Transforming Children’s Services

Transforming children’s services | Public Accounts Committee

This report looks at the current pressures on children’s social care and what the Department of Education has been doing to make the quality or finances of these services sustainable.

The report concludes that the Department for Education has not done enough and requires a step-change in the understanding of pressures, the reduction of unnecessary variation between areas in their social care activities and the costs of providing them, and greater pace in its work with struggling local authorities.

Full report available here

See also: ‘Children deserve better’ than slow progress on social care

NHS waiting times for elective and cancer treatment

This report examines waiting time standards for elective and cancer treatment and factors associated with performance in meeting these standards | National Audit Office


This review presents data on the NHS’s performance against current waiting times standards for elective and cancer care in England, and some of the factors associated with that performance. It draws together existing evidence and analysis by the Department, NHS England, NHS Improvement and other stakeholders. The National Audit Office builds on this evidence base with it’s own analysis to provide added insight into:

  • changes in waiting times performance, and variations in that performance;
  • the impact of waiting times performance on patients;
  • the factors that influence waiting times performance; and
  • NHS England’s and NHS Improvement’s approach to managing and improving waiting times performance.

The report concludes that while increased demand and funding constraints affect the entire system, other factors are linked with differences in performance both over time and across trusts. These include staff shortages for diagnostic services, a lack of available beds, inefficient processes and, in some cases, patient choices. The report calls for significant investment in staffing and infrastructure to meet new commitments outlined in the new NHS Long Term Plan.

See also: NHS must focus on routine care to tackle growing waiting lists, says spending watchdog | BMJ

Identifying and offering brief advice to tobacco and alcohol users

The latest edition of Health Matters focuses on preventing ill health caused by tobacco and alcohol use | Public Health England

This professional resource focuses on preventing ill health caused by tobacco and alcohol use and makes the case for why NHS providers should implement the Screening and brief advice for tobacco and alcohol use in inpatient settings CQUIN, published in March 2019.

tobaco and alcohol
Image source:

Smoking is the single largest cause of preventable ill health and premature death, and there are over 6 million people in England who smoke. It costs the NHS in England approximately £2.6 billion a year for treating diseases caused by smoking, but every £1 spent on smoking cessation saves £10 in future health care costs and health gains.

An estimated 1 in 4 patients in acute hospital beds in England are smokers and the prevalence of smoking in secure mental health units is even higher at 64% of patients. Therefore, a large number of smokers can be reached through health services and in particular hospitals.

Alcohol misuse contributes wholly or partially to 200 health conditions, including cancers, cardiovascular conditions, depression and liver disease. The toxic effect of alcohol misuse over time and acute alcohol intoxication lead to hospital admission.

In England, 10.4 million people consume alcohol at levels above the UK CMOs’ low-risk guideline, increasing their risk of alcohol-related ill health. Alcohol identification and brief advice (IBA) can identify and influence patients who are drinking above low risk.

The national CQUIN scheme offers the chance to identify and support:

  • inpatients who smoke
  • inpatients who are drinking above low risk

It is intended to complement and reinforce existing activity to deliver interventions to smokers and those who use alcohol at increasing risk and higher risk levels.

Full resource at Public Health England

Home to the unknown: getting hospital discharge right

This research explored patients’ unplanned stays in hospital and what it was like for them after they had returned home | British Red Cross

The research sought to reveal: patients’ experiences of being discharged from hospital; hospital systems and healthcare professionals’ experiences and perceptions of the discharge process; and what it was like for people returning home from hospital feeling more or less prepared.

As a result, it aimed to explore the impact of discharge on recovery and wellbeing and to identify opportunities to improve systems, communication and support.

Based on the experience of the British Red Cross and the research, the report argues:

  1. There is a substantial opportunity for commissioners and providers to harness the power of non-clinical support, including the voluntary and community sector (VCS), to relieve the pressure on the NHS and to create better outcomes for people and improved patient flow within and between health and social care providers.
  2. Every point of hand-off between clinical teams in hospital and from the hospital to the community is a potential point of success or failure for patient recovery. The report recommends that there is a clinical responsibility to ensure the effective management of these transitions, so that there is continuity of care and patients don’t fall through the gaps between teams.
  3. The report recommends that a five part ‘independence check’ should be completed as part of an improved approach to patient discharge – prior to discharge or within 72 hours of going home. This would help to inform the setting of a realistic discharge date and would include assessing:
  • Practical independence (for example, suitable home environment and adaptations)
  • Social independence (for example, risk of loneliness and social isolation, if they have meaningful connections and support networks)
  • Psychological independence (for example, how they are feeling about going home, dealing with stress associated with injury)
  • Physical independence (for example, washing, getting dressed, making tea) and mobility (for example, need for a short-term wheelchair loan)
  • Financial independence (for example, ability to cope with financial burdens).

Quality In Public Health: A Shared Responsibility

This framework aims to raise quality in public health services and functions. It is the first such framework for public health, and has been developed by the Public Health System Group with support from important partners across the public health system including from local government and the NHS.

PH quality
Image source:

This document sets out a high-level, shared, system-wide commitment to high-quality public health functions and services.

The document:

  • Provides a framework for improving quality in the delivery of public health
    functions and services that can support sector led improvement
  • Describes what we mean by quality in public health systems, functions and
  • Sets out the roles and responsibilities of key players in the public health
    system to deliver high-quality functions and services
  • Describes the process for improving quality
  • Identifies areas for priority focus and action

The main audiences for the framework are:

  • people working in public health and related areas
  • providers of public health functions and services
  • commissioners and funders
  • local authority councillors and directly elected mayors
  • national government, organisations and policy makers

Giving children the best start in life

The health visiting service plays a crucial role in giving children the best start in life and this collection of case studies shows how councils have embraced the opportunity to make a difference in this key development stage | Local Government Association

Health visitors lead on the delivery of the government’s healthy child programme for children aged 0 to 5, working alongside other health and social care colleagues, including family nurse partnership teams, nursery nurses and other specialist health professionals.

The support provided includes everything from universal help for all new parents, including ensuring good uptake of immunisations, to identifying those
in need of more intensive support. The impact of this early support cannot be underestimated. It builds resilience, encourages healthy lifestyles and aids social and emotional development.

Full document: Health visiting: giving children the best start in life | Local Government Association

Research shows dementia rates falling by 15% per decade over last 30 years

The risk of developing dementia is falling, thanks to lifestyle improvements such as reductions in smoking, new research has found. Researchers have said that while the overall number of cases is rising due to the population living longer, an individual’s chances of having the disease is going down | Alzheimers Research UK

International experts have presented research indicating that dementia incidence rates may be falling by up to 15% decade on decade. Analysing data from seven population-based studies in the United States and Europe, Prof Hofman and a global team of researchers set out to determine changes in the incidence of dementia between 1988 and 2015.

Of 59,230 individuals included in the research, 5,133 developed dementia. The rate of new dementia cases declined by 15% per decade, a finding that was consistent across the different studies included in the analysis.

The findings will be discussed at the Alzheimer’s Research UK Conference 2019 in Harrogate.

Full story at Alzheimer’s Research UK

See also:

In This video, lead author Albert Hofman, discusses trends in dementia incidence over the last three decades at the Alzheimer’s Research UK  Conference 2019. Prof. Hofman goes on to explain the reasoning behind these trends.


Key areas for action on the health and care workforce

Closing the gap: Key areas for action on the health and care workforce | Nuffield Trust |  The King’s Fund | The Health Foundation


Staffing is the make-or-break issue for the NHS in England. Workforce shortages are already having a direct impact on patient care and staff experience. This report calls for urgent action to avoid a vicious cycle of growing shortages and declining quality. The workforce implementation plan to be published later this year presents a pivotal opportunity to do this.

In this report, experts from the Nuffield Trust, The King’s Fund and the Health Foundation set out a series of policy actions that, evidence suggests, should be at the heart of the workforce implementation plan. This report focuses on nursing and general practice, where the workforce problems are particularly severe. The authors suggest a number of high-impact policy actions which, if properly funded and well implemented across the NHS would over time create a sustainable model for general practice and help to eliminate nursing shortages. These will require investment of an extra £900 million per year by 2023/24 into the budget of Health Education England.

Closing the gap: Key areas for action on the health and care workforce – full report

Closing the gap: Key areas for action on the health and care workforce – overview

See also: Offer £5,200 grants to nursing students and ramp up overseas recruitment to stop NHS workforce crisis | The Kings Fund


Around one in 10 new cases of psychosis may be associated with strong cannabis

New study suggests people who use marijuana on a daily basis may be at increased risk for developing psychosis, particularly if they use high-potency marijuana | The Lancet Psychiatry | via BBC 

Researchers, from King’s College London, looked at cannabis use by people in 11 EU towns and cities, including London, as well as one region of Brazil. They compared a sample of 901 people who had experienced psychosis with 1,237 (from the general population) who had not.

They categorised the type of cannabis used by the participants according to strength, although they did not do any lab tests to measure the strength directly. Low potency cannabis was any illicit product thought to contain less than 10% concentration of the ingredient THC. High potency was anything containing more than 10% THC.


The researchers found:

  • Self-reported daily cannabis use was more common among patients with first episode psychosis, compared to controls – 29.5% (or 266 out of 901) of patients versus 6.8% (84/1,237) of controls
  • High-potency cannabis use was also more common among patients with first episode psychosis, compared to controls – 37.1% (334/901) versus 19.4% (240/1,237)
  • Across the 11 sites, people who used cannabis on a daily basis were three times more likely to have a diagnosis of first episode psychosis, compared with people who had never used cannabis
  • This increased to five times more likely for daily use of high potency cannabis
  • There was no evidence of an association between less than-weekly cannabis use and psychosis, regardless of potency

The authors estimate that one in five new cases (20.4%) of psychosis across the 11 sites may be linked to daily cannabis use, and one in ten (12.2%) linked to use of high potency cannabis.  In London, a fifth (21%) of new cases of psychosis might be linked to daily cannabis use, and nearly a third (30%) to high potency cannabis.

Full story: Potent cannabis increases risk of serious mental illness, says study | BBC News

Full research:  Marta Di Forti et al. | The contribution of cannabis use to variation in the incidence of psychotic disorder across Europe (EU-GEI): a multicentre case-control study | The Lancet Psychiatry | Published online March 19, 2019

Children living in emotional distress

Public Health England | March 2019 | Children living in emotional distress

Parental emotional distress can lead to mental health problems including anxiety or depression. It is associated with an increased risk of later behavioural and emotional difficulties in children.  

Public Health England’s (PHE) statistical commentary presents data on the proportion of children living with parents reporting symptoms of emotional distress in England for the period 2016 to 2017.


This update includes new data on:

  • the proportion of children living with either 1 or both parents reporting symptoms of emotional distress overall
  • the proportion of children where at least 1 parent reports symptoms of emotional distress by family type and work status
Key points:
  • around 1 in 3 children lived with at least 1 parent reporting symptoms of emotional distress
  • over 1 in 5 children lived with a mother reporting symptoms of emotional distress
  • around 1 in 8 children lived with a father reporting symptoms of emotional distress
  • 1 in 28 children lived with both a mother and father reporting symptoms of emotional distress
  • there was an increase in the proportion of children living with parents in emotional distress for all indicators compared to data reported between 2015 and 2016
  • children were more likely to live with a parent reporting symptoms of emotional distress if both parents are out of work (Source: PHE)

The document is available from PHE 

In the news:

Daily Mail A third of children live with a parent suffering emotional distress – the highest proportion on record, official data shows