, R., & Wilson, E., C., F., | 2018 | Long-Term Costs and Health Consequences of Issuing Shorter Duration Prescriptions for Patients with Chronic Health Conditions in the English NHS | Applied Health Economics and Health Policy |https://doi.org/10.1007/s40258-018-0383-9

This article can be requested by Rotherham NHS staff here

Health Inequalities Manifesto 2018 presents actions to address mental health inequalities across England

Mental Health FoundationMarch 2018 | Health Inequalities Manifesto 2018 

Health Inequalities Manifesto 2018 is a new publication from the Mental Health Foundation, it underlines how certain population subgroups are at higher risk of mental health problems. This is a result of  of greater exposure and vulnerability to unfavourable social, economic, and environmental circumstances:

  • Material inequality – poverty, poor housing, lack of employment opportunities.
  • Social inequality and injury – stigma and discrimination or experiences related to:
    • living in care
    • immigration status
    • ethnicity
    • sexual orientation
    • disability
    • experience of violence or abuse.
  • Health inequality – including having long-term physical health conditions.
Mental health inequal
Image source: mentalhealth.org.uk

The Mental Health Foundation recognise a social gradient which exists in relation to poverty and/or economic  inequality and poorer mental health and wellbeing. Populations living in poor socio-economic circumstances are at increased risk
of poor mental health, depression and lower wellbeing. They advocate particular approaches and interventions to reduce the risk factors underpinning inequalities and applying these proportionately across the social gradient.

Their review of the latest evidence about how to lessen the risk of mental health  inequalities has enabled the to identify five priorities for action.  The manifesto  presents these actions that can be applied to address mental health inequalities in England. These are:

  1. Healthy children: Promote emotional wellbeing and build resilience from birth through universal and targeted programmes..
  2. Healthy minds:  Introduce a comprehensive and multi-sectoral approach to address mental health promotion, prevention, treatment, discrimination, exclusion, care and recovery.
  3. Healthy places: Apply a socio-ecological approach that takes account of the impact of the social and physical environment, within homes and in settings such as schools and communities.
  4. Healthy communities: Introduce a place-based approach to protect and support good mental health and wellbeing in the community.
  5. Healthy habits: Give people the knowledge, tools and resources to protect and improve their own and their families’ and friends’ mental health.

The full manifesto can be downloaded from the Mental Health Foundation 

40 % of smokers (and general population) ignorant about cause of most smoking- related cancer

Public Health England | March 2018 |  Four in 10 smokers incorrectly think nicotine causes cancer

To mark No Smoking Day (14 March 2018)  Public Health England (PHE) emphasise that going ‘cold turkey’ is the least effective approach to quit cigarette smoking.  Despite this more than half (58%) of smokers still try to quit without using an aid. Although smoking rates are at their lowest ever level, there are still nearly 7 million smokers in England.  A PHE report highlights that public misunderstanding of the harmfulness of nicotine containing products, such as nicotine replacement therapy (NRT) and e-cigarettes, may be linked to inaccurate and confused perception of the risks of nicotine.

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40 per cent of smokers and ex-smokers incorrectly think that nicotine in cigarettes is the cause of most of the smoking-related cancer. Understanding of the harms of nicotine among the general population is also poor.  In actuality the risks of nicotine use are likely to be very low or negligible but it is the cocktail of deadly chemicals in cigarette smoke, including tar and carbon monoxide, which causes almost all of the harm of smoking. Nicotine replacement therapy (NRT)  is safe and licenced for use in pregnancy and for people with cardiovascular disease. There is also wide international consensus that e-cigarettes are far less harmful than smoking.

The use of quit aids can greatly increase smokers chances of quitting successfully. Research shows that:

  • using NRT as a quit aid, such as patches and gums, or e-cigarettes makes it one and a half times as likely they’ll succeed
  • Their chances of quitting are doubled if using a stop smoking medicine prescribed by a GP, pharmacist or other health professional
  • expert support from a local stop smoking service gives the best chance of quitting successfully
  • combining quit aids with expert support quadruples the likelihood an individual will stop smoking successfully

The full press release is at Public Health England 

Related resources:

Local Tobacco Control Files are available from PHE 

PHE’s e-cigarette review can be read here 

Smoking Prevalence Figures can be found at NHS Digital

More than 50 % of patients visiting GPs have multimoribidities, finds Cambridge University study

A new study that is published in the British Journal of General Practice demonstrates that over 14 million people in England have multimorbidities. The researchers provide an up-to-date and comprehensive description of multimorbidity — where patients have two or more currently active, long term conditions.  They found over 50 per cent of GP consultations are now with patients with multimorbidity.
This study looked at the experiences of 404,000 patients within the Clinical Practice Research Datalink (CPRD).  CPRD database is a nationally owned resource of millions of anonymised patient GP records, over the last 30 years it has underpinned 2,000 research articles (via Cambridge University)
heart-1698840_1280The full article can be accessed from the British Journal of General Practice 

Abstract

Background
Multimorbidity places a substantial burden on patients and the healthcare system, but few contemporary epidemiological data are available.

Aim To describe the epidemiology of multimorbidity in adults in England, and quantify associations between multimorbidity and health service utilisation.

Design and setting Retrospective cohort study, undertaken in England.
Method The study used a random sample of 403 985 adult patients (aged over 18 years), who were registered with a general practice on 1 January 2012 and included in the Clinical Practice Research Datalink. Multimorbidity was defined as having two or more of 36 long-term conditions recorded in patients’ medical records, and associations between multimorbidity and health service utilisation (GP consultations, prescriptions, and hospitalisations) over 4 years were quantified.

Results
In total, 27.2% of the patients involved in the study had multimorbidity. The most prevalent conditions were hypertension (18.2%), depression or anxiety (10.3%), and chronic pain (10.1%). The prevalence of multimorbidity was higher in females than males (30.0% versus 24.4% respectively) and among those with lower socioeconomic status (30.0% in the quintile with the greatest levels of deprivation versus 25.8% in that with the lowest). Physical–mental comorbidity constituted a much greater proportion of overall morbidity in both younger patients (18–44 years) and those patients with a lower socioeconomic status. Multimorbidity was strongly associated with health service utilisation. Patients with multimorbidity accounted for 52.9% of GP consultations, 78.7% of prescriptions, and 56.1% of hospital admissions.

Conclusion
Multimorbidity is common, socially patterned, and associated with increased health service utilisation. These findings support the need to improve the quality and efficiency of health services providing care to patients with multimorbidity at both practice and national level.

Full reference: Cassell, A. et al  | 2018 |The epidemiology of multimorbidity in primary care: a retrospective cohort study | British Journal of General Practice |ePub |  D