The sugar tax should be extended to cover sweets, not just soft drinks, according to public health campaigners. The charity Action on Sugar said it wanted ministers to get tough on childhood obesity by forcing confectionery manufacturers to reduce the sugar in their products.
Chocolates and sweet confectionery account for 9% of all the sugar eaten by children aged between four and 10 and for 11% by those aged between 11 and 18.
The levy, which is due to come into force in the UK affecting heavily sugared fizzy drinks from next year, should also be applied to sweet treats sold in coffee shops and restaurants because those often contained a lot of sugar and calories, the campaign group said.
Under the new rules, producers or importers of soft drinks will have to pay a sugar tax of 18p per litre on drinks containing five grams or more of sugar per 100 millilitres and 24p per litre more if their products contain eight grams or more per 100 millilitres. The Treasury expects the levy to raise £520m a year.
“Action on Sugar is urging the next government to implement a mandatory sugar levy on all confectionery products that contain high levels of sugar to ensure maximum impact to help tackle the obesity and type 2 diabetes crisis,” said Graham McGregor, Action on Sugar’s chairman, who is professor of cardiovascular medicine at Queen Mary University of London.
“The levy should be structured by the Treasury as per the soft drinks industry levy, whereby it is aimed at manufacturers to encourage them to reduce sugar in their overall product ranges. The next government needs to bring in tough measures to ensure compliance and put public health before the profits of the food industry.”
Dentists in Britain backed the move as a way of tackling tooth decay. “When the sugar levy is already showing that progress is possible, it makes no sense to draw an arbitrary line and ignore the likes of sweets or energy drinks that are so aggressively marketed at children,” said Mick Armstrong, chair of the British Dental Association. “Ministers keep giving the impression that it’s ‘mission accomplished’ on sugar controls. Dentists are confronting an epidemic of tooth decay and government must show it is prepared to go further on advertising, reformulation targets and through the tax system.”
A sugar tax on sweets had to be mandatory because “voluntary sugar reduction vis reformulation alone will not combat obesity”, said McGregor.
Conservative sources said they would not be extending the sugar tax. “Reducing childhood obesity is vital, and we’re pleased that Public Health England says that our plan to address it is the most ambitious in the world,” a source said.
The Food and Drink Federation, which represents manufacturers, recently warned that the 20% cut in sugar content of most types of foodstuffs being sought by Public Health England by 2020 was highly unlikely to happen because it would not be “technically possible, or acceptable to UK consumers”.
Universities must do more to tackle the growing number of students turning to “smart drugs” to cope with exam stress, leading academics have said.
UK institutions are being called on to consider measures such as drug testing to stem the rise of cognitive enhancement drugs being used by young people to improve their academic performance.
As hundreds of thousands of students across the UK prepare to sit their summer exams in coming weeks, Thomas Lancaster, an associate dean at Staffordshire University, said we were entering a “dangerous world” where students have access to the “study drugs”. He called on universities to have “frank discussions” with students and to develop policies around their use.
“Universities need to seriously consider how to react to the influx of smart drugs on campus. Educating students about smart drugs and seeing if they view this as cheating is important here. If the trend continues, universities may need to think about drug testing to ensure the integrity of the examination process,” Lancaster said.
Smart drugs, also known as nootropics, are a group of prescription drugs used to improve concentration, memory and mental stamina during periods of study. The most commonly used ones are Modafinil, Ritalin and Adderall. These substances are normally used to treat disorders such as narcolepsy and attention deficit hyperactivity disorder.
Larissa Maier, a research associate at the University of Zurich, called for more education about the risks associated with the substances. Her concerns were echoed by Prof Tim Hales, the head of neuroscience at Dundee University. He said: “In the short term some of these drugs may not be harmful, but we don’t know about their potentially harmful cumulative effects. Different students will respond differently, particularly when taking other medications, alcohol or recreational drugs at the same time.”
The growth of smart drugs over the past five years has been well documented, especially in top institutions such as Oxford University. In May 2016 the Oxford student newspaper, the Cherwell, published a survey that showed 15.6% of students knowingly took Modafinil or another such drug without prescription.
Oxford has introduced workshops to educate young people about smart drugs.
A recent European study co-authored by Robert Dempsey, a lecturer in psychology at Staffordshire University, found that the majority of university students believe it is normal to use such drugs to enhance academic performance.
Maier said current estimates indicate about 10% to 15% of students have tried to enhance their cognitive performance with prescription drugs, alcohol or illegal drugs at least once. With a UK student population of 2.3 million, this works out at about 230,000 people.
Students at Oxford. Photograph: Pete Lusabia/Alamy Stock Photo
Oxford University said it had not seen evidence of a widespread problem, but added that students were strongly advised not to take any unprescribed drugs. “Students who are struggling to cope personally or academically will find a range of support at Oxford. They should talk to their tutors, their college welfare officers, Oxford University Student Union, their GP, or the university counselling service.”
The health risks that the drugs could pose are still unclear, but using them without a prescription is illegal and can lead to unwanted side-effects, such as increased anxiety and heart rate.
Maier said the number of students using the drugs could increase due to increased availability both at universities and online.
Dr Dominique Thompson, the director of the students’ health service at Bristol University, said she sees a handful of students a year who come in suffering the side-effects of the medications, such as insomnia. She put the rise in use down to increased competition and pressure on young people.
Thompson said: “There is a huge pressure to do well and excel and be different to everyone else as well as financial pressure now. That may be another factor as to why students feel they need to use any means to do well.”
The Guardian heard from several students who claimed to have faked ADHD symptoms in order to be prescribed Ritalin or Adderall. One student, from UCL, said: “I obtained the drugs from a friend who wanted Ritalin to use as a smart drug. She memorised the symptoms of attention deficit hyperactivity disorder and convinced a GP to prescribe it.”
Non-prescription sale of Noopept, a fine white powder that its makers claim enhances cognitive ability, was banned in the UK last year under the Psychoactive Substances Act. However, several British websites appear to be actively selling this substance.
Modup, a website selling Modafinil, told the Guardian that during exam time the volume of Modafinil shipped to the UK doubles. It claimed the campuses it mainly sent stock to were Oxford and Cambridge, followed by the London institutions Imperial and the London School of Economics.
One second-year student from Cambridge University, who asked to remain anonymous, said: “I know quite a few people who have used study drugs, including several of my housemates and friends. They all tend to take Modafinil rather than either Ritalin or Adderall … given the sheer volume and quality of work expected of people here, I would be unsurprised if my college is representative of the university as a whole.”
Another student from Leeds said they had been taking Modafinil or some variant for essays and exams since the middle of second year. “My own work rate has always been fairly pathetic without it so it’s been vital for me in completing my dissertation and other big projects at uni. I do know people who work very hard anyway, but take it for the non-stop work they have to do for degrees like medicine.”
Universities do not appear to have a plan in place for tackling the problem. Dr Cathy Montgomery, a reader in psychopharmacology at Liverpool John Moores University, said: “Many universities don’t have specific policies regarding use of cognitive enhancers as this is a new area. Most universities do, however, have a drug policy, stating that the use of drugs is prohibited on campus, but this does not necessarily extend to medicines.”
But she said that before policies were put in place, more research should be done: “We need a large-scale epidemiological study looking at use of enhancers across the UK.”
Neal Patel, a spokesman for the Royal Pharmaceutical Society, said: “Unfortunately, prescription-only medicines are available to just about anyone with some spare cash willing to buy them from unscrupulous online providers. You may or may not get what you pay for.
“Unrealistic expectations of the benefits of these powerful medicines, coupled with peer pressure to use them, is an unhealthy mix for students. Our advice remains for people to steer clear of prescription medicines unless they are being prescribed under the supervision of a health professional.”
Our NHS is under attack from all angles. People are living longer, we don’t eat well or exercise enough. Yet we expect more from the NHS; more people are visiting A&E departments and minor injury units year on year, and costs are rising.
How do we tackle this? What if we focus on marginal gains, the performance strategy that helped British Cycling to success in multiple Olympics?
This is an approach that focuses on “small incremental improvements in any process adding up to a significant improvement when they are all added together”. Could this improve patient outcomes and reduce waste in the health service?
One incremental enhancement we could seek in the NHS might be to improve our understanding of and response to the barriers to patient motivation. For example, could we find a way of encouraging stroke survivors to practise their rehabilitation exercises as frequently and intensively as they are prescribed? Patient adherence to rehabilitation regimes after discharge from hospital is described as “less than ideal”. By addressing these barriers, we will be more able to efficiently allocate therapy time, and thereby reduce GP appointments and hospital readmissions.
You might wonder what makes me an expert on this.
Lowering patients’ expectations of recovery can be extremely damaging
In February 2010, at the age of 39, I had a huge brainstem stroke and was diagnosed with locked in syndrome. I was on life support and in intensive care for nine weeks, and was then written-offin rehabilitation after a further six weeks. My husband received a phone call telling him that I would never walk or talk again.
Over eight painstaking months in rehabilitation, I obsessively willed my body back to life, practising actions or movements 450 times per week. Slowly I learned how to do basic things like eat again, and at the end of it all I walked out of hospital. I went for a run on the first anniversary of my stroke. I’m now a motivational speaker and go to the gym every day.
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I never gave up pushing my body to improve: to speak, to eat, to run and to hug my kids. I managed to use my bad prognosis to galvanise my recovery, but the risk is that lowering patients’ expectations of recovery can be extremely damaging. Recovery should be measured in terms of improvements, not “getting better” – and that is always possible. My only focus, with three young children at home, was on when I would achieve my goals, not if.
Since embarking on my career in advocacy and stroke activism, I’ve found many reasons why patients lack the motivation to try to help themselves. They may be suffering from post traumatic stress disorder, which is common after a stroke and, just like depression, it affects mood and motivation levels. The side effects of the drug treatments for strokes – sleeping pills and muscle relaxants – can also affect motivation. After a brain injury many patients suffer varying levels of executive dysfunction affecting the set of mental skills that help to get things done, which can be mistaken for apathy or laziness. The overwhelming tiredness felt by those suffering from neurological fatigue can leave patients unable to complete normal daily tasks and therefore non-compliant with their treatment plans. It may be that some patients simply hate exercising or have no family support.
It is futile prescribing a stroke rehabilitation plan if – for any of these reasons – the patient is unmotivated before the therapy session starts or they are left at home trying to manage their own condition. The NHS should be offering hope and encouragement to motivate patients. And to do that, they need to listen to expert patients.
My advice to the King’s Fund Leadership Summit is that we need a better understanding of patient motivation to help rebuild the lives of stroke survivors. If patients adhere to clinical advice about practising their exercises as frequently and intensively as I did, just imagine how much we could improve their outcomes and reduce the waste in the NHS. But to do this we must understand the complex reasons why patients don’t do this already and listen to those who have struggled through similar experiences.
I don’t promise anything when I speak to people now – I just offer possibilities. I talk about how to optimise improvement, but never use the word recovery. After a life-changing event none of us will ever be the same as we were, even if we physically improve really well. We need to embrace that new self and strive to be the best version of ourselves that we can be, both in hospital and back home.
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I have Down’s syndrome and I live in supported housing. Today a parliamentary select committee has put out a report on the government’s planned changes for supported housing that could force people such as me with a learning disability out of our homes.
Last year the government said it wanted to make changes to funding for supported housing that would limit payments to the local housing allowance rate and let local councils have control over the extra money needed to give people supported housing. This would mean people such as me could lose our right to have our housing paid for and that there could be a lot less supported housing available.
Both these changes would obviously be really bad. Thankfully today’s report agrees, which is good to hear as it is what me and other people in supported housing have been saying for a long time. But I’m still very scared the changes could happen.
In March I gave evidence for this report. It was a historic event as I was the first person with Down’s syndrome ever to give evidence to a select committee. I was very proud to be taking such a big step for people with a learning disability, especially as I know these changes could mean that thousands of people like me lose their homes and independence. As a society, we’d be going backwards.
Before supported housing, people with a learning disability had to live with their families or live in institutions. Most care professionals think institutions are not the best place for people with a learning disability; in some cases people end up having to live far away from everyone they know, and sometimes too, without proper support, people can even be in danger of abuse and neglect. I don’t think that’s a life anyone would choose.
I moved into supported housing when I was 30. Before then I had lived with my parents. I love them but I wanted to be independent. Nobody wants to still be living with their parents at 30! After a lot of talking, my parents agreed and I now live in a house run by Golden Lane Housing, with Elizabeth and Katie, two other ladies who have a learning disability. I love living with them – we’re like family.
I couldn’t live on my own without support, but I don’t want full-time care, because I’m not a child. Supported housing means I can be independent but have day-to-day support from Mencap. My support worker Jeanette helps me get out and do the things I love, which include volunteering at Oxfam, my local bookshop and the Cancer Trust. I make my own choices and I get to live the life I want, something everyone has the right to do.
But this will all change if the government’s planned changes happen. A cut could mean that I couldn’t afford to pay my rent any more. I wouldn’t be able to live with Katie and Elizabeth and I might lose my day-to-day support. It makes me scared for my future because I’d have to move away from my home, my friends and my voluntary jobs and go and live with family. It could change my whole life in a way that I don’t want.
But I’m lucky. A lot of people with a learning disability don’t have family who can support them, so they could be forced to live in an institution, where the support and accommodation might not be right for them. They could away from everything they know and they would lose all their independence. This would be a huge step back for everyone with a learning disability.
I make my own choices and I get to live the life I want, something everyone has the right to do
It is a scary thought and I think it’s clear the government isn’t thinking about all the people who use supported housing. So I’m glad that the select committee report has said that these changes could lead to a really bad situation. This is also what a lot of supported housing providers and Mencap have said and it’s what I think as well. But I don’t know if the government will listen to this new report.
I think things would be very different if people such as me had more of a voice, more power. I don’t think changes like this would be happening. That’s why it’s important that the government listens to us.
I would say to the government: “Stop and think about what you are doing!” It’s good to save money; I am not against changes. But things have to be fair for everyone, and until you can guarantee that changes won’t take away people’s homes, independence and happiness, then these are changes that the government can’t afford to make.
This summer marks 25 years since one of the greatest moments of my career, winning Olympic gold in Barcelona. It often feels like the last 25 years have flown by as quickly as the 9.96 seconds it took to run the race!
A quarter of a century on and I’ve just turned 57. In my mind, I don’t feel any different to how I felt on that day in 1992. I still feel in good shape and to this day I spend more time at the track than I do in my house. However, as I’ve grown older, I’ve become much more mindful of the potential threats to my health than I ever was then.
I’ve recently started working with the men’s health charity Prostate Cancer UK and have learned some startling statistics. As a black man over 50, my risk of prostate cancer is double that of a white man the same age. One in four black men will be diagnosed with prostate cancer in their lifetime – the equivalent of one member of a 4×4 relay squad.
The prostate is an invisible gland; you can’t see it, you can’t feel it. In fact, 17% of men don’t even know they have a prostate.
If I’m being honest, until lately, I was one of the many thousands of men who knew next to nothing about the vital, walnut-size, reproductive gland inside me. More than 11,000 men die from prostate cancer every year in the UK, but over the next 10 years Prostate Cancer UK is ramping up its investment in research and has set a goal to transform the disease into one that the next generation will not fear.
Despite the odds being stacked against black men, just saying the word “prostate” within many black communities remains a massive taboo subject. Still, in 2017, the disease is simply not spoken about and, if it is, it’s in a “hush-hush, don’t tell anyone” type of way. How can it be that something that affects so many black fathers, uncles, sons and friends is continually swept under the carpet and ignored?
My health has always been important to me. When I was in the prime of my career, it was the most important thing. I was conscious of my diet and keeping myself in shape. I had to; other than a pair of running spikes, my physical and mental fitness was all I had – my career depended on it. Unbeatable; indestructible; that’s what I wanted to be, and I believed I was.
As I’ve grown older, my diet is still vital, but I’ve come to realise that no matter how well I eat or how fit I am, I am not indestructible – nobody is. But there are defence measures I can take and arming myself with knowledge is by far the most important.
If prostate cancer is caught early, more often than not, it can be successfully treated. The problem lies in the fact that when it’s in its early stages the disease is just as invisible as the gland itself – it has no symptoms.
This is why awareness of the potential threat, talking to your doctor and spreading the word among men is so important – it saves lives.
I’m currently fronting Prostate Cancer UK’s campaign, Stronger Knowing More, to get black men to face up to their risk of prostate cancer and take action. If you’re a black man, you’re not only more likely to get prostate cancer, you’re more likely to be diagnosed at a younger age.
This challenge is a marathon, not a sprint, and if we’re going to beat it we need to break down the taboos and start talking. It’s only by doing this that we can put a stop to the number of men who die from the disease every year.
The government is under intense cross-party pressure to guarantee that EU nationals will still be able to work in the NHS, as concern grows that Brexit will cause a critical shortage of nurses and doctors.
Tory, Labour and Liberal Democrat MPs said ministers must not only guarantee that EU staff already working in the NHS can stay, but also that recruitment from EU countries can continue.
The calls for NHS workers from the EU to be given special status as Britain heads towards Brexit were echoed by former Tory health minister Dr Dan Poulter, who now combines his role as an MP with work as an NHS psychiatrist. Poulter told the Observer that unless action were to be taken on both fronts – to reassure those already here and to ensure a future flow from the EU – services to patients would be soon be seriously affected.
“The NHS is heavily reliant on the contributions made by many dedicated EU healthcare professionals, and without them, our health and care system simply wouldn’t be able to cope,” Poulter said.
“Protecting the rights of EU nationals to continue to live in the UK and care for patients is essential, but it is also important that we look after the best interests of the patients of tomorrow. Having the right work visa rules to ensure that in future, healthcare professionals from within the EU can continue to contribute to the NHS and care for patients, must be a priority.”
Poulter said he knew of many colleagues from EU countries who were concerned and of two fellow doctors who were planning to return to Spain by the end of the year. Fears that there could be a mass exodus from the NHS are growing as evidence mounts that EU nationals are already beginning to leave. Some 17,197 EU staff, including nurses and doctors, left their posts last year, compared with 11,222 for 11 months in 2014.
Merkel calls on all sides to protect everyday lives of EU citizens in UK – video
The supply of doctors is already a serious worry. A total of 10,363 – nearly 10% – of those working in England’s NHS Hospital and Community Health Services (HCHS) last year were from other member states.
Labour’s health spokesman, Jon Ashworth, highlighted NHS data showing that there are 22,081 EU nationals working as nurses in an NHS which is struggling to fill 26,000 vacancies.
Ashworth said: “This NHS crisis will be compounded if the 140,000 EU nationals working in the NHS and social care sector walk away. It’s time for an ‘NHS guarantee’ for these workers ensuring their rights – offering these workers who care for our sick and elderly the certainty that they deserve.
“What’s more, we need urgent guarantees that the NHS will be able to continue recruiting from the EU as it currently does. Yet we have no clarity whatsoever from the prime minister. Will health professionals from the EU be able to come to work in the UK after Brexit, will there be a cap on their numbers? The government need to tell us their plans and quickly.”
The Liberal Democrats are also demanding that the government grant an urgent “NHS passport” to every EU citizen working in our health service to encourage them to stay.
Theresa May has so far refused to guarantee that EU nationals will be allowed to stay after Britain leaves the EU. The prime minister reiterated last week when article 50 was triggered that she would not do so unless the rights of UK citizens living in other EU states were also guaranteed.
A total of 2,348 doctors from the 27 other EU states left NHS England between July and September 2016 compared with 1,281 in the same period in 2015. That is a rise of 83%.
There were also warnings yesterday that a potential exodus of EU workers could hit other sectors. A spokesman for the CBI said: “Since the referendum, we have heard from members in sectors who depend on EU workers to fill local shortages that they are having difficulties filling.”
As the growing season approaches for Britain’s £3bn horticulture industry, recruiters warned that it would be hit particularly hard by staff shortages. The head of the largest Romanian employment agency for temporary workers in the UK called on the Brexit secretary, David Davis, to be clear that EU workers still enjoyed the same rights.
“There was a lot of talk about restricting the rights of Romanians on the day article 50 was triggered but that did not happen in the end. For the next two years of negotiations there should be clear messages,” said Alexandru Barbacaru of Est-Vest Services.
Anonymous I am once again in the mental health treatment sausage machine. Plucking up courage to approach a GP to admit defeat, being shoved on drugs to stop me topping myself, told that there’s a huge, long waiting list for treatment, the false hope of a “gateway worker” assessment followed by another interminable wait of undefined length. Then I know I will have my allocated batch of treatment before being deemed “fixed” and dispatched back to the world again. I am sick and tired of the roundabout. I suggested that instead of this system, once a mental health patient has had their allocation of therapy, they should remain on the books, so when they feel themselves slipping back down, they can call up for a booster session instead of having to go through the whole rigmarole again.
I’ve just quit my job of six years because, following a disclosure to my new boss that I have bipolar tendencies she proceeded to bully me into submission. She had absolutely no understanding of how to get the best out of (a very talented) employee who has mental health issues. I was stopped from working at home, an important aspect to being able to manage my condition. I had unreasonable targets imposed, with no support offered to go about achieving them. My job was chopped and changed, hours cut and autonomy removed. I have been pushed back to the brink of suicide and had to go on antidepressants to simply survive.
Anonymous From September 2015 until December 2016, while I waited for an NHS referral, I was so ill I didn’t know how to cope and resorted to self harming. These aren’t all of my scars, but they’re the ones no one ever sees; so it’s easy to think they’re not there. One year of my life, and I will have to be reminded of it forever.
Cat, 24, South Yorkshire People often mistake bipolar disorder as your mood rapidly changing from up to down. It’s not like that. That would be my other illness, borderline personality disorder (BPD) or as my psychiatrist put it, emotionally unstable personality disorder. It’s complicated telling people you have both bipolar disorder and BPD, as they both involve intense mood swings. Well, that’s when I do tell people – social anxiety sort of puts a brick wall between me and people. BPD makes your mood change within seconds and it is a strong mood swing. Like fire, it can destroy you and those around you. With bipolar, the mood swing sort of creeps up on you. It’s when the mood gets high (mania) or low (depression) that it becomes destructive.
Every day it feels like I must wear a mask, however, hiding never did me any good with these illnesses. It just becomes more of a shock to those around you when the symptoms start to leak through. Even as I write this, it’s hard to concentrate, thoughts and emotions are saying one thing, while that one bit of mind that tells you “everything will be ok”, is telling me to push on.
The rendition of a darker moment. A painting of a depression experience by Cat, South Yorkshire
I’ll admit when I’ve been at my lowest I’ve done things I’ve regretted. The overdose, which sent me into hospital, was one of the things. I know there’s a stigma around psychiatric hospitals, but I did meet people who it’s worked for. When I was admitted into hospital the first time, I had psychosis – a female voice was constantly screaming in pain in my head. I don’t even bother to count how many times a year I have to go through this. Medication helps keep me in some control, especially with the manic side. I prefer the manic side to the depression side. Mania brings with it the thought that you’re this amazing person, who can do anything, someone who deserves to be with people. The bad side of mania is that loss of control. Nights become sleepless and the thoughts running through your head won’t stop. Every time you try to grab one, it just slips through your fingers. Health and safety also goes out the window.
I managed to get through my art degree. I have to remind myself that I’m more than my diagnosis, but with the right help and support it does become a lot easier.
In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14.
New figures released by Agenda, the alliance for women and girls at risk, have highlighted the routine use of physical and face-down restraint against women and girls in mental health settings. Although government guidance is clear that physical restraint should only be used as a last resort, this research shows that in many trusts it is widespread.
Given that more than half of women who have mental health problems have experienced abuse, restraint not only risks physical harm and can be frightening and humiliating, but being restrained, particularly face-down, can also re-traumatise those with a history of violence and abuse.
Mental health units are meant to be caring, therapeutic environments, for people feeling at their most vulnerable, not places where physical force is routine. That is why we believe face-down restraint must end and other forms of restraint should only be used as a last resort.
Instead, women and girls’ particular needs and experiences, including their histories of trauma, must be taken into account by mental health services and support given to tackle the underlying issues they face.
Katharine Sacks-Jones director, Agenda
Paul Farmer CEO, Mind
Mark Winstanley chief executive, Rethink Mental Illness
Sarah Hughes chief executive, Centre for Mental Health
Kathy Roberts chief executive, Mental Health Providers Forum
Liz Felton chief executive, Together for Mental Wellbeing
Professor Joy Duxbury chair, Restraint Reduction Network
“Just how easy is it to speak about things that have gone wrong?”, asked health secretary Jeremy Hunt in a speech he made last year about improving transparency and ending the blame culture in the NHS. Mr Hunt is himself failing badly on this critical benchmark for greater openness. The Guardian this week has revealed that half a million pieces of medical correspondence, including test results and diagnoses for life-threatening conditions like cancer, sat undelivered in a warehouse between 2011 and 2016. Yet it has taken almost a year for the full extent of this failure to emerge.
Mr Hunt was first made aware of the problem in March last year. But he did not inform MPs until July last year, in a 138-word written statement that mentioned neither the scale of the problem nor the potential harm to patients. The incident was confined to a single paragraph buried in the Department of Health’s annual report. While it appears a team was set up in early summer 2016 to look into the problem, much of the undelivered correspondence did not arrive at the GP surgeries of affected patients until November and December last year. No explanation has been offered for why it has taken nine months from Mr Hunt being informed to urgent correspondence finding its way to patients and their doctors. The idea that letters containing test results and diagnoses for life-threatening conditions can go missing for years is a frightening prospect for any NHS patient. According to the government, 500 patients may have suffered serious harm as a result of the missing correspondence.
The way that Mr Hunt and his department have handled this affair seriously undermines his pitch to be an ardent advocate for patient safety. It bears all the hallmarks of a government whose primary concern is not the health of NHS patients, but sneaking out bad news in order to avoid an embarrassing story. Mr Hunt has rightly drawn lessons for the NHS from the airline industry, which radically improved its safety record by improving transparency. He has introduced grading of hospitals on the openness and honesty of their reporting cultures. But he has failed utterly to hold his own department to the standards he expects of hospitals.
It is critical that affected patients are swiftly identified and offered an apology and financial compensation. But patients who have suffered as a result of NHS mistreatment often say that what’s more important is knowing what’s happened to them will never be allowed to happen to others again. This means tough questions need to be asked within Mr Hunt’s department about what went wrong, and what needs to change. How could such a monumental failing go unnoticed by so many for so long? How could the Department of Health fail to hold the responsible private company – which it part owns – accountable for basic standards like the successful delivery of internal correspondence?
These issues will remain relevant when and if the NHS ever completes its much-delayed transition to digital patient records. Mr Hunt said he wanted the NHS to become paperless by 2018; that goal now looks a long way off. There is nothing to suggest a paperless NHS means a more competent NHS when it comes to communicating with patients and updating their records. NHS IT projects have a terrible track record: the last ill-fated attempt to create electronic patient records was abandoned after nearly £10bn had already been spent on it. The creaking IT infrastructure at many hospital trusts has resulted in several serious data failings, including at St George’s in London and the Leeds Teaching Hospitals Trust, often resulting in cancelled operations.
Communications and IT failures are far from the only risk to patient safety. The current NHS funding crisis has crippled the finances of many hospitals, leaving them with staffing levels that fall far below those recommended as safe by the inquiry into the devastating failures at Mid Staffs. Indeed, its chair, Sir Robert Francis, has warned the NHS now faces an “existential crisis” that makes another scandal on this scale inevitable.
Mr Hunt is perhaps the first health secretary to put patient safety so firmly at the heart of his rhetoric. But rhetoric cannot save patient lives. This week’s revelations of cover-up could not run more counter to his agenda to improve transparency in the NHS to reduce avoidable deaths. Mr Hunt must reflect on why – far from modelling the culture he expects from hospitals – he and his department have so badly failed to practise what he preaches.
Labour’s attempt to terrify the voters of Copeland with talk of dead babies has failed. Now it needs to get serious about developing a credible health policy.
In north Cumbria the NHS faces difficult choices on maternity care. It has been struggling to maintain the support services and staffing necessary for consultant-led maternity care of acceptable quality in both Whitehaven and Carlisle. This means Whitehaven may lose its maternity service. Both staff and public are anxious about the risks.
Labour’s take during the Copeland byelection was “mothers will die, babies will die, babies will be brain-damaged”, and of course “only a vote for Labour will save our hospital”. Meanwhile, at prime minister’s questions this week, Theresa May easily swatted away Jeremy Corbyn’s latest riff on the theme of Tory NHS cuts.
The manner of Labour’s defeat in Copeland is instructive. It took the most emotionally charged line possible, on an issue of great local sensitivity, on its signature issue of the National Health Service, and lost to the government.
Yet the defeat came as evidence mounts that all three of the drivers of current NHS policy – quality and efficiency improvements under the Five Year Forward View, reconfiguration of local health systems under the Sustainability and Transformation Plan (STP) process, and devolution, are in difficulty.
An analysis of Forward View progress by Kingsley Manning, former chair of what is now NHS Digital, has concluded that “the acceptance of sub-optimal productivity is the default position for the NHS”. The STP plans will not change that, he says, because they do not see productivity as a priority.
This week’s report by the King’s Fund on STP progress highlighted the chasm between aspirations and credible delivery plans. Its authors do not believe that proposed cuts in beds will happen and see the delivery timetable for STP changes as unrealistic.
Crucially, from a Labour party perspective, the King’s Fund provides evidence that some of the current problems can be blamed on the 2012 health reforms. It points out the obsession with market forces is undermining the development of new ways of delivering services, and highlights the obvious but little discussed fact that STPs do not legally exist, so they have no authority to implement the changes they are recommending. They have been stitched together to overcome the structural chaos ushered in by Andrew Lansley.
Meanwhile, a report on health devolution by the Institute for Public Policy Research out next week will highlight the changes in accountability, commissioning, financing and regulation needed to unlock the potential of the devolution strategy.
Labour has to build a credible response to these problems. The Copeland defeat shows “save our NHS” will not be enough to save the Labour party. If it is going to demonstrate it is ready for government it will have to stop writing its health policy on a placard.
It will obviously promise more funding, but to do what? Will it have the courage to stop “saving” services and instead build community-based systems which in the long term will need fewer acute hospital beds? Will it push the NHS to face up to weaknesses in clinical productivity and back-office efficiency?
It needs to construct a proper role for the private sector in providing healthcare, rather than endlessly repeating “public sector good, private sector bad”. Companies, notably SMEs, have a critical role to play if the NHS is ever going to exploit the potential of digital to drive efficiency and quality and improve the lives of patients with long-term conditions.
Health devolution is difficult territory for Labour. Andy Burnham personifies Labour’s conflicting views, having moved from attacking the government’s devolution plans to being Labour’s candidate for Greater Manchester mayor. The party needs to decide how balance the benefits of services built around, and accountable to, local populations with its desire for equitable access across the country.
These are all big questions which the NHS is struggling to answer. Labour needs to offer its solutions.
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The high price of new cancer drugs is indefensible and unsustainable, say two of the world’s leading cancer research institutions, who propose a different way to develop them that could sideline big pharma.
“There is a clear and urgent necessity to lower cancer drug prices to keep lifesaving drugs available and affordable to patients,” say leading scientists from the Institute of Cancer Research in the UK and the University of Texas MD Anderson Cancer Center, where many important new cancer drugs have been invented, in a paper in the journal Cell.
In the US, cancer bills are the leading cause of personal bankruptcy, while in the UK, drugs that might prolong life are rejected for NHS use because of their price. Many new drugs have to be used in combination, adding to the cost. Treatment with the two new immunotherapy drugs nivolumab and ipilimumab costs $ 252,000, which is more than the median cost of a US home ($ 240,000 in 2016), they write.
Fantastic scientific work is going on – for instance, in sequencing cancer genomes – which should lead to advances in treatment, said Prof Paul Workman, chief executive of the Institute of Cancer Research in London, which is the world’s most successful academic cancer drug discovery organisation. “All this invention is meaningless if patients cannot afford these drugs,” he said.
“It is unsustainable. For those of us involved in research, it is disturbing that the amount of research that goes on and the success that is made is not translated into treatment for patients. And for patients it is a terrible situation.”
Pharmaceutical companies used to justify their prices by pointing to the high cost of clinical trials involving many thousands of patients. But that is no longer always necessary, the scientists say in their paper. The new targeted drugs require a test for a genetic biomarker to see whether patients will respond or not. That means the drug can be trialled on far fewer people. The drug crizotinib, used for advanced lung cancer, was approved following a trial involving only 347 patients, they point out. Trastuzumab (Herceptin) was first approved for advanced breast cancer and later for early breast cancer, increasing the market for the company but with no reduction in price.
“Some drugs are tested on 50 or 100 patients and yet these drugs still go to Nice [the National Institute for Health and Care Excellence, which decides whether the NHS can afford a new drug] at the maximum price,” said Workman.
Workman, together with colleagues from the US and the Netherlands, proposes that academic discovery centres like his should forge relationships with new commercial partners – probably not the major drug companies but smaller biotech or generic drug firms.
Academics should take greater control of the drugs they discover, they argue, and join with small companies that will agree to cap the price when the drug reaches the market. They would not have the expectation of big profit margins, as the major pharmaceutical companies do. But in an era where drugs are tested on smaller populations and genetic testing means they are more likely to be effective, they would not need to “cost in” all the failed attempts at producing blockbusters, as the big companies do.
Workman said the institute was already talking to small companies about the possibility of a new way of developing more affordable cancer drugs. He believes other scientists will support the ideas in the paper. “We’re calling for a more mature and open conversation about how this could be done and offering a solution,” he said.
A few months into my first job in the NHS, some 38 years ago, I watched Prime Minister Jim Callaghan being interviewed, on his return to the UK after an international mid-winter summit in the Caribbean, about the strikes in public services that have come to be known as the winter of discontent. I and pretty well everyone working in the NHS, and most of the population, knew there was a crisis. Callaghan’s dismissive comment were famously reported as “Crisis, what crisis?” They didn’t go down well, he didn’t act, and he went on to lose the impending election.
Today, can it really be that our current prime minister is the only one who doesn’t realise there is an NHS crisis?
The comment by the British Red Cross chief executive that there is a “humanitarian crisis” upped the ante, but at prime minister’s questions Theresa May said he was crying wolf. However, the fact is that, humanitarian or not, crisis means crisis, and if she carries on with her current denial – and inaction – the NHS will soon cease to be able to cope.
There have been three further NHS crises since 1979: in 1987-8, as the NHS ran out of money and failed to cope with the winter pressures it faced; in the early 90s, when the sickest patients were left waiting on trolleys in corridors for days; and in 2006, when the NHS overspent across the board because it couldn’t do the limitless amount the Blair government expected of it. Each crisis began to be sorted only when the government of the day finally accepted there was problem, and that ministers had to play a leading part in solving it. And so will this one.
Theresa May and Jeremy Corbyn clash over NHS at first PMQs of 2017
My own experience taking on and turning round three different “failing” hospitals taught me that failure occurs when those responsible for poor performance can’t or won’t face up to the reality and instead present it as merely “challenging”. This government describes a service that is being financed as requested, struggling to meet surprising “record” demand but “mainly” coping reasonably, as (it thinks) NHS England confirms, and which would cope well if the resources diverted to thoughtless people who aren’t very ill were used to support the truly needy.
The reality is starkly different. Senior NHS staff know it but keep quiet because they risk being sacked if they speak out. Demand is rising steadily, in line with long-term predictions, at up to 5% a year, so there is no justification for any surprise. On the other hand, waits are rising up to 20 times as fast, which should be cause for alarm. NHS England’s most recent quarterly figures for major A&Es show an increase in attendances of under 5% and an increase of over 70% in waits of more than four hour in a year. Astonishingly, that the numbers waiting more than four hours increased by more than the number of patients, so fewer patients were seen within four hours than a year previously. If these rates of decline continue, the NHS will simply keel over.
Jeremy Hunt: up to 30% of people using A&E departments do not need emergency care
What capacity exists is increasingly silting up as patients are unable to move from one part of their care to the next because there is no room. Because they are stuck where they don’t need to be, they prevent the next (sicker) group of patients from getting the care they need promptly, a classic downward spiral. To make matters worse, capacity is actually being reduced in social care and the NHS – the result of a financial settlement for this parliament with minimal growth and an assumed £22bn of savings. As his Commons appearance last week revealed, the NHS England chief, Simon Stevens, now realises the settlement was insufficient from the outset.
The capacity shortfall has little to do with the “thoughtless 30%” so excoriated by Jeremy Hunt for turning up unnecessarily at A&E. May’s suggestion, making already overwhelmed GPs work longer hours, completely misses the point, and suggests she does too. It would obviously help a bit if some of the 30% didn’t turn up unnecessarily, but it wouldn’t create capacity where it is currently lacking. The real problems relate to blockages in treating those who are really ill and in immediate need of treatment, and those who need further support in their own home or a care home, to make their discharge from hospital possible. These are the problems May must turn her mind to.
The best report on the NHS in the last 30 years, chaired by Sir Roy Griffiths, memorably said: “If Florence Nightingale were carrying her lamp through the corridors of the NHS today she would almost certainly be searching for the people in charge.” Yet today, three decades on, no one is in charge of the NHS. So much time is spent buck-passing and cost-shifting for problems that require concerted action.
In the meantime, ballooning wait times prejudice safety everywhere, on occasion with disastrous and fatal consequences. This is what “mainly” coping really means. And as the delays increase, so will these consequences.
The biggest crisis facing the NHS is that, no matter how high or low the funding, transformational change fails to happen. It is easy to justify why reform is so slow and patchy currently, but neither did it happen in the years following the NHS Plan in 2000, when the annual real funding increases were among the highest in NHS history.
The same promises were made – risk stratified prevention, involving people in their own care, a digital revolution, a massive expansion of primary care. Waiting lists tumbled, A&E treatment times were slashed and there was huge capital investment, but the underlying shape of the service remained largely unchanged.
That history is one reason why the Treasury is so resistant to injecting more cash. After the NHS England chief executive, Simon Stevens, appeared in front of the Commons public accounts committee this week former permanent secretary Nick Macpherson tweeted: “NHS bottomless pit. Money should be linked to reform.”
Nick Macpherson (@nickmacpherson2)
Simon Stevens a good guy but he should not determine health spending. NHS bottomless pit. Money should be linked to reform. #soundmoney
January 11, 2017
In other parts of the public sector, the current “burning platform” of sustained and substantial real-term funding cuts has driven major restructuring. Councils have been merging management teams and back-office systems, selling buildings and consolidating staff in fewer centres and engaging with the public online rather than face-to-face. This is been delivered by facing up to tough decisions and planning ahead, knowing that they have to break even each year.
But there is a difference between tight control of public spending and setting the NHS up to fail. Undermining prevention by cutting public health budgets, driving people to A&E through inadequate primary care, and stopping hospital patients returning home by eating away at real-term social services spending for seven years is a triple assault on the NHS that is overwhelming the system. Add in the efficiencies – cuts – being driven through the payment system and the pressures become intolerable.
Our health spending as a proportion of our national wealth has always been low. According to the Health Foundation, we would need to increase our spending as a proportion of GDP by around 10% to catch up with France and Germany. Health spending should be seen as an investment. Mental health services in particular have a direct economic benefit.
More cash is needed to break the vicious circle. The vortex of acute sector deficits is sucking in funds from the rest of the system, undermining precisely the developments that can help to avoid emergency admissions. It has swallowed up virtually all the money intended for service transformation. Beyond this, cuts to local government funding for social care and public health need to be reversed.
Leaving aside the politics of the health secretary, Jeremy Hunt, trying to wriggle off the four-hour A&E target by applying it only to the most serious cases, it is the right move for the health service. When the entire system is under such pressure there is no sense in prioritising rapid treatment of minor ailments.
But Nick Macpherson is right. More money has to be linked to reform. Numerous hospitals are still failing on basics such as effective management of patient flows through the hospital, driving efficiencies in A&E and on wards, managing their estates and driving down the cost of back-office systems – including by outsourcing.
Too few managers and clinicians have the skills to design and implement improvements to care pathways. Simple ideas that have been around for years such as social workers stationed in A&E to divert older people from hospital admissions are still under-exploited.
The NHS and the rest of the health and care system desperately needs more cash, but this cannot be swallowed up in funding business as usual. Firm commitments need to be made and kept across the hospital sector to ensure organisations are as lean and efficient as possible. That is the only way to ensure the endlessly discussed investments in primary, community and mental health care are finally delivered.
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For a man who has boasted about his record of enthusiastic manual engagement with the public, Donald Trump is shy about grabbing women – or anyone – by the hand. Or at least he was. In his 1997 book The Art of the Comeback, Trump called hand-shaking “one of the curses of American society”, adding: “The more successful and famous one becomes, the worse this terrible custom seems to get. I happen to be a clean hands freak. I feel much better after I thoroughly wash my hands, which I do as much as possible.”
If Trump has spent the past year furiously cleaning those little fingers (he was an outwardly keen gladhander on the presidential campaign trail), then he is more discreet than Robbie Williams. In a clip that went viral faster than an outbreak of E coli on a cruiseship, the singer was captured grimacing and using hand sanitiser after a New Year’s Eve singalong of Auld Lang Syne. A subsequent Instagram video, in which Williams does the same thing after wishing a woman Happy New Year, suggests he might have been joking, but how concerned should a public figure be about contact with the great unwashed?
Sarah Wollaston ought to know. The GP-turned-MP and chair of the health select committee confirms that some bacteria and viruses can pass between hands, and points out the importance of handwashing in the bathroom and before eating. “But it would never occur to me not to shake hands with someone because I was worried about my health,” she adds. “And if you’re worried about that kind of thing, you probably shouldn’t be a politician.” Wollaston says decades of medical practice have made her “bomb proof”, but advises all MPs to take the precaution of getting a flu jab.
Ann Widdecombe calls concern about handshaking “an absolute nonsense”. En route to a Caribbean cruise, where she is similarly blase about bacteria, she adds: “What an attitude to take. You might as well worry about shaking hands with people in church when doing the peace.”
Special advisers say politicians can be wary. “I know several people who have kept hand sanitiser in the car to use after a really big door-knocking session,” says Ayesha Hazarika, who worked with Ed Miliband among others. She won’t name names. Nor can she recall encountering germ freaks, but says the former Labour leader was a genuinely enthusiastic gladhander. “Let’s be honest, we weren’t blessed with brilliant photo ops, but Ed loved dashing into a crowd and shaking hands and chatting away,” she says. And no, he didn’t have a secret stash of sanitiser, she adds.
Trump and Williams are not alone in being, or playing at being, paranoid. British athletes were advised not to shake hands during the 2012 Olympics, for example. But the president-elect’s fans should be warned: while fist bumps have been recommended as a more hygienic alternative to the handshake, a team including members at the London School of Hygiene and Tropical Medicine recommended in 2007 that the least risky greeting was … a kiss. Presumably without lips.
The last 12 months have been the worst in the history of the NHS. Our health system is under pressure like never before. The moment of crisis many warned of has arrived, and it is not clear that the NHS can be retrieved from this state of affairs.
We used to say that flailing A&Es represented an early warning sign that the health service was under pressure. And so that has proven to be. England’s major A&Es are under record strain with black alerts being regularly sounded, and in some instances wards turning patients away. Last year the A&E crisis spread to other sectors.
Ambulance response times have reached critically low levels, with one third of ambulances failing to meet their targets for life threatening callouts. The acute care sector is bulging with unnecessary admissions particularly from over-75s who are presenting themselves at A&Es when they should be cared for by the social care sector that has suffered £5bn of cuts.
In the community, general practice is on life support; as more is demanded of it, the proportion of the NHS budget that goes to primary care has effectively shrunk. Primary care provides 90% of the consultations in the NHS yet only gets 8% of the budget. GPs are leaving, and new entrants are declining to enter general practice.
We once bickered with the Treasury for clawing back millions in Department of Health underspend under Labour. Under the Tories, that is a distant memory as NHS trusts recorded a deficit in excess of £2bn last year.
A government elected to fix near-bankrupted banks has replaced that by bankrupting our hospitals. Idiotic spending decisions in the NHS have been rife.
The most worrying aspect of the government delivering the lowest additional funding increase to the NHS in its history has been the knock-on effect on patients, in terms of treatment and facilities available. More than 13,000 beds have been closed, cutting the capacity of the NHS by 5 million a year.
So bad was 2016, that nine former health secretaries condemned the government for failing to live up to its promises on mental health.
Commissioners and providers alike have had to resort to rationing care to try to balance their books. Unfortunately, this is not always to the benefit of customers or patients.
As the health service’s budget faces greater pressure than before, it is difficult to ignore the toll the intrusion of the free market has taken. Last year, £13bn of healthcare was purchased from non NHS providers (pdf), a 76% increase since 2010. Given that the private sector has a stated goal to make 8%-14% profits from the NHS, can taxpayers really afford this choice?
While the NHS has increased the cash it takes from the private sector by 30% to £558m last year (pdf), waiting lists have soared to an eight-year high. Now, 4 million patients are on waiting lists. This in effect means NHS patients are being delayed in their treatment to make way for wealthy private patients who can afford to skip the queue.
The pressure on our staff has also reached unprecedented levels. Nurses have seen real-term pay cuts since 2010 of over £2,000. Moreover, aspiring nurses will also be denied a bursary to train and this at a time when unfilled nursing vacancies have climbed 600% since 2010. It will not surprise you to learn that applicants for trainee nursing courses have fallen 20% this year.
Likewise, the pressure on junior doctors remains intense. They too have seen real-term pay cuts, as well as an enforced contract.
It remains impossible to meet the demands of the ill-described seven-day NHS until serious funding issues have been resolved, otherwise we are asking our doctors to shoulder the blame for unsafe care.
The continuing media war Jeremy Hunt has waged against doctors has so depleted workforce morale that there are more doctors wanting to leave the NHS than are in training.
It will take a political will only witnessed twice in the last 70 years, 1948 and 1997, to alter the current trajectory on which the NHS is set. The £22bn of efficiencies (a euphemism for cuts), dressed up as sustainability and transformation plans smacks of what was tried with the Nicholson challenge. The National Audit Office has warned that these efficiencies are not possible without causing lasting damage to the NHS’s ability to provide safe care.
We are at a cliff edge. Do we carry on into the unknown with broken funding promises and more cuts or do we cry foul now, and demand a rethink before it is too late?
Let’s pledge in 2017 to fight for its survival. The NHS belongs to us, not the politicians and not the privateers. We cannot trust the government to be its safe custodian. It’s up to each and every one of us to fight for the NHS, otherwise it won’t be there to look after us, never mind the next generation.
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Last year was characterised by sudden, unpredicted change. Some certainties unravelled overnight, as polls turned out not to reflect votes, others had been building for some time.
The crisis in health and care services is being dangerously accelerated by cuts, but you can trace its roots back to decades-old failure to take seriously the ever-growing gap between what services can deliver and the growing demands on them. It is easy to believe that all the future holds is the loss of services. But the future will be whatever we choose to make it.
There is a time for tweaking and refining the existing model, but perhaps the middle of the widespread collapse of health and care services is not that time. We need significant central government investment to avoid crisis becoming catastrophe, but then what?
Sustainability and transformation plans (STPs), which were the big headline of NHS change in 2016, are for the most part prime examples of how we lack a model for radical change in public services. They are the system responding to crisis by doing what we always do – just faster, at bigger scale and with more anxiety. The more urgent and important the work, the less leaders feel able – or obliged – to involve a wide group of organisations, let alone people who use services and their families.
Most STPs express what leaders were already intending to do, with little of the involvement of new people that would have led to new aims, approaches and behaviour. Lack of collaboration has bred suspicion, but they are not the secret cuts plans they have been dubbed: they are more likely to avoid talking about cuts that have been inevitable for years.
Where they say the right things about community-based care or prevention, many are essentially works of fiction with no model for the culture, power and economic changes needed.
There is much talk of scale in public service delivery, but nearly always this is the industrial age’s need to operate in large units. Our large organisations, silted up with the governance requirements that must accompany any big budget, are not the place where change will happen.
The real challenge is to scale those bureaucracies down to be human and family-sized again. The lesson of successful models – such as personal budgets, Shared Lives, community enterprise, Buurtzorg, local area coordination and Homeshare – is that we avoid the prototype-then-replicate approach and instead create enough infrastructure for people to form similar but entirely individual relationships everywhere. This is the scaling model of the internet age.
The only kind of change you can make happen suddenly, on a large scale, is destruction, whereas creation of anything real and valuable starts small, but ambitious. For real change to take hold, you need to involve people who don’t always agree with each other and you need a tolerance for messiness: the neater the plan, the more fictional it is.
There many kinds of people who care about each other and who already change the world around them: hundreds of Homeshare households, thousands of community entrepreneurs, 10,000 Shared Lives carers, tens of thousands of timebankers and millions of unpaid family carers. Can those overlooked groups join together, gradually and messily, to become a national movement that chooses to build a better, more human future? Do we still have time?
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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.
Theresa May’s decision to single out Ealing for attack on adult social care at prime minister’s questions is bizarre and unfair (Councils can get social care cash early, says PM, 15 December). Despite significant funding pressures, Ealing council has one of the best re-ablement services in the country, with 93% of older people who use this service still at home three months after hospital discharge, a record we are proud of. Ealing works closely with our local NHS to provide a seamless discharge service: our rate of delays to discharge due to social care issues is average, not the worst.
Since 2010, government cuts have led to a reduction in Ealing’s adult social care budget of nearly 20%. The council tax precepts the government has allowed us are sticking plasters by comparison. I’m proud that, rather than levying a precept on Ealing residents, as the prime minister seems to want us to do, our success in growing Ealing’s economy and building homes has provided us with the resources to provide extra social care funding that more than matches what a precept would raise. We’ve allocated £2.3m extra for social care this year, rising to £4m by 2019, along with a £5m transformation fund to redesign services so fewer people need intensive help in future.
Councils, like Ealing, that are innovating, redesigning and delivering high-quality social care in very difficult financial conditions, while not demanding extra money from just about managing local families, deserve Theresa May’s praise, not her censure. Cllr Julian Bell Labour leader of Ealing council
• My Labour-controlled local authority recently announced cuts to its budget of £82m up to 2020 and more than 400 job losses. These are on top of the cuts already implemented of £250m and 2,000 redundancies since 2010. In real terms, the council’s budget will have been cut by 50%. Any small increase to social care funding through higher council tax has to be set in this overall context (Council tax hike considered to cover social care costs, theguardian.com, 12 December).
All over the country, local authorities are facing a similar funding crisis, with accumulating evidence of how vital local services have been decimated and the serious consequences for local communities. No amount of Orwellian double-speak about efficiency savings, partnership working and smart delivery should be allowed to disguise the fact that the loss of skilled workers, the closure of facilities and cutbacks to services are leading to the biggest crisis of local provision ever seen in this country.
It’s time for councillors to reject the logic of imposed austerity. There should be a coordinated campaign by all Labour-led authorities not to set another round of cuts budgets. To the predictable response that the government will threaten to suspend councillors and impose administrators – so what? Nothing could be worse than meekly accepting what is, effectively, the destruction of local government in any recognisable form. They should be leading a campaign to restore real local democracy and funding to provide decent local services. Get up off your knees and fight for the working-class communities you are supposed to represent. Steven Schofield Bradford
• Changes to council tax and the social care precept will seem to many nothing more than a temporary fix. There is real concern about the postcode lottery nature of these tax-raising powers intended to fund our ailing social care system.
While the changes to the social care council tax precept from 2% to 3% over the next two years are welcome, they do not provide additional funding. The government has missed the opportunity to bring forward some of the £1.5bn additional funding for social care through the Better Care Fund already announced for 2019/20.
The most deprived areas in the UK derive the lowest proportion of their income from council tax. The government’s intention in allowing councils to increase council tax is to spread the financial burden of the nation’s rising social care bill. But council tax payers in deprived areas may be less likely to be able to afford the increase, and many of these who are on low incomes will already be paying reduced rates.
The UK has a long tradition of providing care to those who need it most. If that is to continue, the government must invest in a robust social care system that can cater for all based on needs and not on geography. From a taxpayer’s perspective this is a zero-sum game. For every £1 not invested in social care, the cost to the NHS is considerably more. Paul Dossett Head of Public Sector, Grant Thornton UK LLP
• Gaby Hinsliff is right (Do-it-yourself social care only works for the very rich, 16 December). Grown children’s ability to step in where the state fails to care for their elderly parents becomes increasingly decisive. But with the proposed increase in council tax the state is forcing the unemployed to step in. Since April 2013 the unemployment benefits of grown children have been taxed by 259 councils out of 326 in England. Taxation of the weekly £73.10 jobseeker’s allowance/income support/employment and support allowance of single mothers and vulnerable citizens deemed fit for work by the Department for Work and Pensions will now be increased to require the least able to step in to pay for the care of anyone’s elderly parents.
Tenants are also forced to step in by paying not only the increase in council tax but also increases in rent out of their unemployment benefits since April 2013; that is due to the cuts in housing benefit called “local housing allowance”, “single room supplement” or “benefit cap”. Some of them are struggling to pay off rent, council tax, utility and fines arrears that accumulate during the three-month absence of income caused by a benefits sanction.
The supreme court has noted the injustice of taxing benefits in Mosley v Haringey. “Their income was already at a basic level and the effect of Haringey’s proposed scheme would be to reduce it even below that level and thus in all likelihood to cause real hardship, while sparing its more prosperous residents from making any contribution to the shortfall in government funding.” Rev Paul Nicolson Taxpayers Against Poverty
• I have cancer (non-Hodgkin’s lymphoma) and I was recently taken by ambulance to Plymouth’s Derriford hospital with a pulmonary embolism (a blood clot on the lung). I was admitted to A&E around 1am but spent more than 12 hours on a trolley until a bed could be found for me on the medical assessment unit (MAU). I was one of many patients – most were elderly and frail – waiting on trolleys where there was very little spare room for any more. Nursing staff told me that the delay was because the MAU could not find beds on other wards for patients ready for transfer. I was also told this problem was caused by these wards struggling to discharge medically fit older people because these patients needed social care that is not available.
My experience is just one example of the crisis facing hospital services around the country. Patient care is suffering as a direct result of the economically misguided and unjust consequences of this government’s austerity programme. This policy should be reversed by central government providing immediate funds directly to local government to enable an equitable and adequate provision of social care services to free up beds in NHS hospitals and relieve the pressures on A&E services. Nigel Charles South Brent, Devon
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