Coaching/mentoring offer – for people representing patient voice in the NHS

NHS England | November 2018 | Current Opportunities to get involved

NHS England has developed a coaching/mentoring development opportunity for Patient and Public Voice partners (PPVs). They are offering places to PPVs who are currently volunteering with NHS England (they anticipate that applicants would have been volunteering for at least six months representing patient voice); or are supporting transformation programmes in Sustainability and Transformation Partnerships (STPs) or Integrated Care Systems (ICS) on a regular basis. The coaching would be provided by accredited employee coaches who also coach and mentor NHS England employees (Source: NHS England). 

For the full details see NHS England 


New resource launched to improve dementia care

People living with dementia will benefit from improved care following the launch of a new resource for healthcare providers and carers | Health Education England

Success in dementia

Managing Success in Dementia is a resource commissioned by Health Education England (HEE) and developed by Skills for Care, Skills for Health and Leeds Beckett University to support leaders and managers working across health and social care to implement the training outcomes of the Dementia Training Standards Framework – in particular those responsible for implementing training at Tier 2 level.

Tier 2 training provides additional skills and knowledge for people who regularly work directly with people living with dementia.

Full document: Managing success in dementia care: A support resource for implementing Tier 2 of the Dementia Training Standards Framework in health and social care settings

Children of the millennium

Children of the millennium: understanding the course of conduct problems during childhood | The Centre for Health Economics | University College London Institute of Education  

Image source:

This report presents an analysis of the Millennium Cohort Study which follows the lives of children born in 2000 and 2001.  The report finds that one child in every twelve in the UK has behavioural problems from a young age into their teenage years and calls for the government, NHS, schools and local authorities to do more to support children with persistent behavioural problems.

Children with persistent problems are much more likely to have a multitude of risks early in life, including poverty and housing insecurity, parental mental illness and developmental delay.


The report calls for:

  • Government to seek to reduce child poverty and housing insecurity
  • The NHS to continue to boost mental health support to new parents
  • Local authorities to get the funding they need to boost early years services such as Sure Start and to offer evidence-based parenting programmes to families with the greatest needs.

Full document: Children of the millenium: Understanding the course of conduct problems during childhood | Centre for Mental Health

Additional link: Centre for Mental Health press release

Increasing continuity of care in General Practice

The Health Foundation is supporting five large-scale GP practices and federations to carry out targeted improvement work to increase continuity of care in their practices.

The Increasing Continuity of Care in General Practice programme will explore what continuity of care will look like, considering relationships between GPs and patients, and also examining whether better information and management practices can help increase continuity with the aim of bringing benefits to both staff and patients.


This programme is inspired by recent Health Foundation research which demonstrated that patients with ambulatory care sensitive conditions who see the same GP a greater proportion of the time have fewer unplanned hospital admissions. The programme has been developed with the advice and support of the Royal College of General Practitioners.

Each project will run for up to two years and each project team will receive up to £250,000 of funding to support the implementation, evaluation and dissemination of findings from their work.

Full story at The Health Foundation

Are we failing people with learning disabilities? A fair, supportive society: summary report

University College London | November 2018 |Are we failing people with learning disabilities?

A new report published by UCL’s Institute of Health Equity (IHE) highlights that  40 per cent of children with a learning disability remain undiagnosed and that adults with learning disabilities will die 15-20 years earlier (on average) than the general population which is 1,200 premature deaths each year.


Responding to the findings Sir Michael Marmot , director of IHE said:

“This is a direct result of a political choice that destines this vulnerable group to experience some of the worst of what society has to offer: low incomes, no work, poor housing, social isolation and loneliness, bullying and abuse.

“A staggering 40% of people with learning difficulties aren’t even diagnosed in childhood. This is an avoidable sign of a society failing to be fair and supportive to its most vulnerable members. We need to change this. The time to act is now.”

The IHE makes a number of actions and 11 recommendations to improve life expectancy for people with disabilities.  (Source: UCL)

Read the IHE paper 

Easy read version 
In the media:

Guardian Two in five people with learning disabilities not diagnosed in childhood

Study finds North-south divide in early deaths deepening

University of Liverpool| November 2018 | Study finds North-south divide in early deaths deepening

Data analysed as part of new research into the excess mortality and socioeconomic deprivation  reveals a profoundly concerning gap in mortality between the North and the South, especially in men.  The researchers involved from Keele, Liverpool, Manchester and York universities, looked into mortality rates in 5 most northerly government regions (Yorkshire and Humber, North East, North West, East Midlands West Midlands) and 5 most southerly government regions ((East of England, South Central, South West, South East, and London).  Using data from the Office of National Statistics (ONS) they aggregated and compared the northern and southern regions between the years 1981 and 2016. 



The study found that:

• Accounting for age and sex, northerners aged 25-44 were 47% more likely to die from cardiovascular reasons, 109% more likely to die from alcohol misuse and 60% more likely from drug misuse, compared to southerners.

• London had the lowest mortality rates, with the North East having the highest, even after adjusting for age, sex and socio-economic deprivation.

• Suicide among men, especially at ages 30-34, and cancer deaths among women were also important factors.

• National cardiovascular death rates declined over the study period, though the North – South gap persists.

The study also revealed that, although there was little difference between early deaths in the North and the South in the 1990s, by 2016 a gap had opened up nonetheless.

(Source: University of Liverpool)

The study has now been published in the Lancet Health 



Since the mid-1990s, excess mortality has increased markedly for adults aged 25–44 years in the north compared with the south of England. We examined the underlying causes of this excess mortality and the contribution of socioeconomic deprivation.


Mortality data from the Office of National Statistics for adults aged 25–44 years were aggregated and compared between England’s five most northern versus five most southern government office regions between Jan 1, 1981, and Dec 31, 2016. Poisson regression models, adjusted for age and sex, were used to quantify excess mortality in the north compared with the south by underlying cause of death (accidents, alcohol related, cardiovascular disease and diabetes, drug related, suicide, cancer, and other causes). The role of socioeconomic deprivation, as measured by the 2015 Index of Multiple Deprivation, in explaining the excess and regional variability was also explored.


A mortality divide between the north and south appeared in the mid-1990s and rapidly expanded thereafter for deaths attributed to accidents, alcohol misuse, and drug misuse. In the 2014–16 period, the northern excess was incidence rate ratio (IRR) 1·47 for cardiovascular reasons, 2·09 for alcohol misuse, and 1·60 for drug misuse, across both men and women aged 25–44 years. National mortality rates for cardiovascular deaths declined over the study period but a longstanding gap between north and south persisted in 2016 in the north vs from 23·5 to 9·9 in the south. Between 2014 and 2016, estimated excess numbers of death in the north versus the south for those aged 25–44 years were 1881 for women and 3530 for men. Socioeconomic deprivation explained up to two-thirds of the excess mortality in the north. By 2016, in addition to the persistent north–south gap, mortality rates in London were lower than in all other regions, with IRRs ranging from IRR 1·13 for the East England to 1·22  for the North East, even after adjusting for deprivation.


Sharp relative rises in deaths from cardiovascular reasons, alcohol misuse and drug misuse in the north compared with the south seem to have created new health divisions between England’s regions. This gap might be due to exacerbation of existing social and health inequalities that have been experienced for many years. These divisions might suggest increasing psychological distress, despair, and risk taking among young and middle-aged adults, particularly outside of London.
Full reference: Kontopantelis, E., Buchan, I., Webb, R. T., Ashcroft, D. M., Mamas, M. A., & Doran, T. |2018| Disparities in mortality among 25–44-year-olds in England: a longitudinal, population-based study| The Lancet Public Health|DOI:



Outpatients app ‘saving NHS millions’

NHS Confederation | November 2018 |Outpatients app ‘saving NHS millions’

A new app- the MyCare app- developed by Milton Keynes University Hospital NHS Foundation Trust, the app allows patients to change and confirm appointments on a smartphone, tablet or computer, with outpatient letters emailed in real time.  The app has been co-designed by patients and clinicians.  


Chief executive of the trust Joe Harrison explains, “for most hospitals in the country, it is easier for somebody to book a hotel, flight and a cab to pick them up from Sydney, Australia than it is for them to change or cancel their outpatient appointment – because we don’t allow people to do it in their own time, on any device, in a way that is convenient to them.”

While many trusts are providing patient portals, Milton Keynes is the first NHS hospital to provide the ability for people to directly manage their appointments, including rearranging them solely online without needing to call the hospital (Source: NHS Confederation).

MyCare at  Milton Keynes University Hospital NHS Foundation Trust 

Nearly 50 per cent of sport injuries treated in A&E are in kids

University of Newcastle| November 2018 |Almost half of sport injury-related A&E attendances are children

New research indicates that children under the age of eighteen are the highest burden of sports-related injury to A&E. With 12 year-old females, and 14-year-old males being the most at risk of sustaining a sports injury. The research involved analysis of injury attendance data at two hospitals, one in Oxford and the other in Banbury, from January 2012 – March 2014. Attendances recorded totalled almost 64,000 (63,877), of these  11,676 were sport-related, with 5,533 of these in  children and young people aged 0-19.

The research conducted by researchers at the University of Newcastle and University of Oxford, found the most injurious sports activities for girls were trampolining, netball and horse riding; for boys this was rugby union, rugby league and football.


Graham Kirkwood, senior research associate at Newcastle University, said: “These figures are equivalent to 68 boys and 34 girls in every thousand attending NHS emergency departments in a year. This is a heavy burden on the NHS and on children and families from sport-related injury.”

He added: “Children need to be physically active but making organised sports as safe as possible needs to be part of any effective child obesity strategy.” (Source: University of Newcastle)

Full news release at the University of Newcastle

The full article is available to read at Journal of the Royal Society of Medicine 

To analyse and report on sports-related injuries using enhanced injury data collected by the testbed for the NHS emergency care injury data set and admissions data collected from inpatients.


Ecological study design.

Two Oxfordshire NHS England hospitals.

Emergency department attendees and inpatients aged 0–19 years with sports injuries.

Data were analysed from 1 January 2012 to 30 March 2014 by age, gender sport, injury location, injury mechanism and diagnosis including concussion/post-concussion, bone fractures and ligament damage. Admissions data were analysed from 1 January 2012 to 24 January 2015.


Children and adolescents aged 0–19 years accounted for almost half (47.4%) of sports injury-related emergency department attendances and almost one-quarter (23.5%) of sports injury-related admissions for all ages. The highest rates of attendance occurred at 14 years for boys (68.22 per 1000 person-years) and 12 years for girls (33.72 per 1000 person-years). For male 0–19-year-olds the three main sports were (in order) football (soccer), rugby union and rugby league and for females, trampoline, netball and horse-riding. The largest gender differences were in netball where injuries were predominantly in females and in wheeled motorsports where injuries were predominantly in males. Almost one-quarter of emergency department sports-related injuries recorded were fractures, the highest percentage to the upper limbs.


Public health departments in local authorities and schools should consider target sports injury prevention at children in the first four years of secondary school. For younger age groups, trampolines in the home warrant improved safety. Rugby and horse-riding should also be a focus for interventions.

Full reference: Kirkwood, G., Hughes, T. C., & Pollock, A. M. |2018 | Results on sports-related injuries in children from NHS emergency care dataset Oxfordshire pilot: an ecological study|Journal of the Royal Society of Medicine|

In the media:

BBC News Children and adolescents ‘account for half of sports A&E attendances’

A healthy lifestyle cuts stroke risk, irrespective of genetic risk

University of Cambridge | November 2018 | A healthy lifestyle cuts stroke risk, irrespective of genetic risk

Research led by researchers at the University of Cambridge was designed to investigate whether a genetic risk score for stroke is associated with actual (“incident”) stroke in a large population of British adults.

The international research team developed a genetic risk score based on 90 gene variants known to be associated with stroke from 306,473 white men and women in the UK Biobank – a database of biological information from half a million British adults.

All participants in the observational study  were aged between 40 and 73 years with  no history of stroke or heart attack. Adherence to a healthy lifestyle was based on four factors: non-smoker, diet rich in fruit, vegetables and fish, not overweight or obese (body mass index less than 30), and regular physical exercise.

The participants were followed up on average seven years later with hospital and death records used to identify stroke events. Across all categories of genetic risk and lifestyle, the study found the risk of stroke was higher in men than women.


Risk of stroke was 35% higher among those at high genetic risk compared with those at low genetic risk, irrespective of lifestyle (Source: University of Cambridge).

The full news story is available from the University of Cambridge 

Read the article in the BMJ 

Full reference: Rutten-Jacobs Loes, CALarsson , S.C.Malik, R.Rannikmäe, K., et al.| Genetic risk, incident stroke, and the benefits of adhering to a healthy lifestyle: cohort study of 306 473 UK Biobank participants| 


Objective To evaluate the associations of a polygenic risk score and healthy lifestyle with incident stroke.

Design Prospective population based cohort study.


Setting UK Biobank Study, UK.


Participants 306 473 men and women, aged 40-73 years, recruited between 2006 and 2010.

Main outcome measure Hazard ratios for a first stroke, estimated using Cox regression. A polygenic risk score of 90 single nucleotide polymorphisms previously associated with stroke was constructed at P less than 1×10−5 to test for an association with incident stroke. Adherence to a healthy lifestyle was determined on the basis of four factors: non-smoker, healthy diet, body mass index less than30 kg/m2, and regular physical exercise.

Results During a median follow-up of 7.1 years (2 138 443 person years), 2077 incident strokes (1541 ischaemic stroke, 287 intracerebral haemorrhage, and 249 subarachnoid haemorrhage) were ascertained. The risk of incident stroke was 35% higher among those at high genetic risk (top third of polygenic score) compared with those at low genetic risk (bottom third): hazard ratio 1.35, P=3.9×10−8. Unfavourable lifestyle (0 or 1 healthy lifestyle factors) was associated with a 66% increased risk of stroke compared with a favourable lifestyle (3 or 4 healthy lifestyle factors): 1.66, P=1.19×10−13. The association with lifestyle was independent of genetic risk stratums.

Conclusion In this cohort study, genetic and lifestyle factors were independently associated with incident stroke. These results emphasise the benefit of entire populations adhering to a healthy lifestyle, independent of genetic risk.

Screen time does not impact sleep in children, finds study

Science Daily | November 2018 |Children’s sleep not significantly affected by screen time, new study finds

Earlier research has suggested that between 50 and 90 per cent of school- age children might not be getting enough sleep, citing digital technologies as a potential contributor to this. Now research findings from the Oxford Internet Institute at the University of Oxford, indicate that screen time has a modest impact on child’s sleep. The research team used data from the United States’ 2016 National Survey of Children’s Health, which included parents from across the country whom completed self-report surveys on themselves, their children and household. The survey included questions that required caregivers to estimate their child/ren’s sleep duration over one day, if their child/ren went to bed at approximately the same time each night and the amount of time spent on digital screens (including mobile phones, computers, handheld video games and other electronic devices). 


Although the study found a correlation, the lead researcher, Professor Andrew Przybylski, author of the study published in the Journal of Pediatrics explains it is modest. “The findings suggest that the relationship between sleep and screen use in children is extremely modest. Every hour of screen time was related to 3 to 8 fewer minutes of sleep a night.” (Source: Science Daily)



To determine the extent to which time spent with digital devices predicts meaningful variability in pediatric sleep.

Study design

Following a preregistered analysis plan, data from a sample of American children (n = 50 212) derived from the 2016 National Survey of Children’s Health were analyzed. Models adjusted for child-, caregiver-, household-, and community-level covariates to estimate the potential effects of digital screen use.


Each hour devoted to digital screens was associated with 3-8 fewer minutes of nightly sleep and significantly lower levels of sleep consistency. Furthermore, those children who complied with 2010 and 2016 American Academy of Pediatrics guidance on screen time limits reported between 20 and 26 more minutes, respectively, of nightly sleep. However, links between digital screen time and pediatric sleep outcomes were modest, accounting for less than 1.9% of observed variability in sleep outcomes.


Digital screen time, on its own, has little practical effect on pediatric sleep. Contextual factors surrounding screen time exert a more pronounced influence on pediatric sleep compared to screen time itself. These findings provide an empirically robust template for those investigating the digital displacement hypothesis as well as informing policy-making.


Full reference: Przybylski, Andrew K. | 2018| Digital Screen Time and Pediatric Sleep: Evidence from a Preregistered Cohort Study | The Journal of Pediatrics| Volume 0 | Issue 0 |DOI:

The full article is available from the Journal of Pediatrics