The lives we want to lead: LGA launches own green paper as adult social care reaches breaking point

Adult Social Care |July 2018 | LGA launches own green paper as adult social care reaches breaking point

The Local Government Association (LGA) has today launched a green paper, it seeks to start a much-needed debate about how to shift the overall emphasis of our care and health system so that it focuses far more on preventative, community-based personalised care, which helps maximise people’s health, wellbeing and independence and alleviates pressure on the NHS. 

 The LGA eight-week consultation therefore sets out options for how the system could be improved and the radical measures that need to be considered given the scale of this funding crisis. Possible solutions to paying for adult social care in the long-term outlined in the consultation include:

  • Increasing income tax for taxpayers of all ages – a 1p rise on the basic rate could raise £4.4 billion in 2024/25
  • Increasing national insurance – a 1p rise could raise £10.4 billion in 2024/25
  • A Social Care Premium – charging the over-40s and working pensioners an earmarked contribution (such as an addition to National Insurance or another mechanism). If it was assumed everyone over 40 was able to pay the same amount (not the case under National Insurance), raising £1 billion would mean a cost of £33.40 for each person aged 40+ in 2024/25.
  • Means testing universal benefits, such as winter fuel allowance and free TV licences, could raise £1.9 billion in 2024/25
  • Allowing councils to increase council tax – a 1 per cent rise would generate £285 million in 2024/25 (Source: LGA)The green paper is available at LGA 


The King’s Fund The King’s Fund comments on Local Government Association’s social care Green Paper

In the news:

Complex regional pain syndrome in adults updated for 2018

Royal College of General Practitioners | July 2018 |

The Royal College of General Practitioners have updated guidelines for patients with complex regional pain syndrome (CRPS).

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The guidelines provide recommendations for diagnosis, treatment and referral in a variety of clinical settings, including:

  • primary care
  • occupational therapy and physiotherapy
  • surgical practice
  • rheumatology
  • neurology and neurosurgery
  • sport and exercise medicine
  • dermatology
  • pain medicine
  • rehabilitation medicine
  • emergency medicine
  • long-term care.

The guidelines are available from RCGP

Celebrating 70 individuals who have made a massive difference to the NHS

Care Quality Commission | July 2018 | Driving improvement – individuals who have made a difference

To mark 70 years of the NHS, the Care Quality Commission (CQC) has published 70 stories underlining individuals who have gone ‘over and above’  and made a significant impact on the care people receive across health and social care services. This collection of 70 case studies highlights the work that individuals – from volunteers, to front line staff to senior leaders – have done to deliver great services in hospitals, care homes, GP practices and elsewhere. (Source: CQC).

Driving improvement
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There are case studies from the following sectors:

The toolkit for a sustainable health workforce in the WHO European Region

World Health Organization | July 2018 | The toolkit for a sustainable health workforce in the WHO European Region

The WHO has published a new toolkit: Towards a sustainable health workforce in the WHO European Region: framework for action, which adapts the Global strategy on human resources for health: workforce 2030 to the context of the WHO European Region.

toolkit for health
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It is framed around four strategic domains mirroring the themes of the global strategy

  •  education and performance
  • planning and investment
  • capacity-building, and analysis and monitoring 
  • it proposes policy options and implementation modalities. 

The toolkit is formulated to provide Member States with information and signpost to practical materials, such as HRH assessment, policy and planning tools, analytical approaches and case studies, to support their efforts to strengthen HRH in a sustainable way, including through investment in capital and recurrent expenditure (Source: WHO).  
The toolkit is available to download from WHO here 

Emerging Concerns Protocol

Care Quality Commission | July 2018 | Joint statement on emerging concerns protocol

The Care Quality Commission (CQC) is among one of eight health and social care regulators to sign a new agreement to enable them to share concerns with one another more effectively.

The other signatories of the protocol are:

  • General Medical Council
  • General Pharmaceutical Council
  • Health and Care Professions Council
  • Health Education England
  • Local Government and Social Care Ombudsman
  • Nursing and Midwifery Council
  • Parliamentary and Health Service Ombudsman
Emerging concerns
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In addition, the following organisations are working with our emerging concerns
working group:

• General Dental Council
• NHS England
• NHS Improvement

The ‘Emerging Concerns Protocol’ seeks to provide a clearly defined mechanism for these regulators to share information and intelligence that may indicate risks to users of services, their carers, families or professionals.

The news release from CQC is here 

Emerging Concerns Protocol can be read at CQC 



The Determinants of Health Care Expenditure Growth

Centre for Health Economics University of York | July 2018 | The Determinants of Health
Care Expenditure Growth

The University of York’s Centre for Health Economics (CHE) has released its latest research considering the determinants of health care expenditure growth.


This paper considers the detailed breakdown of  hospital inpatient expenditures across the period 2007/08 to 2014/15. Decomposition techniques are used to unpick the observed rise in expenditure into a component due to a change in the distribution of
characteristics, for example, greater prevalence of morbidity, and a component due to structural changes in the impact of such characteristics on expenditures (coefficient effects, for example, due to technological change). This is undertaken at the mean using standard decomposition techniques, but also across the full distribution of expenditures to gain an understanding of where in the distribution growth and its determinants are most relevant. Decomposition at the mean indicates a larger role for a structural
change in characteristics rather than a change in coefficients. A key driver is an increased prevalence of comorbidities. When considering the full distribution we observe a decrease in expenditure at the bottom of the distribution (bottom two quintiles) but increasing expenditure thereafter. The largest increases are observed at the top of the expenditure distribution. Where changes in structural characteristics dominate changes in coefficients in explaining the rise in expenditure. Increases in comorbidities (and the average number of first diagnoses) across the two periods, together with increases in non-elective long stay episodes and non-elective bed days are important drivers of expenditure increases.

The Determinants of Health
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The full report is available from CHE 

World Hepatitis Day 28 July

Public Health England | July 2018 | Around 80% of people don’t realise hepatitis C can lead to cancer

Tomorrow (28 July) is World Hepatitis Day, to raise awareness of viral hepatitis. In conjunction Public Health England (PHE) is working with the Hepatitis C Trust to raise awareness of the infection.


A study commissioned by The Hepatitis C Trust showed 80% of people were aware of HCV, however, less than 40% knew it infects the liver, and less than 30% knew the virus is curable.

Public Health England (PHE) is urging people to get free testing for hepatitis C virus (HCV) after new data shows a lack of awareness of the disease and the factors that can put people at risk of infection.

You should get tested if you:

  • received a blood transfusion before September 1991, or a blood product before 1986 in the UK
  • shared needles or other equipment to inject drugs, even if it was just once or many years ago
  • had medical or dental treatment abroad in unsterile conditions
  • had a tattoo, piercing, acupuncture, electrolysis, or semi-permanent make up using equipment that may have been unsterilised
  • had unprotected sex with someone who has or might have hepatitis C
  • shared a razor or toothbrush with someone who has, or might have hepatitis C

Full details are from PHE

Scope of the prescribed medicines review

Public Health England | July 2018 | Scope of the prescribed medicines review

Public Health England (PHE) have been commissioned to review the evidence on dependence on and withdrawal from prescribed medicine. The review will cover adults, dependence, withdrawal and discontinuation syndrome, benzodiazepines, Z-drugs, GABA-ergic medicines, opioid pain medications, antidepressants and community prescribing. The review is due to be published in spring 2019.

 The review will draw together the best evidence on:

  • prevalence and prescribing patterns
  • the nature and likely causes of dependence and the short term discontinuation or longer term withdrawal symptoms associated with prescribed medicines among some people who take these medicines
  • effective prevention and treatment of dependence, withdrawal and discontinuation syndrome for each drug category

Delivering integrated care: the role of the multidisciplinary team

SCIE |July 2018 | Delivering integrated care: the role of the multidisciplinary team

A new report from SCIE (Social Care Institute for Excellence) looks at the role the of multidisciplinary team in delivering integrated care. 


Key messages

  • Multidisciplinary teams (MDTs) have been shown to be an effective tool to facilitate collaboration between professionals and hence improve care outcomes.
  • Successful working requires at minimum an identified manager or coordinator, regular joint meetings and the effective sharing of electronic records.
  • Teams do not necessarily have to be located in the same premises to work successfully.
  • Multidisciplinary working can be approached in more than one way as the case studies in this briefing demonstrate.
  • The success of the MDT approach is not guaranteed: without strong organisation the impact may be negative rather than positive.
  • Ongoing integrated care developments should provide further evidence to enable us to understand how MDTs should be used in the future.

    Full details are available from SCIE 

The report can be read at the SCIE website 

Resources to support safer bowel care for patients at risk of autonomic dysreflexia

NHS Improvement | July 2018 | Resources to support safer bowel care for patients at risk of autonomic dysreflexia

A Patient Safety Alert has been issued signposting resources to support safer provision of bowel care for patients at risk of autonomic dysreflexia (AD).

The Patient Safety Alert can be read here 

NHS Improvement has also signposted a number of resources on their website