Sundowning (changes in behaviour at dusk)

As the clocks go back this weekend, and with evenings becoming darker earlier, Helen Green who works on Dementia UK’s Admiral Nurse Dementia Helpline talks about how she united one family troubled by sundowning 

Sundowning is a term used for the changes in behaviour that occur in the evening, around dusk. Some people who have been diagnosed with dementia experience a growing sense of agitation or anxiety at this time.

Sundowning symptoms might include a compelling sense that they are in the wrong place. The person with dementia might say they need to go home, even if they are home; or that they need to pick the children up, even if that is not the case. Other symptoms might include shouting or arguing, pacing, or becoming confused about who people are or what’s going on.

This article at Dementia UK explains how the Dementia Helpline supported one family troubled by sundowning

See also Dementia UK’s leaflet on Good habits for bedtime


Practical tips on preventing sundowning

  • Follow a routine during the day that contains activities the person enjoys
  • Going outside for a walk or visiting some shops is good exercise
  • Limit the person’s intake of caffeinated drinks. Consider stopping the person from drinking alcohol altogether. Caffeine-free tea, coffee and cola are available, as is alcohol-free beer and wine
  • Try and limit the person’s naps during the day to encourage them to sleep well at night instead
  • Close the curtains and turn the lights on before dusk begins, to ease the transition into nighttime
  • If possible, cover mirrors or glass doors. Reflections can be confusing for someone with dementia
  • Once you are in for the evening, speak in short sentences and give simple instructions to the person, to try and limit their confusion
  • Avoid large meals in the evening as this can disrupt sleep patterns
  • Introduce an evening routine with activities the person enjoys, such as: watching a favourite programme, listening to music, stroking a pet etc. However, try to keep television or radio stations set to something calming and relatively quiet—sudden loud noises or people shouting can be distressing for a person with dementia.

NHS England concludes wide-ranging deal for cystic fibrosis drugs

NHS England has announced it has secured a definitive agreement with Vertex Pharmaceuticals to make available all three of their UK-licensed cystic fibrosis medicines

NHS patients will now have full access to Orkambi, Symkevi and Kalydeco, and around 5000 people may now take up these treatments.  Clinicians will be able to begin prescribing these drugs within 30 days. The agreement provides access to all three drugs for all current licensed indications, as well as future licence extensions too.

Full story at NHS England

Electronic prescribing and safe discharge

Electronic prescribing and medicines administration systems and safe discharge | Healthcare Safety Investigation Branch 

This report examines electronic prescribing and medicines administration (ePMA) systems and highlights that many NHS trusts are taking up this technology as they reduce medication errors, but that incomplete use of e-systems could create further risks to patient safety.

Image source:

The report sets out recommendations around better information sharing and communication, improving medication messaging and alerts to ensure the safe discharge of patients.

For more information, including the safety recommendations in full, download and read the full report:
Electronic prescribing and medicines administration systems and safe discharge | HSIB

Investigation into pre-school vaccinations

This investigation sets out the system for providing vaccinations to pre-school children in England. It is prompted by public concerns about the levels of uptake of pre‑school vaccinations | National Audit Office

Health professionals consider that vaccinations are a crucial tool in protecting the health of individuals and that of the wider population, particularly for people with existing health problems who are more vulnerable to infectious diseases and for those who cannot receive vaccinations themselves. For vaccinations to be most effective, the World Health Organization (WHO) recommends that enough people need to be vaccinated to stop disease spreading across the population. This is called ‘herd immunity’.

injection-1674900_1280 (1)

There are seven types of vaccines (which protect against 13 diseases) routinely provided to children by the National Health Service (NHS) before they go to school aged five. In 2017‑18, the Department of Health & Social Care (the Department) set NHS England a performance standard of 95% uptake for pre-school vaccinations (except flu). There has been a general fall in uptake of pre-school vaccinations in England since 2012-13 and, in many cases, uptake of these vaccinations
is below the Department’s performance standard.

This report sets out:

  • the current levels of vaccination uptake and cases of disease across England
  • Public Health England (PHE)’s and NHS England’s understanding of the problem
  • PHE’s and NHS England’s response to the problem.

The report uses the MMR vaccination, the 4-in-1 booster and the Hib/MenC booster to highlight many of the challenges that exist in the system for pre‑school vaccinations and illustrate in more detail how uptake of vaccinations is falling.




2018 Urgent And Emergency Care Survey Statistical Release

This survey looked at people’s experiences of using Type 1 (major A&E) and Type 3 (urgent care centres, minor injury units, urgent treatment centres) urgent and emergency care services, from decision to attend to leaving | Care quality Commission

132 trusts took part in the survey, of which 63 trusts had both a Type 1 and a Type 3 department, and 69 trusts had only a Type 1 A&E. The survey only includes Type 3 departments that are run directly by acute trusts, and not those run in collaboration with, or exclusively by others.

Key findings for England

The majority of people were positive about most aspects of the urgent or emergency care they received. Results across both type 1 and type 3 services have remained generally stable and have not significantly changed between 2016 and 2018.


Respondents in both the type 1 and type 3 surveys were very positive when answering questions about their interactions with staff. For example, the majority of respondents ‘definitely’ felt listened to, ‘definitely’ had confidence and trust in the staff examining and treating them and felt they were treated with respect and dignity ‘all of the time’. Staff are also generally providing clear explanations to most people about their treatment.

The survey results suggest there is scope for improvement in a number of areas across both service types, including:

  • waiting times
  • help from staff to control their pain
  • information provision when leaving A&E or the urgent care centre

Certain groups of patients consistently reported poorer experiences of urgent and emergency care services, including:

  • younger type 1 respondents (aged 16 to 35)
  • type 1 respondents who said that they had been to the same A&E about the same condition or something related to it within the past week
  • for both type 1 and type 3 respondents, people whose visit to A&E or the urgent care centre lasts for more than four hours

Further detail at Care Quality Commission

Full report: Urgent and emergency care survey 2018: Statistical release

The State Of Medical Education And Practice In The UK

The State Of Medical Education And Practice In The UK: The Workforce Report 2019 | 
General Medical Council (GMC) 


This report draws on the GMC’s medical register data and findings from a new survey on doctors’ workplace experiences. It sets out recommendations to help inform emerging workforce strategies and people plans across the UK. The data shows that the UK’s medical register continues to grow, with many overseas doctors joining our workforce. However, the GMC states that health services must prioritise strategies to retain UK and non-UK trained doctors, and develop supportive workplace cultures with compassionate leaders.

Full report: The State Of Medical Education And Practice In The UK: The Workforce Report 2019

See also: Attracting supporting and retaining doctors a must to meet healthcare challenges | GMC press release

Anorexia in younger children may be increasing

Observational surveillance study (305 incident cases) estimates an annual incidence rate for anorexia nervosa of 13.68 per 1000,000 population. Comparison with earlier estimates suggests that the incidence rate in children 12 years and under has increased over the past 10 years | BMJ Open


Objectives This study aimed to estimate the incidence of DSM5 anorexia nervosa in young people in contact with child and adolescent mental health services in the UK and Ireland.

Design Observational, surveillance study, using the Child and Adolescent Psychiatry Surveillance System, involving monthly reporting by child and adolescent psychiatrists between 1st February 2015 and 30th September 2015.

Setting The study was based in the UK and Ireland.

Participants Clinician-reported data on young people aged 8–17 in contact with child and adolescent mental health services for a first episode of anorexia nervosa.

Main outcome measures Annual incidence rates (IRs) estimated as confirmed new cases per 100 000 population at risk.

Results 305 incident cases of anorexia nervosa were reported over the 8-month surveillance period and assessed as eligible for inclusion. The majority were young women (91%), from England (70%) and of white ethnicity (92%). Mean age was 14.6 years (±1.66) and mean percentage of median expected body mass index for age and sex was 83.23% (±10.99%). The overall IR, adjusted for missing data, was estimated to be 13.68 per 100 000 population (95% CI 12.88 to 14.52), with rates of 25.66 (95% CI 24.09 to 27.30) for young women and 2.28 (95% CI 1.84 to 2.79) for young men. Incidence increased steadily with age, peaking at 15 (57.77, 95% CI 50.41 to 65.90) for young women and 16 (5.14, 95% CI 3.20 to 7.83) for young men. Comparison with earlier estimates suggests IRs for children aged 12 and under have increased over the last 10 years.

Conclusion These results provide new estimates of the incidence of anorexia nervosa in young people. Service providers and commissioners should consider evidence to suggest an increase in incidence in younger children.

Full study: Petkova H, Simic M, Nicholls D, et al. | Incidence of anorexia nervosa in young people in the UK and Ireland: a national surveillance study | BMJ Open 2019;9:e027339 |  doi: 10.1136/bmjopen-2018-027339

See also: Number of children with anorexia on the rise, study suggests | The Guardian

Financial Performance Report

Financial performance report: first quarter 2019/20 | NHS England and NHS Improvement 

This report provides an update on the financial performance of NHS England and includes the year to date and forecast position for CCGs, areas of direct commissioning, central running costs and programme budgets. It also includes year to date and forecast performance against commissioner efficiency plans.

Full detail at NHS England

Unacceptable inequalities in health outcomes” for LGBT people “glare out wherever you look”

Commons Select Committee | October 2019| Unacceptable inequalities in health outcomes” for LGBT people “glare out wherever you look”

LGBT people are being let down in health and social care, by structures and services that are not inclusive or designed with them in mind, and by a lack of leadership in Government, NHS and social services.

In the report Health and Social Care and LGBT Communities published today (22 October), the Women and Equalities Committee has found that too often LGBT people are expected to fit into systems that assume they are straight and cisgender. But the Committee has found that deep inequalities exist in health outcomes for these communities and that treating them “the same” as non-LGBT people will not address these poor outcomes (Source: Commons Select Committee).

Full Commons Select Committee press release 

Read the summary

Read the conclusions and recommendations

Read the full report