One in four UK babies miss out on health visitor checks

One in four babies born in the UK are not receiving mandatory checkups from health visitors during the first two years of their life.

A fifth of babies do not receive the recommended reviews after they turn one, and one in four miss out at the age of two, according to the government’s commission on social mobility.

Health visitors, responsible for assessing a child’s early years development, are supposed to carry out checks straight after birth, at six to eight weeks, at one year and then at between two and two-and-a-half years.

However, the commission found that one in five children had not received the mandatory 12-month check by the time they reached 15 months old.

London children were the least likely to receive the right number of health visits, the report found, with fewer than half receiving the final two checkups.

A survey of parents found that the vast majority wanted the health visits to continue, with just 5% saying they did not feel they required advice during their first six months as a parent.

“Despite the conventional wisdom that parents fear interference from the ‘nanny state’, in reality many say that they welcome advice in the early years of their child’s life,” the commission said.

It said it was concerning that one in four two-year-olds did not have their health and education needs reviewed by a professional. “Despite this being a crucial period for families, there is still too little support for parents in the earliest stage of their child’s life. With the socioeconomic gap in outcomes emerging early, providing support to parents at this point could reap dividends for social mobility later on in life.”

The Conservative party’s 2010 manifesto included a key pledge to increase the number of health visitors. NHS Digital figures show the number of full-time or equivalent health visitors in England fell by almost 1,000 between October 2015 and August 2016.

In December a survey of health visitors by the Institute of Health Visiting found that 85% of respondents felt their workload had increased in the last two years. Some were having to look after between 500 and 1,000 children, when the maximum recommended is 250.

Labour said the commission’s figures showed the government was failing to invest in early years support. Emma Lewell-Buck, the shadow minister for children and families, said: “Becoming a parent for the first time is an exciting but scary time and it is shocking that not all parents are getting the support they need.

“The Tories promised more health visitors by taking away money from Sure Start Centres. Six years later we have lost over 700 centres and we are still waiting for the health visitors. The Tories have completely failed to invest these crucial early years.”

A spokesperson for Public Health England said: “Ensuring every child has the best start in life is one of our key priorities. We are supporting local authorities in commissioning services that support families and provide early help when needed.

“We are also working with councils to give health visitors professional guidance and leadership, as well as evidence of what works, to help them meet their public health responsibilities.”

The commission also said parents were finding it more difficult to access local children’s centre services, citing a 2015 survey which found more than 60% of children’s centre managers said they were cutting back on services to meet their budgets.

Government figures in December revealed that 156 Sure Start children’s centres had closed in England in 2015, almost double the number in the previous year.

One in four UK babies miss out on health visitor checks

Seven-day NHS plan puts weekday surgeries at risk, warns top GP

Britain’s top GP has said surgeries will have to stop seeing patients during the week unless ministers abandon their drive to guarantee access to family doctors at weekends.

Dr Helen Stokes-Lampard condemned the policy, a key Conservative pledge, as unrealistic and said it was ignoring the lack of demand among patients to see GPs at weekends and a serious shortage of family doctors.

The government has promised to ensure that people in every part of England will be able to see a GP from 8am to 8pm every day of the week by 2020 as a key element of its push to create a “truly seven-day NHS” by the end of the current parliament.

“It’s unrealistic in the current climate. We haven’t got the people, we haven’t got the resources. If you give people access on a Sunday afternoon they’re not going to have access on a Tuesday morning. They can’t have it all”, the chair of the Royal College of GPs said in an interview.

Calling for surgeries weekend opening to be restricted to Saturday mornings, Stokes-Lampard said: “We should be responding to what is needed in an area, and balance that realistically by what can be provided safely. Because quite frankly if you open on a Sunday afternoon but you’re closed on a Tuesday morning, who’s going to benefit?.

There is so little demand from patients to see a GP on Sundays that plans to compel at least one surgery in each area to open on that day by 2020 should be dropped, she said. Nor do many people want to attend a surgery on a Saturday afternoon, she added.

David Cameron pledged access to GPs from 8am to 8pm seven days a week at the Conservative party conference in 2014, and established a £50m “challenge fund” to deliver it. Some surgeries that have begun opening at weekends, however, have scrapped their experiment because of the small numbers of patients seeking appointments on Saturdays and Sundays.

The chair of the Royal College of GPs, Dr Helen Stokes-Lampard. Photograph: Andy Hall for the Observer

A relentless rise in the need for care is prompting more GPs to retire early or move abroad, leaving the profession facing a growing workforce crisis and patients facing long waits for appointments, Stokes-Lampard said. As a result “we’re layered too thin at the moment, we’re spread too thin. We can’t sustain a good five-day service at the moment, a seven-day service is unrealistic. If we can’t provide eight to six Monday to Friday because we’re stretched to breaking point, we’re certainly not going to be able to provide seven days a week.”

She said general practice was “closer to the edge than it has ever been in living memory”, and cast serious doubt on ministers being able to fulfil another key NHS pledge – to increase the number of GPs in England by 5,000 by 2020 compared with 2015. It will be very hard to deliver that number without many GPs coming from overseas or former doctors being persuaded back into work, she said.

The Liberal Democrat MP Norman Lamb, who was a coalition health minister until May 2015, denounced the pledge of access to GPs all day and every day as a “superficially attractive gimmick”.

“This target is driven by seductive headlines, not sound policy. It will distort priorities and resources away from action which could make a real difference to people’s lives, such as ensuring that people have both their physical and mental health needs effectively met in primary care,” he said.

“No one believes that there will be sufficient resources to deliver this plan. The risk is that it will leave dangerous gaps in provision during the week.

“Pursuing superficially attractive gimmicks like this amounts to a smokescreen for the dire threat the NHS and care system now faces as it is starved of the resources it needs to provide effective, prompt and safe care.”

The shadow health secretary, Jonathan Ashworth, said: “These serious doubts about a flagship government pledge will raise widespread concerns. It’s yet another warning about the scale of the underfunding and understaffing now impacting our NHS.

“In her six months as prime minister Theresa May has shown no regard for the state of the NHS, so it’s no surprise it now looks like her own manifesto commitments will be broken.

“But in 2017 the government simply must not carry on ignoring the warnings. Instead they need to come forward with a genuine plan to give the NHS and social care the resources they need to deliver the very best care every patient deserves.”

The Department of Health insisted the government would achieve its ambition of seven-day opening, and that the policy was popular. “This is a common sense reform with wide public support, and one we will deliver”, a spokeswoman said.

“People don’t just get ill Monday to Friday, nine to five, and 18 million patients now have weekend and extended access to a GP, which has already shown evidence of relieving pressure on other parts of the NHS.

“To deliver our pledge, we are putting an extra £2.4bn into GP services, which will help expand the workforce.”

Seven-day NHS plan puts weekday surgeries at risk, warns top GP

"Patients who should live are dying": Greece"s public health meltdown

Rising mortality rates, an increase in life-threatening infections and a shortage of staff and medical equipment are crippling Greece’s health system as the country’s dogged pursuit of austerity hammers the weakest in society.

Data and anecdote, backed up by doctors and trade unions, suggest the EU’s most chaotic state is in the midst of a public health meltdown. “In the name of tough fiscal targets, people who might otherwise survive are dying,” said Michalis Giannakos who heads the Panhellenic Federation of Public Hospital Employees. “Our hospitals have become danger zones.”

Figures released by the European Centre for Disease Prevention and Control recently revealed that about 10% of patients in Greece were at risk of developing potentially fatal hospital infections, with an estimated 3,000 deaths attributed to them.

The occurrence rate was dramatically higher in intensive care units and neonatal wards, the body said. Although the data referred to outbreaks between 2011 and 2012 – the last official figures available – Giannakos said the problem had only got worse.

Like other medics who have worked in the Greek national health system since its establishment in 1983, the union chief blamed lack of personnel, inadequate sanitation and absence of cleaning products for the problems. Cutbacks had been exacerbated by overuse of antibiotics, he said.

“For every 40 patients there is just one nurse,” he said, mentioning the case of an otherwise healthy woman who died last month after a routine leg operation in a public hospital on Zakynthos. “Cuts are such that even in intensive care units we have lost 150 beds.”

“Frequently, patients are placed on beds that have not been disinfected. Staff are so overworked they don’t have time to wash their hands and often there is no antiseptic soap anyway.”

No other sector has been affected to the same extent by Greece’s economic crisis. Bloated, profligate and corrupt, for many healthcare was indicative of all that was wrong with the country and, as such, badly in need of reform.

Acknowledging the shortfalls, the government announced last month that it planned to appoint more than 8,000 doctors and nurses in 2017.

Since 2009, per capita spending on public health has been cut by nearly a third – more than €5bn (£4.3bn) – according to the Organisation for Economic Co-operation and Development. By 2014, public expenditure had fallen to 4.7% of GDP, from a pre-crisis high of 9.9%. More than 25,000 staff have been laid off, with supplies so scarce that hospitals often run out of medicines, gloves, gauze and sheets.

In early December Giannakos, a nurse by training, led a protest march, which started at the grimy building housing the health ministry and ended outside the neoclassical office of the prime minister, Alexis Tsipras. At the ministry, hospital technicians erected a breeze-block wall and from it hung a placard with the words: “The ministry has moved to Brussels.”

Few advanced western economies have enacted fiscal adjustment on the scale of Greece. In the six years since it received the first of three bailouts to keep bankruptcy at bay, the country has enforced draconian belt-tightening in return for more than €300bn in emergency loans. The loss of more than 25% of national output – and a recession that has seen ever more people resorting to primary health care – has compounded the corrosive effects of cuts that in the case of public hospitals have often been as indiscriminate as they are deep.

Pressure to meet creditor-mandated budget targets means that in 2016 alone, expenditure on the sector has declined by €350m under the stewardship of Syriza, the leftist party that had once railed against austerity, said Giannakos, citing government figures.

More than 2.5 million Greeks have been left without any healthcare coverage. Shortages of spare parts are such that scanning machines and other sophisticated diagnostic equipment have become increasingly faulty. Basic blood tests are no longer conducted at most hospitals because laboratory expenditure has been pared back. Wage cuts have worsened the low morale.

“The biggest problem is shortage of staff because people are retired and never replaced,” said Dr Yiannis Papadatos, who runs the intensive care unit of one of the three paediatric hospitals in Athens. “Then there’s the problem of equipment and, periodically, lack of supplies like gloves, catheters, and cleaning tissues.”

Small acts of heroism have done much to keep the broken system afloat: doctors and nurses work overtime, with donors and philanthropists also helping.

Papadatos said: “I was brought up partly in Kenya by parents who emphasised the virtues of helping others. These days I spend a lot of time going round asking friends, or the private sector, for help when our hospital runs out of supplies. The monitors we use to track heart rhythms, blood pressure, that sort of thing, were all donated. People like to give. It makes them feel good.”

Unionists argue that healthcare is an easy target because successive governments have refused to properly tackle tax evasion, the biggest drain on public coffers. In a rare public admission, the International Monetary Fund recently conceded that cuts had been so brutal “basic public services such as transport and healthcare are being compromised”.

But at a time when the Greek debt crisis has flared again, after Tsipras’s controversial announcement of a series of welfare benefits, there are many who fear worse is to come.

One of them is British-trained Dr Michalis Samarakos, who believes that while the health system is in need of further reform it also runs the risk of running out of specialists and clinical trainees. Already there has been a massive exodus of doctors abroad, mostly to Germany and the UK, as a result of lack of opportunity.

“The best are leaving because their potential cannot be developed here,” he said. “I can see it teaching sixth-year students at Athens University, everyone wants a reference, everyone wants to go.

“It’s become a growing problem. We don’t have nephrologists, for example, because there are no prospects for specialists, either in or out of the system [in private practice].

“Trainee doctors are the backbone of any hospital – without them hospitals can’t function. Unless there is a big change, I worry greatly that things can only become worse.”

"Patients who should live are dying": Greece"s public health meltdown

London must stand together in 2017 if its golden age is not to end

For three decades, with barely a blip, the UK capital has been going from strength to strength. Nothing has stunted its potency and growth, not the 7/7 bombings or the 2011 riots, not Black Monday or the 2008 global crash, not even the original Millennium Dome. Its economy drives and subsidises the rest of the country, its still-new tier of regional government – the mayoralty and the Greater London Authority (GLA) – has been a success and it has hosted a triumphant Olympic Games. Its population, after shrinking through years of managed decline, is now at an all-time high, and may hit 10 million by 2030. But London enters 2017 with a question mark after its name. Might its golden age be coming to an end?

After the fireworks, the New Year begins amid unaccustomed unease. The heavy, grey cloud above is Brexit, with major employers in an international city whose wealth has been built on financial services pondering their options for the future. Meanwhile, austerity, albeit moderated by Miliband-ish measures from Theresa May, continues to erode from below. It doesn’t lighten the general mood that armed police officers have become a routine feature of everyday London life. In all these circumstances optimism is essential, but staving off its opposite will require fortitude and skill.

The mayor, of course, has a big part to play in all of this. Sadiq Khan’s 2017 will involve the Labour man in unending nagging of and negotiating with the Conservatives in charge of national government, hoping to secure the best possible post-Brexit deal for the capital and, by extension, the country. His panel of Brexit advisors, bankers, accountants, Peter Mandelson and all, doesn’t delight those who think he’s insufficiently left-wing. But pragmatism is an essential mayoral art: if you want a bunch of Tories to take you seriously, you don’t surround yourself with Corbynites.

Policy delivery will begin with Khan hailing a freeze on those public transport fares that Transport for London (TfL) sets, but not the universal one some of his election campaign statements and a line in his manifesto claimed. Political opponents will attack him (again) for that, and for the demands he is making on TfL’s finances as a whole as his first mayoral budget, covering all GLA functions, comes under closer public scrutiny.

Khan’s new “hopper” fare, which enables bus passengers to catch two buses for the price of one during a 60 minute period, has given him – not to mention a lot of Londoners on low incomes – a quick early win. But this initiative, though welcome, needs to be seen in the context of falling bus ridership, something TfL can ill afford given its increasing dependence on fares revenue.

This, in turn, is a consequence of worsening road traffic congestion, which London’s economy could do without. Congestion also harms air quality, another issue the mayor has sought to make a fast start on. He is set to kick-off implementing his anti-pollution policies by introducing an emissions surcharge (the so-called “T-charge” on toxicity) on high-pollution vehicles entering the congestion charge zone early in 2017, but will be urged by critical friends to go further with his policies as a whole.

Holding down public transport fares is one part of a broader attempt to address London’s high cost of living, which leaves too many of its households, including around 40% of its children, struggling to make ends meet on unacceptably low pay and excluded from many of the city’s many riches. Housing costs are, famously, a huge factor in this and also hugely difficult to control. The mayor’s housing team has assembled a purposeful strategy for getting more homes built for sale, rent or a combination of both at prices ordinary Londoners can afford. Khan will hope to be able to boast of initial successes as he embarks on the vast task of trying to better match housing delivery to the city’s social and economic need. The backdrop to all this is the ongoing three-year monster mission of writing a new London Plan.

There are going to be tensions. Hammered by successive grant cuts and hampered by limits on their freedom to borrow to build, some of the capital’s boroughs, often Labour-run, are becoming ever more adroit at finding ways to meet at least some local “affordable” housing demand, but these can mean private sector partnerships involving publicly owned land that don’t always work as well as planned. The available alternatives – largely, small variations on doing nothing – aren’t all that attractive either.

Squeezed between the same rock and hard place we find shortages of school places and health and social care provision also having their impact at borough, and indeed neighbourhood level. Dynamic boroughs and the mayor alike are trying to get more more purchase on low-cost childcare and improving post-school skills training, as the city strives for greater autonomy in the running of its affairs.

A striking thing about the politics of London is the high degree of consensus about the benefits of devolving power over such things as welfare programmes, property taxes and infrastructure investment from Whitehall. Agreement crosses party lines and unifies business interests, social sector campaigners and more. There is strength in that solidarity. London will need every ounce of it to keep on prospering in 2017 and beyond.

London must stand together in 2017 if its golden age is not to end

London ambulance staff log calls with pen and paper after IT failure

Staff at one of the country’s biggest ambulance services had to log emergency calls manually overnight because of technical issues in the control room, delaying response times.

It is understood London ambulance service’s computer system crashed, forcing staff to record details of calls by pen and paper for nearly five hours on one of the busiest nights of the year.

A spokeswoman said staff were trained to deal with such situations and were able to prioritise responses to those in greatest need.

The deputy director of operations Peter McKenna said: “Due to technical difficulties, our control room was logging emergency calls by pen and paper from 12.30am to 5.15am.

“Our control room staff are trained to operate in this way and continue to prioritise our response to patients with life-threatening conditions, using the same triage system as usual.

“We also have additional clinicians on duty to offer control room staff clinical advice if it is needed.”

London ambulance staff log calls with pen and paper after IT failure

How we transition into the new year

You may have woken up today feeling a little more wobbly than usual, not just from last night’s festivities, but about what 2017 holds. We can’t help our memories of last year colouring our expectations of the next. We’re wired that way.

We know this from the Colour Phi experiment in 1976, where respondents were shown a blue dot at the top left hand corner of a screen followed soon after by a red dot at the bottom right.

What they reported seeing was a dot moving from top to bottom, and changing to red midway. Our brain creates an illusion, joining up the two dots and projecting the colour of the red dot backwards in time.

The same applies to how we view our own life story and our hopes for the new year. It’s a funny point each January where we’re caught between imagining the future and knowing the past. In Roman tradition, Janus is the god of endings and beginnings, with two faces, looking backwards and forwards.

This story of transition should reassure us. We make it up as we go along. So we can allow ourselves the possibility of change: nothing is fixed, it’s only a matter of perception.

Dr Daniel Glaser is director of the Science Gallery at King’s College London

How we transition into the new year

Ex-bodybuilder Taryn Brumfitt campaigns to ditch diets and end myth of the ideal shape

Many of us waking up will feel the familiar pang of New Year’s Day self-loathing and decide that this is the day to start that new diet, begin that new detox, finally attempt to get the body of our dreams. Within a month we will probably feel miserable, hungry and no closer to achieving our goal.

Now a new film is set to challenge the increasingly pervasive message that there is one way to look by tackling the myth of the perfect body and the celebrity culture that fuels it. Embrace follows Australian writer and campaigner Taryn Brumfitt as she travels across the world talking to a huge variety of women about how they see themselves. She speaks to actor and talk-show host Ricki Lake about body image and Hollywood, to an entertainingly direct Amanda de Cadenet about what it was like living with tabloid scrutiny at the age of 18 (“The message I took from it was that if you were thinner you were better … these days I’d say if you want to eat the biscuit, eat the fucking biscuit”) and to Harnaam Kaur, a British Sikh woman who celebrates the beard caused by polycystic ovary syndrome rather than break her religious beliefs.

Most movingly of all, the film introduces us to women who have seen their bodies change in dramatic ways, from Kirsty who lost a breast to cancer (“My boys think it’s cool, they’ve got a mum with one boob – it’s a bragging point”) to the inspirational Turia Pitt who suffered burns to 65% of her body when she was caught in a bush fire and who admits: “I’ve gone through something so huge … and I think, well, if I’ve managed to start my life from scratch then I’m not sure why other people can’t. That probably sounds a little bit harsh but it’s just how I feel.”

“I made the film because I really wanted to have a conversation about this,” says Brumfitt. “I felt as though a lot of people behind closed doors felt the way I did – that they were being pressured to look a certain way and I wanted people to know that they’re not alone.”

Brumfitt knows the price of striving for perfection. After the birth of her third child she became obsessed with regaining a pre-pregnancy figure and began a punishing weight-loss and exercise regime that culminated in competing in a bodybuilding contest. But despite having what society would claim was the perfect figure, she was desperately unhappy and decided to return to a more relaxed regime. One day she posted an online before-and-after picture, with a twist. The before picture was her at her thinnest, the happy after shot was Brumfitt as she was, carrying a few pounds yet content.

“I thought it might help people but the response was mind-blowing,” she says. “It went viral and became this internet sensation and suddenly I found myself doing media across the world and talking about how women see their bodies.”

Taryn Brumfitt. Photograph: PR Company Handout

Brumfitt swiftly realised that the brief chats she was doing on morning television were only scratching the tip of a very large iceberg. She started up the Body Image Movement to provide a forum for discussion but still wanted to do more. “I was hearing from all these women from all over the world and I knew this was a subject that needed a bigger platform so I nonchalantly thought, ‘Oh, I know, I’ll make a documentary, how hard can that be?’ And of course the answer was very.”

It might have been hard but the result is compelling. Embrace delves into every aspect of body image pressure from the plastic surgeon who spends a large amount of time telling Brumfitt that her post-pregnancy nipples “should be up here” (“I took one for the team there,” she remarks drily) through the magazine editors who talk frankly about the way in which the perfect body is sold to the world. There are screenshots of the body shamers who contacted Brumfitt online after her pictures went viral, telling her she should be ashamed and that her husband must be devastated.

“I really gave the audience the parental guidance version of that,” she admits with a laugh. “It bothered me at first but then I realised what’s the point? I feel great about my body. The more shocking thing was that no matter where I went in the world, body shaming and body hating was everywhere. It was like an epidemic and I found that heart-breaking and mind-blowing.”

Certainly one of the most powerful moments in the film comes when Brumfitt asks women across the world how they feel about their bodies. They are a range of ages, body shapes and nationalities yet they all say they’re unhappy with how they look.

“I feel as though I’m drowning in a sea of media,” announces a distressed mother talking about how hard it is to convince her teenage daughter that she doesn’t have to look a certain airbrushed way – and Embrace is at its strongest when it tackles how we collude in this objectification.

“We live in a world where women are objectified and sexualised in advertising campaigns or on television on a daily basis,” says Brumfitt. “I really do hope that this film allows us to keep pushing back against the toxic ideal of perfection.”

She has already had positive responses from some unlikely sources. “Quite a few men who have seen the film have contacted me and been so beautiful,” she says. “They’ve said things like, ‘I’ve told my wife for ever that I love her the way she is and I just don’t care about all the things she’s so worried about’. And that’s important because I don’t think this is just a women’s issue – it’s a problem for humanity.”

Indeed, although Embrace was “made for women first and foremost”, Brumfitt says she’s increasingly aware of how many young boys are also suffering from body image problems.

“There have been so many studies recently on the use of steroids in teenage boys – they’re under pressure to conform to a certain kind of muscled, manly stereotype as well and they’re equally bombarded with images of how they should look and behave.”

Her main hope is that the uplifting Embrace will convince audiences to start treating their bodies as something to love rather than loathe. “Absolutely. We need to detox from the toxic messages we’ve allowed inside our minds for so long,” she says. “I want people to know that they do have a choice: you can either spend your life being at war with your body and hating it, dieting, shaming yourself, using exercise as punishment, or you can embrace your body, move it for pleasure and live an exciting and uninhibited, liberated life. I know which one I’d choose.”

Embrace will be available in cinemas across the UK from 16 January

Ex-bodybuilder Taryn Brumfitt campaigns to ditch diets and end myth of the ideal shape