Leading For Integrated Care

This report explores the progress, challenges and opportunities the move towards greater integration presents, through interviews with 16 people leading or chairing an integrated care system or sustainability and transformation partnership | The Kings Fund


The report underlines that these local systems are still evolving. But it is important
to note that the interviewees did believe that it was evolving: progress is being
made towards a more integrated way of working. This has meant major changes
for leaders, many of whom have spent their careers within a world where
organisational autonomy was key and success was based on your organisation’s
own performance.

Full report: Leading For Integrated Care: ‘If You Think Competition Is Hard, You Should Try Collaboration’ | The Kings Fund

Estimating Need In Older People

Estimating Need In Older People: Findings For England. An analysis by Age UK


This report by Age UK outlines how ill health, poverty, unmet needs for care and support, poor housing, loneliness and social isolation are profound challenges for many older people. It estimates the numbers and percentages of people aged 65 and over in England with these disadvantages, and collates insights from older people’s own voices about the experience of living with them.

Full report at Age UK

Falling Short: The NHS Workforce Challenge

Falling short: the NHS workforce challenge. Workforce profile and trends of the NHS in England | The Health Foundation

This report analyses the changes in the size and composition of the NHS workforce in England in the context of long-term trends, policy priorities and future projected need. It builds on previous reports to provide analysis of longer-term trends and insights into the changing NHS staff profile.

Image source: https://www.health.org.uk/

The report focuses specifically on the NHS workforce issues that have been identified in recent years: nursing shortages, and shortages of staff in general practice and primary care.

The report also explores key pressure points:

  • student nurses
  • the international context and international recruitment
  • retention

The report concludes by summarising the key workforce challenges that will need to be considered in the development of the full NHS people plan.

Full report: Falling short: the NHS workforce challenge. Workforce profile and trends of the NHS in England

Adults who are more active live longer

Findings of a new systematic review confirm the important place of physical activity in a healthy lifestyle, and support the physical activity advice for adults in the UK | BMJ | via National Institute for Health Research


People who are more physically active in middle age are less likely to die early, whether they do light or moderate to vigorous activity. The largest reductions in death are seen for those who do around 375 minutes a day of light intensity physical activity, such as walking, cooking or gardening, or 24 minutes a day of moderate to vigorous physical activity.

People who did most exercise were 73% less likely to have died early than those who did the least. Whereas, people who were sedentary for 9.5 hours or more were about twice as likely to die early, while enrolled in the studies.

Researchers reviewed data from eight studies (including 36,383 adults aged over 40) in which people wore activity monitors to record their movements. The average follow-up was 5.8 years.

The study strengthens the evidence in support of the current UK guidelines on physical activity for adults.

Further detail at National Institute for Health Research

Full reference: Ekelund U, Tarp J, Steene-Johannessen J et al. |  Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: systematic review and harmonised meta-analysis |  BMJ | 2019 | 366:l4570.

A less healthy lifestyle increases the risk of dementia

The less healthy your lifestyle, the more you are at risk of developing dementia in later life, a new systematic review has shown. Researchers analysed the results of 18 studies with over 44,000 participants | BMJ Open | via National Institute for Health research


Having two or more ‘modifiable risk factors’, including smoking, high blood pressure, poor diet, inactivity, obesity and excessive alcohol consumption, puts adults at greater risk of developing dementia.

The included studies followed up people without signs of cognitive decline to see who developed dementia of any cause.

A third of the studies could be combined in a meta analysis and these showed a 20% increase in the risk of dementia for one risk factor, which rose to 65% for two risk factors. The presence of three risk factors doubled the risk of dementia.

There was also a reduction in risk conveyed by having fewer risk factors and this, despite any direct evidence from intervention trials, holds out hope that interventions which either reduce or remove risk will lead to a reduction in the incidence of dementia diagnoses.

These results are consistent with our growing knowledge of the links between unhealthy lifestyles and dementia and are highly relevant to the promotion of healthy ageing behaviours in mid-life and beyond,  providing a compelling call to action in terms of public health and ageing.

Further detail at National Institute for Health Research

Full reference: Peters R, Booth A, Rockwood K et al. Combining modifiable risk factors and risk of dementia: a systematic review and meta-analysis. | BMJ Open | 2019 | 9:e022846.

NICE impact report: lung cancer

NICE impact reports review how NICE recommendations for evidence-based and cost-effective care are being used in priority areas of the health and care system, helping to improve outcomes where this is needed most. This report considers how NICE’s evidence based guidance can contribute to improvements in the care of people with lung cancer.

Image source: https://www.nice.org.uk/

Lung cancer is the third most common cancer in England and is the leading cause of  cancer death. In 2017, there were almost 39,000 new cases of lung cancer and just over 28,000 related deaths.

Since 2005 and the publication of NICE’s first guideline on lung cancer, NICE has produced a suite of lung cancer related guidance, which aim to improve outcomes by focusing on survival rates and ensuring the most effective tests and treatments are used.

In England, overall survival rates for cancers are improving but there is still a marked difference between lung cancer and other cancers. Between 2012 and 2016 more than 95% of people with breast or prostate cancer survived more than 1 year after their diagnosis, compared to less than 40% of people with lung cancer.

There is an even greater difference between 5-year survival rates. More than 85% of people with breast or prostate cancer survived more than 5 years but just over 15% of people with lung cancer survived this long. When comparing with other countries in Europe, England’s long-term survival for people with lung cancer is poor, ranking 26th out of 29 countries.

Further detail at NICE

Full report: NICEimpact Lung Cancer

Preventing mental health problems in children and young people

As part of the Mental Health Foundation’s 70th anniversary, three reports have been commissioned, each looking at a different stage in life and the key things that both challenge and support mental health at these stages. This is the first of these three reports, and focuses on children and young people. It is intended both as a review of the recent evidence, and as a guide to anyone wishing to gain a rapid understanding of a preventative approach to mental health.

Image source: https://www.mentalhealth.org.uk/

Mental health problems, such as anxiety or depression, can happen at any age. However, childhood and young adulthood represents a particularly important time for development and mental health. By understanding the things that can challenge good mental health, as well as the things that can protect and promote it, we can introduce policies and services that support children and young people to reach their full potential, preventing mental health difficulties from progressing to the point where it becomes difficult to cope.


Based on the research and the suggestions of our Youth Advisory Panel, to support good mental health and prevent the development of mental health problems, we should:

  1. Provide resources to parents and caregivers (parenting programmes, education, employment and housing resources) that help them to be consistent sources of support for their children.
  2. Ensure that as part of their education, children are equipped with the skills they need to understand, talk about and manage challenging feelings.
  3. Embed the teaching of skills that support good mental health into the curriculum and into youth work and other young-person focused organisations.
  4. Ensure that effective early support is available for young people’s mental health that considers young people’s views on what makes that support acceptable and accessible.
  5. Enable community leaders to bridge the gap between communities and local government and make sure people have a choice and a voice in deciding what their area needs to support good mental health.

Full detail at Mental Health Foundation

Full report: State of a generation: Preventing mental health problems in children and young people

Mental Health Foundation Strategy 2020-2025

This strategy provides a vision of a society which puts mental health at its heart which if heeded, would see a sustained reduction in levels and severity of mental ill health and better mental health for all | Mental Health Foundation

MHF strategy
Image source: https://www.mentalhealth.org.uk/


This publication suggests that prevention of poor mental health is not only possible, but urgently needed. The strategy affirms the Mental Health Foundation’s commitment to making prevention happen, so that people across the UK can live mentally healthier lives.


The strategy is focusing on three key areas:

1. Impact

The Mental Health Foundation will systematically consider how to scale ideas informed by evidence, and will build partnerships and alliances that increase the impact and reach of their work.

2. Influence

The Foundation will harness evidence and the voice of lived experience to advocate for preventive approaches and create campaigns which tackle the root causes of poor mental health.

3. Integrity

The Foundation will continue to build a strong organisation that lives its values – that is open, kind, outward-looking and sustainable.

Full document: Mental Health Foundation Strategy 2020-2025: Making Prevention Happen

Diversity and Inclusion: How you can make a difference

Healthcare Financial Management Association| November 2019 | Diversity and Inclusion: How you can make a difference

A new report from the Future-Focused Finance (FFF) and the Healthcare Financial Management Association (HFMA), explores the practical actions that can make a difference and drive positive change; this report outlines why diversity and inclusion are important; considers the current position; and suggests what actions can be taken to make a difference (Source: HFMA).

Image source: hfma.org.uk


Manchester research: New assessment could identify risks of frailty

University of Manchester|  November  2019 | New assessment could identify risks of frailty

A group of researchers from the  Universities of Strathclyde,  Manchester, Liverpool, Edinburgh and Yale have developed a new assessment which could be used to identify individual’s risk factors for frailty. 

Increasing the risk of frailty is a defining characteristic of the ageing process but it has no precise clinical definition and there are currently no analytical techniques that can accurately quantify its status.


The assessment could also determine whether a patient would be able to withstand intensive courses of treatment, such as chemotherapy, as well as helping to understand, prevent, cure or minimise age-related impairments (Source: University of Manchester).

The research has been published in the journal Nature Communications.

Rattray, N. J. W., | 2019|Metabolic dysregulation in vitamin E and carnitine shuttle energy mechanisms associate with human frailty | Nature Communications | https://www.nature.com/articles/s41467-019-12716-2


Global ageing poses a substantial economic burden on health and social care costs. Enabling a greater proportion of older people to stay healthy for longer is key to the future sustainability of health, social and economic policy. Frailty and associated decrease in resilience plays a central role in poor health in later life. In this study, we present a population level assessment of the metabolic phenotype associated with frailty. Analysis of serum from 1191 older individuals (aged between 56 and 84 years old) and subsequent longitudinal validation (on 786 subjects) was carried out using liquid and gas chromatography-mass spectrometry metabolomics and stratified across a frailty index designed to quantitatively summarize vulnerability. Through multivariate regression and network modelling and mROC modeling we identified 12 significant metabolites (including three tocotrienols and six carnitines) that differentiate frail and non-frail phenotypes. Our study provides evidence that the dysregulation of carnitine shuttle and vitamin E pathways play a role in the risk of frailty.

Full article available from Nature Communications

University of Manchester [press release]  New assessment could identify risks of frailty