Junior doctors contract deal is positive for the NHS, says NHS Employers

NHS Employers | June 2019 | Junior doctors contract deal is positive for the NHS, says NHS Employers

Responding to junior doctors’ vote in favour of improvements to their contract, Danny Mortimer, chief executive of NHS Employers, said:

“This deal is a positive one for the NHS, which sees additional investment from the government and NHS England alongside a number of improvements to the junior doctors contract which aim to improve the working lives of junior doctors.

“We are glad that doctors have chosen to support the deal which, as well as a pay uplift, focuses on improving safe working and training. This agreement comes as a result of incredibly hard work on all sides to review and improve the contract, and to build a safe and constructive way forward for this crucial part of our workforce (Source: NHS Employers).

Full story from NHS Employers 

In the news:

The Guardian Junior doctors agree new contract to end four-year dispute

Indicators of a healthy workplace

Public Finance | June 2019 | Indicators of a healthy workplace

Managers have a vital role to play in promoting day-to-day health and wellbeing at work and supporting a cultural shift that will benefit both individuals and the organisation,  Alison Sweeting, of the Chartered Institute of Public Finance & Accountancy, highlights six indicators of a healthy workplace.

  1. Line managers are confident and trained in people skill
  2.  Employees feel valued and involved in the organisation
  3. Managers use appropriate health services to tackle absence and help people get back to work
  4. Managers promote an attendance culture by conducting return-to-work discussions
  5. Jobs are flexible and well designed
  6. Above all, be sure to promote the use of annual leave

Read the full article from Public Finance



Workforce crisis: age-friendly employment is key to improving the retention of older workers

NHS Confederation | June 2019 | Workforce crisis: age-friendly employment is key to improving the retention of older workers

NHS Confederation’s blog has a new post from Anna Dixon, chief executive of the Centre for Ageing Better, the post discusses how the  NHS is struggling to retain a core demographic of its workforce: those aged between  50 and State Pension age who would like to be in work but are not.

Full post from NHS Confederation 


Hidden no more: Dementia and disability 

All Party Parliamentary Group | June 2019 | Hidden no more: Dementia and

A new report from the All Party Parliamentary Group aims to shine a spotlight on dementia as a disability, to enable people with dementia to assert their rights to services and for their rights as citizens to be treated fairly and equally. Thousands of people who responded to the All-Party Parliamentary Group (APPG) inquiry agreed that they see dementia as a disability. But they told the APPG that society is lagging behind and failing to uphold the legal rights of people with dementia.  Within the report the All Party Parliamentary Group identify six key areas for action which have a direct impact on people’s daily lives, these are: 

Image source: alzheimers.org.uk
  1. Employment
  2. Social protection
  3. Social care
  4. Transport
  5. Housing
  6. Community life

Full details from the Alzheimer’s Society

Birmingham research: Global surgical guidelines drive cut in post-surgery deaths

University of Birmingham | June  2019 | Global surgical guidelines drive cut in post-surgery deaths – study

Between 1998 and 2014 the NHS decreased post-operative deaths by  more than a third (37.2%)  following the introduction of globally recognised surgical guidelines – paving the way for life-saving action in low- and middle-income countries (LMICs), finds research from experts at the University of Birmingham. 


Analysis of the data revealed a consistent downward trend over the 16-year period, with the greatest reductions achieved in oesophagogastric (68.8%) and breast (69.3%) surgery.

The findings of this have been published in a research letter to British Journal of Surgery

Read the full news story from the University of Birmingham


Young women who smoke face highest risk of major heart attack, research shows

University of Sheffield | June 2019 | Young women who smoke face highest risk of major heart attack, research shows

Research produced as part of a collaboration between the University of Leeds and  Sheffield Teaching Hospitals NHS Foundation Trust is the first to shed light on the risk impact of smoking on heart attack. It finds female smokers have a higher risk of heart attack than males, earlier research has not quantified and compared the incidence of acute ST Segment Elevation Myocardial Infarctio (STEMI) associated with smoking between genders and within different age groups.


Heart disease is the major cause of death for women and men worldwide, and STEMI is among the most life-threatening forms of heart disease. The study employed a retrospective ecological cohort study to compile data for all patients in the South Yorkshire region of the UK who presented with acute STEMI between January 2009 and July 2014.

The largest relative risk difference between men and women smokers was in the 50-64 years old group, but the highest risk increase in both genders was in the 18-49 years group—the youngest group.

Female smokers in this age group had a greater than 13 times higher risk of STEMI compared to their non-smoking female contemporaries. Young male smokers had an 8.6 times increased risk (Source: University of Sheffield)

Unabridged press release Young women who smoke face highest risk of major heart attack, research shows


Background Smoking is a well-documented risk for acute ST-segment elevation myocardial infarction (STEMI). The differential effect between sexes has yet to be quantified.

Objectives The purpose of this study was to differentiate the effect of smoking on increased risk of STEMI between sexes.

Methods For this retrospective ecological cohort study, all patients at a U.K. tertiary cardiothoracic center who presented between 2009 and 2014 with acute STEMI were combined with population data to generate incidence rates of STEMI. Age-standardized incidence rate ratios (IRRs) using the Poisson distribution were calculated comparing STEMI rates between smokers and nonsmokers stratified by sex and 3 age groups (18 to 49, 50 to 64, and more than 65 years).

Results A total of 3,343 patients presented over 5,639,328 person-years. Peak STEMI rate for current smokers was in the 70 to 79 years age range for women (235 per 100,000 patient-years) and 50 to 59 years (425 per 100,000 patient-years) in men. Smoking was associated with a significantly greater increase in STEMI rate for women than men (IRR: 6.62; 95% confidence interval [CI]: 5.98 to 7.31, vs. 4.40; 95% CI: 4.15 to 4.67). The greatest increased risk was in women age 18 to 49 (IRR: 13.22; 95% CI: 10.33 to 16.66, vs. 8.60; 95% CI: 7.70 to 9.59 in men). The greatest risk difference was in the age 50 to 64 years group, with IRR of 9.66 (95% CI: 8.30 to 11.18) in women and 4.47 (95% CI: 4.10 to 4.86) in men.

Conclusions This study quantifies the differential effect of smoking between sexes, with women having a significantly increased risk of STEMI than men. This information encourages continued efforts to prevent smoking uptake and promote cessation.

The Library can provide access to this article, Rotherham NHS staff  request  here 

University of Sheffield Young women who smoke face highest risk of major heart attack, research shows


Thousands more to ‘survive and thrive’ after stroke thanks to NHS specialist teams

NHS England | June 2019 | Thousands more to ‘survive and thrive’ after stroke thanks to NHS specialist teams

Rolling out  expert stroke teams across the country as part of the NHS Long Term Planwill ensure thousands more people ‘survive and thrive’, England’s top doctor announced today.

Speaking at the NHS Confederation conference, Professor Stephen Powis, NHS national medical director, revealed that the NHS has already saved hundreds more lives through the introduction of stroke networks across two major cities. Powis cited a major new study which found 170 extra lives are saved a year in London and Manchester alone thanks to the establishment of Hyper Acute Stroke Units (HASUs).

The units bring experts and equipment under one roof to provide world-class care and treatment around the clock, reducing death rates and long-term disability.



Working at the centre of a network of local hospitals, the units give patients faster access to specialist diagnosis and treatment, such as brain scans, clot-busting drugs and mechanical thrombectomy.

Patients treated at the specialist centres also spend less time in hospital, which is better for them and frees up staff and beds to care for more patients.

Professor Powis said: “Faster diagnosis, quicker access to better treatment, ongoing rehab for survivors, and 24-hour specialist units, will make the NHS even more effective at tackling strokes.

“But it’s clearly far better for everyone if we can help someone avoid having a stroke in the first place.

“For me this is a real inequalities issue – we know that people who are from disadvantaged or black or ethnic minority backgrounds are more likely to be among those who go undiagnosed and untreated, and are therefore more likely to die or be severely disabled by stroke.

“So the NHS will also take practical action to ensure that people living with the risk of stroke hanging over them will be offered the opportunity to understand and reduce that risk, and family doctors and their expanding teams, including nurses and clinical pharmacists, will be central to this.” (Source: NHS England)

Full news story from NHS England 

Of interest:

NIHR Centralising stroke services can save lives

Children of obese mums at higher diabetes risk

University of Edinburgh | June 2019 |Children of obese mums at higher diabetes risk

New research indicates that babies who are born to mothers with obesity have a higher risk factor for developing type 2 diabetes in later life. The study also reports that being overweight in pregnancy also increases the child’s diabetes risk by a half. 


The experts behind the research analysed data from the birth records of 100000 children born in Aberdeen during 1950 and 2011 and linked them with the national register for diagnosed diabetes in Scotland. Figures revealed around one quarter of women were overweight during pregnancy over the 60-year period. One in ten were obese, with a body mass index (BMI) greater than 40.

Offspring whom mums were overweight or obese during pregnancy had an associated risk factor of between 1.4 and 3.5-fold increased incidence.

The study indicates that the proportion of obese mothers increased five-fold from around one in 30 during the 1950s to almost one in six between 2000 and 201 (Source: University of Edinburgh)

Read press release in full from University of Edinburgh

Journal article Consequences of being overweight or obese during pregnancy on diabetes in the offspring: a record linkage study in Aberdeen, Scotland

Full reference: Lahti-Pulkkinen, et al. | 2019| Consequences of being overweight or obese during pregnancy on diabetes in the offspring: a record linkage study in Aberdeen, Scotland| Diabetologia| 1-8.



Maternal obesity in pregnancy is associated with cardiovascular disease and mortality rate in the offspring. We aimed to determine whether maternal obesity is also associated with increased incidence of type 2 and type 1 diabetes in the offspring, independently of maternal diabetes as a candidate mechanistic pathway.



Birth records of 118,201 children from 1950 to 2011 in the Aberdeen Maternity and Neonatal Databank were linked to Scottish Care Information–Diabetes, the national register for diagnosed diabetes in Scotland, to identify incident and prevalent type 1 and type 2 diabetes up to 1 January 2012. Maternal BMI was calculated from height and weight measured at the first antenatal visit. The effect of maternal obesity on offspring outcomes was tested using time-to-event analysis with Cox proportional hazards regression to compare outcomes in offspring of mothers in underweight, overweight or obese categories of BMI, compared with offspring of women with normal BMI.



Offspring of obese (BMI more than or equal to 30 kg/m2) and overweight (BMI 25–29.9 kg/m2) mothers had an increased hazard of type 2 diabetes compared with mothers with normal BMI, after adjustment for gestation when weight was measured, maternal history of diabetes before pregnancy, maternal history of hypertension, age at delivery, parity, socioeconomic status, and sex of the offspring: HR 3.48 (95% CI 2.33, 5.06) and HR 1.39 (1.06, 1.83), respectively.



Maternal obesity is associated with increased incidence of type 2 diabetes in the offspring. Evidence-based strategies that reduce obesity among women of reproductive age and that might reduce the incidence of diabetes in their offspring are urgently required.

CBT could benefit mental health of children with long term conditions

NIHR | June 2019 | CBT could benefit mental health of children with long term conditions

Researchers at the University of Exeter led a systematic review which looked at the impact of cognitive behavioural therapy (CBT) on the mental health of children with long term conditions.  In England, nearly a quarter (23%) of secondary school age pupils reported that they had a long-term medical illness or disability in a recent survey. Children and young people who have long term conditions are four times more likely to experience feelings of depression, anxiety and other mental health issues than those who are physically healthy. 

The team of researchers identified some evidence of the benefits of CBT in inflammatory bowel disease, chronic pain and epilepsy; although the evidence in this area is limited and further research would be valuable (Source: NIHR). 

Study Design: Evidence synthesis of quantitative and qualitative research.

Methods: The search strategy will be developed by an Information Specialist in consultation with topic experts, children, young people and their families. Sources will include electronic databases, citation chasing and hand-searching. Inclusion and exclusion criteria will be applied to the title and abstract of each identified citation independently by two reviewers with disagreements being settled by discussion with a third. Full text will be obtained for papers that appear to meet the criteria and a similar process used. A standardised, piloted data extraction form will be used to collect data from each included paper. Appropriate quality appraisal checklists will be used according to the study design. Quality appraisal and data extraction will be performed by one reviewer and checked by a second, with disagreements settled through discussion with a third. Synthesis methods will be determined in response to the nature of the findings but will include meta-analysis if appropriate. An overarching synthesis will bring together the findings from the two reviews through the systematic development and refinement of a conceptual framework to map out the conjectured links between the different types of intervention and anticipated outcomes, gaps in the evidence and factors that enhance or limit intervention success. Consultation with stakeholders will seek feedback on the credibility of the findings, the clarity of the framework and the extent to which it illustrates their experience.

Population: Children and young people (aged 0-25 years) with a diagnosed long term physical health conditions (LTCs) and a diagnosis of a mental health disorder (assessed by a validated and standardised measure) or at risk of such a diagnosis and experiencing symptoms of mental distress (scoring above an established cut point on a validated questionnaire).

Health Technologies: Any intervention, delivered to children and young people with the aim of reducing mental distress.

Outcomes: Outcomes describing the mental state of children and young people e.g. symptoms of depression, anxiety, emotional distress or behavioural disorders, psychological health, psychological function, suicidal behaviour, psychological aspects of health related quality of life, sleep quality and incidence of self-harm; costs and resource implications and experiences of interventions for children and young people with LTCs and mental ill health.

Timetable: The project is scheduled to take 15 months to complete, with dissemination continuing after this. Month 1-11 Conduct of systematic reviews (literature searches, study selection and retrieval, data extraction, quality appraisal, synthesis); Month 11-13 Overarching synthesis and development of conceptual framework; Month 11-12 – Report drafting; Month 13-14 – Co-creation of plain language summaries; Month 14 – Consultation with stakeholders; Month 15 – Editing.

Expertise: The team comprises a core group experienced at completing systematic reviews to deadline supplemented with people with the necessary experience of LTCs and mental ill health from a clinical perspective. Our Project Advisory Group provides additional expertise from clinical, third sector and family perspectives. In addition we will be recruiting children and young people to a C&YP Research Advisory Group.


Full details from NIHR

Smiling matters: oral health care in care homes

Care Quality Commission | June 2019 | Smiling matters: oral health care in care homes

Care Quality Commission (CQC) has published its review of oral health care in care homes across England. The review also includes a number of case studies .Their findings show that too many people living in care homes are not being supported to maintain and improve their oral health. 

Image source: cqc.org.uk

What CQC did

Dental professionals accompanied our adult social care inspectors on 100 routine inspections. Three years on from the publication of the NICE guideline
(NG48), oral health in care homes is still not a priority and people are not always able to access the dental care they need.

Seventeen per cent of care homes said they never assessed people’s oral health on

What CQC found

Among the homes visited:

  • most had no policy to promote and protect people’s oral health (52%)
  • nearly half were not training staff to support daily oral healthcare (47%)
  • 73% of care plans reviewed only partly covered or did not cover oral health
  • it could be difficult for residents to access dental care
  • 10% of homes had no way to access emergency dental treatment for residents

CQC recommend

A cross-sector approach including:

  • sharing best practice
  • repeating and reinforcing the guidance
  • mandatory staff training
  • oral health check-ups for all residents moving into a care home
  • a multi-agency group to raise awareness