Millions of Britons could have their access to free health insurance taken away after Brexit, a parliamentary report has said.
MPs on the health select committee urged the government to offer more guarantees for Britons visiting the continent after hearing evidence that without the right to receive treatment in countries that are part of the European Economic Area, people with cancer could find it too expensive to go to Europe.
In a strongly worded report on the effect of Brexit on health and social care, the committee said the challenges created by losing reciprocal health arrangements should not be underestimated.
British travellers can currently use the European health insurance card, which guarantees access to healthcare free or at a reduced cost in Europe. The EU member state providing treatment is able to claim back costs from the patient’s home country. Some estimates suggest that up to 27 million Britons have the cards.
The inquiry heard evidence that losing this agreement could create challenges for many travellers, including disabled people and those with mental or physical health conditions. Prof Martin McKee of the London School of Hygiene and Tropical Medicine said a week’s full private health insurance for a holiday in France for someone with diabetes or mild depression would cost between £800 and £2,500.
The report also noted that hundreds of thousands of expats living abroad could lose reciprocal healthcare rights, leaving some facing hardship. McKee, a professor of European public health, said many Britons in Spain have properties that are now worth little. “Many will come back in a state of poverty because they bought properties in Andalusia and other places … They will be throwing themselves on the mercy of the state when they come back,” he said.
Christopher Chantery, a British resident in France, told the committee many pensioners moved to the country “in good faith on the implicit promise that these arrangements would continue. Suddenly, something happens that brings those arrangements to an end. It is absolutely terrible for many people”.
British nationals living abroad have to get an S1 form, which gives them health cover, paid for by the UK, within Europe.
The committee, which includes Labour and Conservative MPs, called on the government to preserve the existing system as opposed to seeking a new arrangement. What was currently in place offered taxpayers good value for money, it said.
In the same report, the committee warned that the Brexit vote could lead to a brain drain, with morale among EU nationals in the NHS low due to uncertainty about their future. It called for more reassurances and said the government should continue to be able to recruit the “brightest and best from all parts of the globe” after Britain leaves the EU.
The Department of Health could not comment due to general election purdah rules. But when asked about reciprocal healthcare at the start of the year, the health secretary, Jeremy Hunt, said it was one of the rights of those who retired to Spain or France and he wanted to secure it early on in negotiations, but could not guarantee this.
Speaking to the Guardian, Prof Jean McHale, the director of the Centre for Health Law, Science and Policy at the University of Birmingham, said: “If questions of healthcare provision and patient mobility are not included in the negotiations, if there is not a transitional period and we move to hard Brexit, there will be major practical questions. What happens at midnight on Brexit D day to the person in hospital in another EU member state who has been in a car accident?”
Children in Syria are suffering from “toxic stress”, a severe form of psychological trauma that can cause life-long damage, according to a study that charts a rise in self-harm and suicide attempts among children as young as 12.
A report by Save the Children and its partner agencies in Syria paints a harrowing picture of the country’s children, 5.8 million of whom are in need of aid, after a war which reaches its sixth year next week.
Authors of the study, the largest of its kind to be undertaken during the conflict, warned the nation’s mental health crisis had reached a tipping point, where “staggering levels” of trauma and distress among children could cause permanent and irreversible damage.
More than 70% of children interviewed experienced common symptoms of “toxic stress” or post-traumatic stress disorder, such as bedwetting, the study found. Loss of speech, aggression and substance abuse are also commonplace. About 48% of adults reported seeing children who have lost the ability to speak or who have developed speech impediments since the war began, according to the report, entitled Invisible Wounds (pdf).
Mohammed, an aid worker with Shafak, a Save the Children partner in Idlib, said children were in a state of constant anxiety: “We notice that they are always stressed and react to any unfamiliar noise – [such as] if a chair moves or the door bangs – because of their fear of the sound of airplanes and rockets. Children are increasingly isolated and don’t like to participate in our activities, and in the young children we’re seeing a lot of cases of involuntary urination.”
Firas*, the father of Saeed*, three, said: “My son wakes up afraid in the middle of the night. He wakes up screaming. A child was slaughtered in front of him, so he started to dream that someone is coming to slaughter him.”
The majority of children interviewed showed signs of “severe emotional stress” and 78% of them felt grief and extreme sadness some of the time. The study focused on 458 children, adolescents and adults, and was undertaken between December 2016 and February 2017, in seven of Syria’s 14 governorates. It also revealed:
51% of adults interviewed said adolescents are turning to drugs to cope with stress
59% of adultssaid they knew children and adolescents who had been recruited into armed groups. Almost half knew of children working at checkpoints or barracks
One in four children is now at risk of developing a mental health disorder
Of the adults questioned, 60% cited the loss of education as one of the biggest impacts on their children’s daily lives. Since war began there have been more than 4,000 attacks on schools in Syria, according to Unicef.
The interviews, by Save the Children staff, partners and trained psychosocial practitioners, took place mainly in opposition-held areas, including Aleppo, Damascus, Dara’a, Hasakah, Homs and Idlib. The organisation is unable to operate in places held by the government or Isis, but the charity said that issues experienced by children in these areas are likely to be similar. Two-thirds of children had lost a loved one, had their home shelled or bombed or suffered war-related injuries.
In Madaya, which has been under siege since mid-2015, medical staff reported at least six children, the youngest a 12-year-old girl, and seven adults had attempted suicide in just two months.
All children’s focus groups and 84% of adults cited an “overwhelming feeling of being unsafe” as the single biggest cause of children’s high levels of stress.
Hala, a teacher in Madaya, said: “Children wish they were dead, and that they would go to heaven to be warm and eat and play. They wish they would be injured by a sniper, because if they got injured they would go to the hospital and leave the siege and eat whatever they want.”
However, despite the high levels of need, in some regions of more than 1 million people, there is only one psychiatrist.
Alexandra Chen, a child protection and mental health specialist at Harvard University, said that toxic stress is the most dangerous form of stress response, when children experience strong or prolonged adversity without adequate adult support.
“This is likely to have a life-long and devastating impact on these children’s mental and physical health, disrupting the development of the brain and other organs and increasing the risk of heart disease, substance abuse, depression and other mental health disorders into adulthood,” said Chen.
She said that with an end to the violence and with the right support, children can recover.
“However, the child mental health crisis is reaching a tipping point in Syria just as family support structures and official services are collapsing.”
The report called for a ceasefire and for all parties to stop using explosive weapons in populated areas, schools and hospitals, as well as an end to siege tactics, and unrestricted humanitarian access to all areas. It also called on donors to commit to supporting children’s mental health in Syria.
Dr Marcia Brophy, a psychosocial adviser for the Middle East at Save the Children, said: “We risk condemning a generation of children to a lifetime of mental and physical health problems. We need to ensure that children who have already lost six years of their lives to war don’t have to lose their whole future as well.”
Some 13.5 million people inside Syria, including 5.8 million children, are in need of aid, Save the Children said. About 4.8 million people are trapped in besieged and hard-to-reach areas.
At least 250,000 people have died and 4.9 million, 2.3 million of them children, have fled the county, the majority to Turkey, Jordan, Lebanon and Iraq.
Patients could be at risk from online companies offering doctors’ services, the Care Quality Commission has said.
The warning comes after investigators found two firms were putting patients at risk by failing to examine their medical history before prescribing medicines. There were also questions over whether clinicians had the relevant skills or qualifications to prescribe or diagnose illnesses.
The inspectors found there were no processes for contacting a patient’s GP, including when medication was prescribed that required monitoring or a follow-up. The medics failed to check patient identity before prescribing online and there was no way of checking if people lacked the capacity to consent to treatments.
The two online firms were MD Direct (which had traded through the website assetchemist.co.uk) and HR Healthcare Ltd (treated.com). The CQC said its inspection of HR Healthcare was influenced by an investigation by BBC Radio 5 Live, which looked at the site’s online sale of antibiotics.
Following this, the CQC suspended the registration of HR Healthcare Ltd. MD Direct voluntarily cancelled its registration; the site assetchemist.co.uk now uses a different online GP provider for its prescription service.
As well as these two inspections, a review of all 43 online services registered with the CQC revealed others were potentially posing a risk to patients.
The CQC has now brought forward a programme of inspections. It is particularly concerned about sites where patients can choose their own drug and select their symptoms or diagnosis from a drop-down menu. The prescription is then reviewed by a medic and passed to a pharmacist who processes it.
Steve Field, the chief inspector of general practice at the CQC, said: “The growth in online technology presents a real opportunity to improve people’s access to medical advice and treatment. It is important that healthcare services continue to innovate. However, in some cases we have found websites which in effect allow people to select their own medication, including medicines restricted as prescription-only, with little or limited clinical oversight.
“Patients can go online, self-diagnose their condition, order their own medicine and obtain a prescription from the online doctor service, with minimal checks on [their identity] and whether the medication is safe or appropriate for them, often within a matter of seconds. We know there are often inadequate identity checks, no checks on patient history or suitability, no checks with patients’ GPs and no follow-ups or monitoring.
“Following our review of all online services registered with CQC, we will now visit each provider, working closely in partnership with the relevant regulators and checking that providers are following the appropriate professional guidance. We will take action to cancel or suspend the registration of providers who are putting their patients at risk.”
Field said that, as with conventional GP surgeries, online companies and pharmacies were required to provide safe, high-quality and compassionate care. “They must not cut corners,” he said.
A further joint statement from four regulatory bodies – the CQC, the General Medical Council, the General Pharmaceutical Council and the Medicines and Healthcare products Regulatory Agency (MHRA) – reminds firms and their medics that they must provide safe and effective care, and follow professional guidelines.
Lord O’Shaughnessy, the health minister, said: “We have empowered the CQC to run a tough and comprehensive inspection regime and commend their work to uncover failings in digital care provision. Online providers can be a convenient option, but patient safety must always be the priority and we urge the public to follow CQC’s advice when buying medicines online.”
Gerald Heddell, the director of inspection, enforcement and standards at the MHRA, said: “Prescription-only medicines are prescription only for a reason and should only be taken under the supervision of a healthcare professional. A proper consultation with a medical professional is essential to ensure that an appropriate diagnosis of your condition can be made, your medical history can be reviewed, your recovery can be monitored and any adverse reactions can be dealt with.”
The “global gag rule” imposed by Donald Trump, blocking US funds to any organisation involved in abortion advice and care overseas, could impact millions of women and girls, endangering their lives and those of their babies, Bill and Melinda Gates have warned.
The changes are expected to result in funding from the world’s biggest donor to family planning and women’s health programmes in the developing world being slashed. It could, Bill Gates told the Guardian, “create a void that even a foundation like ours can’t fill”.
Gates and his wife spoke out as they published a progress letter to Warren Buffett, the businessman who 10 years ago invested a large part of his fortune in the couple’s foundation which has at its centre the mission to save children’s lives. Empowering women and girls, the couple said, was central to that aim.
Trump signed an executive order reimposing the Mexico City policy, also known as the global gag rule, on his first full day in office. Republican presidents since Ronald Reagan in 1984 have imposed the policy, while their Democrat counterparts have lifted it. The rule strips funds from any organisation that “performs or actively promotes abortion as a method of family planning” overseas.
But Trump’s order goes further, applied to any organisation that receives funding from US Aid , not just those involved in family planning. That expansion, said Melinda Gates, was a surprise.
“We’re concerned that this shift could impact millions of women and girls around the world,” she said. “It’s likely to have a negative effect on a broad range of health programs that provide lifesaving treatment and prevention options to those most in need.
“This includes programmes that prevent and treat HIV, TB and malaria, and provide healthcare to women and children around the world. Enabling women to time and space their pregnancies and providing access to treatment and prevention of infectious diseases is lifesaving work. It saves moms’ lives and it saves babies’ lives, and that has long had wide support in the United States.”
Bill Gates said their foundation would not be able to bridge the potential funding gap. “The US is the No 1 donor in the work that we do. Government aid can’t be replaced by philanthropy. When government leaves an area like that, it can’t be offset, there isn’t a real alternative. This expansion of this policy, depending on how it’s implemented, could create a void that even a foundation like ours can’t fill.”
He had an early phone call with Trump in November and then a meeting in December with the president-elect in New York, he told the Guardian. They talked about the eradication of polio, which Gates hopes could come as early as this year, and the research his foundation is supporting towards an Aids vaccine and ways to protect people from pandemics such as Ebola in west Africa.
“So that was a good discussion – the fact that he was interested in having me talk about the Foundation’s work – I was pleased,” said Gates. But the philanthropist did not anticipate the scope of the executive order affecting family planning, an issue at the centre of the foundation’s work, that Trump was to sign.
Bill and his Melinda Gates with investment veteran Warren Buffett (R) in 2006. Photograph: Nicholas Roberts/AFP/Getty Images
The letter to Buffett is an assessment of the progress the Gates Foundation has made since 2006, when he pledged 10m shares in his company Berkshire Hathaway in annual instalments worth a total of $ 31bn at the time. The couple write of the progress that has been made in saving children’s lives, particularly through immunisation and vaccine development, and the work that lies ahead in making childbirth safer and tackling malnutrition.
Their letter makes clear what is at stake with Trump’s move to reimpose the global gag rule, arguing that women and maternal health are key to so many global health issues.
Empowering women is a key theme of the letter in which the couple argue that enabling women to access contraceptives control over the number of pregnancies they have is crucial. When women have a gap of at least three years between births, their children are more likely to survive and be healthy and well educated, the couple say. “Like vaccines, contraceptives are one of the greatest lifesaving innovations in history,” writes Bill Gates in the letter.
What is the ‘global gag rule’, and why does Trump support it?
Since they set up their foundation its focus has shift from the hunt for technological solutions towards social change. The attention to women’s empowerment came from the evidence, the couple say.
“You cannot go out and be in the developing world and then come back and look at the data and turn away from the importance of women in the developing world,” said Melinda Gates.
Whether they breastfeed and take their children to be vaccinated makes a profound difference to how the child grows and his or her life chances, and men are not always there, she added. “So you have to look at the woman’s role and when you look at it you realise it can be an accelerator to every single thing you want to have happen in the world for global health and global development and social change.”
In their letter, Bill Gates sats that poverty is sexist, a phrase he first heard from the U2 frontman Bono.
“The poorer the society, the less power women have. Men decide if a woman is allowed to go outside, talk to other women, earn income. Men decide if it’s acceptable to strike a woman. The male dominance in the poorest societies is mind-blowing.”
In the letter, Melinda Gates adds: “It’s also crippling. Limiting women’s power keeps everyone poor.”
She and her husband tell of their visits to sex workers in India whom the couple say they encouraged to form self-help groups, thinking the women would help each other insisting their clients wore condoms to protect themselves from HIV. That vision, said Bill Gates, “was way too narrow”. The sex workers began to support each other in every aspect of their lives.
“Warren, if Melinda and I could take you anywhere in the world so you could see your investment at work, we probably would take you to meet sex workers. I met with a group in Bangalore, and when they talked about their lives, they had me in tears,” writes Bill Gates.
“One woman told us she turned to sex work after her husband left her – it was the only way to feed her children. When people in the community found out, they forced her daughter out of school, which made the girl turn against her mother and threaten to commit suicide.
“That mother faced the scorn of society, the resentment of her daughter, the risks of sex work, and the humiliation of going to the hospital for an HIV test and finding that no one would look at her, touch her, or talk to her. Yet there she was, telling me her story with dignity.”
Bill and Melinda Gates receive medals from Obama at presidential medal of freedom ceremony in November 2016. Photograph: Carlos Barria/Reuters
There have been setbacks, such as the failure yet to end polio, but the couple emphasise the enormous progress that has been made in the last couple of decades in global health and speak in the letter of their optimism for the future.
“Polio will soon be history. In our lifetimes, malaria will end. No one will die from AIDS. Few people will get TB. Children everywhere will be well nourished. And the death of a child in the developing world will be just as rare as the death of a child in the rich world.
“We can’t put a date on these events, and we don’t know the sequence, but we’re confident of one thing: The future will surprise the pessimists.”
The government is on course to impose steep cuts in public spending from April and increase taxes by the end of the decade to their highest level as a share of national income since 1986–87 to combat the UK’s persistent budget deficit.
But slower economic growth following the Brexit vote will still leave the UK with one of the largest black holes in public spending in the developed world, meaning the next government must find £40bn to eliminate the budget deficit in the next parliament, according to the Institute for Fiscal Studies.
“For all the focus on Brexit the public finances in the next few years look set to be defined by the spending cuts announced by George Osborne,” said IFS director Paul Johnson.
“Cuts to day-to-day public service spending are due to accelerate while the tax burden continues to rise. Even so the new chancellor may not find it all that easy to meet his target of eliminating the budget deficit in the next parliament.
“Even on central forecasts that is going to require extending austerity towards the mid-2020s. If the economy does less well than hoped then we may see yet another set of fiscal rules consigned to the dustbin.”
The leading tax and spending thinktank said downgrades in GDP growth over the next four years will strain the public finances, which are already on course to be £13bn worse off in this financial year than forecast, after weak growth in tax receipts.
Highlighting the pressure on the chancellor, Philip Hammond, the IFS’s annual assessment of the public finances found that Britain’s ageing population and increasing demands on the NHS will blow a large hole in the government budget over the next two parliaments.
It said: “Demographic and non-demographic pressures are projected to put upward pressure of 1% of national income on health, social care and pension spending by 2025.
“Taking into account possible negative effects from lower growth, the government may need to enact further measures worth £40bn (in 2016–17 terms) in order to eliminate the deficit in the next parliament,” the report said.
Deep cuts in welfare benefits are due to take effect from April alongside cost cutting in Whitehall department budgets. Yet the government still plans to pay for large giveaways in the form of a higher income tax personal allowance at the basic and higher rate and was expected to maintain freezes on fuel duty that totalled £4.5bn a year.
The IFS said the promised spending and slower growth would force the government to implement tougher austerity, even though the chancellor has abandoned his predecessor’s pledge for a budget surplus by 2020.
It said: “Real levels of day-to-day public service spending have actually fallen very little overall in the last three years. The rate of reduction is set to speed up after this year, with cuts of nearly 4% due between 2016–17 and 2019– 20.
“In addition, tax is rising as a share of national income and by 2019–20 is due to reach its highest level since 1986–87.”
It said a deficit in 2016-17 of 3.5% of GDP, or £68.2bn, was £12.7bn higher than the Office for Budget Responsibility, the Treasury’s independent forecaster, had predicted in March 2016.
“This increase was not a result of a downgrade to the forecast for economic growth, but arose as a result of weak growth in tax receipts – in particular, income tax, National Insurance contributions (NICs) and stamp duty land tax – and faster growth in local authority spending,” it said.
Hammond said in the autumn statement last year that he plans to boost public investment spending beyond pre-crisis levels as a proportion of overall public spending, with much of the extra cash to be spent on transport infrastructure.
However, many departments will need to make further savings on day-to-day spending by the end of the parliament.
The IFS said: “Public spending, especially on health, pensions and overseas aid will be higher as a share of national income than in 2007–08, while spending on schools, defence and (in particular) public order and safety will be lower.”
Children’s health in the UK is in jeopardy, with higher child death rates, obesity and ill-health than in much of Europe, according to a landmark report.
“The bottom line is that the UK could do far more to improve child health and wellbeing. UK performance on several measures, though better than the United States, is worse than many European countries,” says Professor Neena Modi, president of the Royal College of Paediatrics and Child Health (RCPCH), in the report.
“Particularly troubling are the stark inequalities in child health that have widened in the last five years.”
The report, published on Thursday, shows that:
The UK has the 15th highest mortality rate for babies under the age of one year out of 19 European countries and one of the highest rates for older children and young people. There are around 130 more deaths of one to nine-year-olds in the UK every year than there would be if it met the European average. The leading causes are cancer, injuries and poisonings, congenital conditions and neurological and developmental disorders.
Smoking in pregnancy, which increases the risk of deaths in babies and disease in later life, is 11% in England and 15% in Northern Ireland, higher than in many European countries and strongly associated with deprivation. The rate is 5% in Lithuania and Sweden.
Breastfeeding rates are low – only 34% of babies are breastfed at all by six months, compared with 71% in Norway.
In England’s most deprived areas, 40% of children were overweight or obese in the last year, compared to 27% in the most affluent.
“We are terribly concerned,” Modi told the Guardian. “What is particularly shocking is that although we’ve known these things for a long time, we are still in a situation where there is such wide health disparity between the most advantaged and the least advantaged.
“The shocking thing is that we know what’s wrong, we know where we stand, we’ve known this for some time but we seem to be absolutely stuck.
“Children are a low priority. In this country children are still not seen. They are not visible. But as a scientist I would say the other reason we’re lagging behind is because the link between child health and adult health and everything that follows downstream from that in terms of the economic prosperity of nations is not adequately recognised.”
Infant mortality in Europe
Children living in the most deprived areas are much more likely to be in poor health, be overweight or obese, suffer from asthma, have poorly managed diabetes, experience mental health problems, and die early, the report shows.
“Poor health in infancy, childhood, and young adult life will ultimately mean poor adult health, and this in turn will mean a blighted life and poor economic productivity. The UK is one of the richest countries in the world; we can and must do better, for the sake for each individual, and that of the nation as a whole,” said Modi.
Sarah Toule, head of health information at World Cancer Research Fund, agrees:“We strongly support RCPCH’s call on the government to close the poverty gap and improve our children’s health and future.”
The report calls for child health to be pushed high up the government’s agenda, as a cross-departmental issue. Each government – Scotland, Wales, Northern Ireland and England – should develop a child health and wellbeing strategy and consider children’s health in all policymaking.
The college also calls for a broadcasting ban on adverts for high fat, sugar and salt foods before 9pm, support for breastfeeding and minimum unit pricing of alcohol – which would help make strong drinks unaffordable for children and young people. In addition, the college want the public smoking ban extended to schools, playgrounds and hospitals.
The call for action was backed by the Obesity Health Alliance, a coalition of over 35 leading charities, Royal Medical Colleges and campaign groups, who said: “We must take bold action now by bringing in measures like the soft drinks industry levy, reducing the sugar, saturated fat, and salt from everyday foods and restricting junk food marketing to children to give us a fighting chance to help make our children healthier now, and in the future.”
The Child Poverty Action Group also applauded the report’s recommendations. “The Royal College’s report demonstrates all too clearly how poverty in the UK is jeopardising children’s health,” said Alison Garnham, chief executive.
“We are nowhere near where we should be on children’s wellbeing and health given our relative wealth. In the face of a projected 50% increase in child poverty by 2020, this report should sound alarms. It is saying that unless we act, the price will be high – for our children, our economy and our overstretched NHS which will take the knock-on effects.”
A cross-governmental approach, considering child health in every policy, was the right one, Garnham said. “But the overall question the report raises for our prime minister is will she continue with the deep social security and public service cuts she inherited – to the detriment of our children’s health – or will she act to ensure that families have enough to live on so that all children get a good start? If other comparable countries can produce results that put them in the top ranks for child health, why not us?”
A Department of Health spokesman said: “We are determined to tackle health inequalities and help children and families lead healthier lives. To help, over the next five years we will invest more than £16bn in local government public health services.”
Public libraries’ significant role supporting the mental health of young people risks being undermined by swingeing budget cuts forced on local authorities, the head of their professional body warned this week. He added that, if funding is not protected, the work of libraries as frontline information resources for young people in need will be pushed on to the already overstretched police, health and social services.
It is estimated that one in 10 UK children experience mental health problems, as do one in four adults. Nick Poole, head of the Chartered Institute of Librarians and Information Professionals (Cilip) providers, told the Guardian that cuts to local library services would “continue to bite the availability of dedicated resources such as advice on anxiety, stress, exams and bullying”.
He warned: “Under-investing in our libraries simply pushes costs elsewhere and means that a young person growing up today has less help and is more vulnerable to the impact of mental health problems on their life.”
His comments follow prime minister Theresa May’s announcement this week of a raft of measures to “transform” attitudes towards mental health, including an extra £15m for community care, extra training for teachers and improved workplace support.
Wellbeing initiatives run by libraries around the country include the Association of Senior Children’s and Education Librarians’ autism–friendly libraries, the Cilip-backed reading for pleasure and empowerment scheme as well as yoga and mindfulness sessions run as part of Oldham libraries’ mental health and wellbeing support. Birmingham, Devon and Bolton city councils are also among library authorities that run dedicated mental health services.
I would like to think that the powers that be recognised the role of libraries in helping vulnerable people.
The Shelf Help scheme, which is dedicated to children and young people and was launched in 2016 by the Reading Agency, provides a list of 35 books selected by mental health experts and young readers that range from self-help and information guides to comics, memoirs and novels including The Curious Incident of the Dog in the Night-Time by Mark Haddon and The Perks of Being a Wallflower by Stephen Chbosky. Subjects covered range from body image to depression and self-esteem.
Suffolk library authority said that 68% of the books on the scheme had a 30% or higher loan status than other stock. Last year, 10,000 wellbeing inquiries were handled by the county’s libraries. Although it did not have an official breakdown of who sought help through its branches, Sarah Lungley, mental health and wellbeing coordinator, said anecdotal evidence suggested that the majority of enquiries came from concerned parents of young people experiencing difficulties.
“We are in a really good position to connect people to the help and services that they need,” Lungley said. “I would like to think that the powers that be recognised the role of libraries in helping vulnerable people. A lot of people in the community who struggle with mental health will be left vulnerable and lonely if their local library shuts.”
Poole added: “Children, young people and their parents are simply going to find it harder to find a well-stocked library where they can find information about the issues they face.” Without access to professional librarians trained in mental health resources, he said, those struggling would be more reliant on unmediated internet searches to gain information. “As a parent myself, I would be worried about my children using Google like that.”
Public libraries have been caught in the crossfire of a ferocious funding battle being fought between local councils and central government. Official figures released at the end of 2016 revealed that library budgets had fallen by £25m in a year, as a result of councils raiding their resources to shore up frontline services such as social care.
According to an annual survey of library authorities in the UK undertaken by the Chartered Institute of Public Finance and Accountancy (Cipfa), total expenditure for the sector fell from £944m to £919m over the year, a 2.6% fall. Over the same period, 121 libraries closed, taking the total number open down to 3,850.
Before Christmas Poole predicted that over the next five years, a further 340 libraries will face closure if proposed cuts go ahead. Libraries in Warrington, Lancashire, Edinburgh, Denbigh and Swindon are among those facing the most severe losses.
Poole said: “We have to find a way of making our political stakeholders understand that a big part of what libraries do is making sure that people with a whole range of issues feel safe and can access information.
“If we remove that function from communities, all you are doing is pushing those library users on to the police and healthcare professionals. If Theresa May isn’t aware of that, her comments are nothing more than an empty soundbite.”
‘The library was a calm, quiet and safe place for me to be’
Fifteen-year-old Josh is adamant that his local library has saved his life. A year-and-a-half ago, school felt like a prison for him, as he struggled to keep up with his classmates due to a variety of issues including severe anxiety and Irlen syndrome, a problem that affects his ability to read and process information. He was also suspected to be on the autism spectrum.
Two years earlier, anxiety attacks and vulnerable feelings had begun to make him dread each school day. “School became an oppressive place to be,” he says. “I was scared and upset and everything just became too much. Everything made me worried and afraid.”
The troubled teen was not a victim of bullying, but the normal noise and chaos to be found in any classroom were a daily nightmare he had to confront.
Only one place made him comfortable: his local library. “The library was a calm, quiet and safe place for me to be,” he says.
Already a regular user, Josh welcomed the available support and guidance when he needed it. Based in a deprived part of Suffolk, his library benefits from a coordinated county-wide health and wellbeing policy funded by the Mental Health Pooled Fund, which is a combination of Suffolk County Council and Suffolk’s Clinical Commissioning Group.
He was eventually allowed to swap school days for days in the library – and the impact on his learning has been considerable: “Because I don’t have to go into school much, I use the library to do my revision. It’s quiet and I find it much easier to study. I am relaxed and calm when I am working because I can take as much time as I want without being constantly rushed.”
When stuck on a difficult maths or English problem, librarians are at hand to guide him towards answers. “They have really supported me,” he says. “They are always there to talk to and help me through a basic part of a question and then will find me a book to help me with the rest. It has given me a lot more confidence.”
A sign of how positive an experience it has been for Josh is that he has now begun volunteering, leading groups of eight to 12-year-olds who have been bullied by older children. “I wanted them to get off the street and come into the library and have a safe space to be,” he says. His idea was to set up an after-school club; by the end of 2016, 20 children were attending every Wednesday.
“It’s great,” says the teenager. “It has given them their own space where they aren’t being picked on by the older children. Before it was a struggle to talk to people because it really scared me. But now I am much more calm and confident.” He smiles: “I seem to be smiling a lot more and am feeling a lot better about life.”
The NHS is facing a “humanitarian crisis” as hospitals and ambulance services struggle to keep up with rising demand, the British Red Cross has warned, following the deaths of two patients after long waits on trolleys in hospital corridors.
Worcestershire Royal hospital launched an investigation on Friday into the deaths and did not deny reports that they had occurred after long waits on trolleys in corridors over the new year period.
On Friday, doctors’ leaders warned that more patients could die because of the chaos engulfing the NHS.
The deaths prompted claims that the health service was “broken”, and long waits for care, chronic bed shortages and staff shortages were leading towards what the head of Britain’s A&E doctors called “untold patient misery”.
It is believed that one woman died of a heart attack after waiting for 35 hours on a trolley in a corridor, and another man suffered an aneurysm while on a trolley, and could not be saved.
It is also believed that another patient was found hanged on a ward at the same hospital, which admitted that it was under serious pressure, partly as a result of the extra strain hospitals face during winter. The deaths are said to have happened between New Year’s Day and Tuesday 3 January.
Many other patients who visited Worcestershire Royal hospital this week told the Guardian of long waits in A&E, corridors lined with patients, and overstretched staff doing their best to cope.
Dr Mark Holland, the president of the Society for Acute Medicine, said: “For a long time we have been saying that the NHS is on the edge. But people dying after long spells in hospital corridors shows that the NHS is now broken.
“We have got to the point where the efforts of staff to prop up the system are no longer enough to keep the system afloat. We are asking NHS staff to provide a world-class service, but with third world levels of staffing and third world levels of beds.
“That so many other hospitals in England are facing the same pressures as the one in Worcester means that other fatalities could occur. I would suggest that the same thing could happen in other hospitals, because lots of hospitals are under the same pressures.”
It is also possible that mainly frail elderly patients admitted to hospital over the festive period may have died because they received inadequate care on wards where staff were ill-equipped to deal with their conditions, Holland added.
“At the moment, we have lots of patients in the wrong beds in hospitals. That is, patients admitted as an emergency, but who do not need an operation, being looked after on wards that usually look after patients with surgical care needs,” he said.
“They may not have nurses with the right skill mix or the same level of dedicated medical cover [as general medical wards], so we know that these patients often don’t get the same level of care. Therefore I fear that during the Christmas and new year period, people in non-specialist beds may have come to harm.” Holland added that he could not estimate how many may have died as a result.
Fifty of England’s 152 NHS acute hospital trusts were forced to declare an alert last month, and sometimes temporarily scale back the level of care they offered to patients, because they could not cope with the number of people seeking medical attention, according to analysis by the Nuffield Trust health thinktank. Every hospital in Essex has had to go on “black alert” – the NHS’s highest level – in recent weeks.
In December, seven trusts had to declare the highest level of emergency 15 times, meaning they were unable to give patients comprehensive care. Paramedics have told the Guardian they have had to wait for up to eight hours at a time outside A&E units to discharge a patient into the care of hospital staff, because emergency departments cannot accept any more admissions, thereby lengthening 999 response times.
Dr Taj Hassan, the president of the Royal College of Emergency Medicine, said figures it obtained from hospitals across the UK showed some were treating as little as 50%-60% of A&E patients within four hours, far below the 95% target.
“Figures cannot account for untold patient misery,” he said. “Overcrowded departments, overflowing with patients, can result in avoidable deaths.” Hassan and Holland blamed the government’s underfunding of the NHS and social care systems for contributing to hospitals becoming worryingly full.
“The emergency care system is on its knees, despite the huge efforts of staff who are struggling to cope with the intense demands being put upon them. The situation is intolerable for both staff and patients, who are all too often left in the undignified position of waiting on a trolley in a corridor for a bed to become free,” said Hassan, who is an A&E consultant at two hospitals in Leeds.
Separately, the London Ambulance Service is looking into the possibility that problems when its IT system crashed on New Year’s Day contributed to the death of at least one patient. Staff had to make paper records of 999 calls in what one ambulance crew member described as “a shambles”.
The latest official NHS performance figures, released on Friday, showed that A&E units across England were forced to divert patients to nearby hospitals 57 times over the Christmas period. In addition, 34 hospitals said they had experienced major problems coping with demand.
The NHS is facing “potentially the worst January” ever as it struggles to deal with the backlog of patients occupying beds over Christmas, a leading doctor has warned.
Dr Mark Holland, president of the Society for Acute Medicine (SAM), said hospitals had already seen large numbers of elderly patients over the festive period and that the health service was on the brink of a major crisis.
Holland, who is based in Manchester, said hospitals were operating under a “false sense of security” as elective procedures dipped during the Christmas period with those beds becoming available for emergency patients.
Once routine operations start up regularly this week, hospitals must make these allocated beds available again. A bout of flu, the winter vomiting virus, or even a cold snap, could prove the tipping point, he warned.
He said the service was going to face the health equivalent of the “credit card bill from hell” after the festive period and called on the government to announce its contingency plans for a “possible worst-case scenario”.
Holland, who leads the national body for acute hospital staff, told the Press Association: “There’s this problem over Christmas and New Year where actually, because you get this glut of beds that become available, you’re just building trouble up for ourselves in January.
“And then … when the flu kicks in, if the winter vomiting virus kicks in, which would potentially close a ward, or if there’s just a cold snap – when any of these things occur we will be under more pressure, but actually we’ll still be spending most of January trying to clear the Christmas and New Year backlog.”
This year January could be “one of the worst we have faced” due to record numbers of elderly patients who cannot be discharged because they are waiting for social care, he said.
Using an analogy of Christmas spending Dr Holland said it was down to the balance of beds within hospitals. “Imagine, at the end of January, we are going to get our credit card bill for Christmas,” he said.
“However, this January its like we’ve not paid last month’s credit card bill, we’ve not paid November’s credit bill, and over Christmas we’ve gone out and had a really good spend. The credit card bill we are going to get from January is just the credit card bill from hell … it’s going to be the worst ever credit card bill for the NHS.”
There were currently “too many unknowns to tell us if we will be able to get through January and avert a major crisis”, he added.
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.”
Real progress in driving down infections and deaths from malaria will be at risk if substantially more funding is not forthcoming, according to the latest annual report on the epidemic.
Last year, more than 400,000 people (pdf) – mostly small children and pregnant women – died from malaria. Insecticide-impregnated bed nets to sleep under and effective drug treatments have brought the number of deaths down by nearly 30% worldwide in the five years from 2010 to 2015; the number of new cases over the same period is down by more than 20%. But the report, published by the World Health Organisation, shows there are substantial gaps in the coverage.
Some countries such as Sri Lanka and Kyrgyzstan have eliminated malaria and the WHO says the target of elimination in ten countries by 2020 will be met. Last year at least ten countries had 150 cases or fewer and nine more had between 150 and 1,000.
But the task of reducing the toll of malaria in the heavily endemic countries of sub-Saharan Africa, which have 90% of cases and 92% of deaths, is hard and needs more resources, says the report.
“We are definitely seeing progress,” said Dr Pedro Alonso, director of the WHO Global Malaria Programme. “But the world is still struggling to achieve the high levels of programme coverage that are needed to beat this disease.”
On the positive side, more children are being tested to determine whether they have malaria, so that the treatment is effective, and more pregnant women are being given drugs to prevent them getting malaria.
But an estimated 43% of the population of sub-Saharan Africa was not protected by nets or indoor spraying to kill the mosquitoes that transmit the disease last year. A third of the children with fever in 23 African countries were not taken to a health facility where they could be tested and appropriately treated.
While funding went up steeply between 2000 and 2010, it has flatlined for the last five years. It is estimated that $ 6.4bn (£5bn) per year is needed to keep the global malaria elimination efforts on target in 2020, but in 2015 it was only $ 2.9bn, or 45%. A third of that is provided by the governments of countries where malaria is endemic. Last year the US contributed 35% of the total and the UK put in 16%. The report says that substantially more money is needed both from international donors and from the affected countries.
“If this flatlining remains, we will not be able to achieve the ambitious goals and targets the world agreed on a year ago,” said Alonso. In 2015, the World Health Assembly adopted a global technical strategy for malaria, with milestones every five years until 2030. It calls for a 40% reduction in malaria cases between 2015 and 2020. Only 40 of the 91 countries with endemic malaria are on track to achieve that.
As a mother, award-winning author and licensed psychotherapist, I advise parents to prepare homemade recipes this Thanksgiving. When treating moody, hyper, anxious, sleepless and unfocused children, it is imperative to improve nutritional status and avoid chemicals. Although appearing easier, convenient holiday foods can derail plans for a pleasant holiday get-together.
This is because processed food contains preservatives,artificial food dyesand neurotoxic chemicals, which can cause bad behavior.
The Ills of Instant Foods
My book titled, Healing Without Hurting reveals that instant foods are loaded withfood additives, which cause and aggravate ADD/ADHD and behavioral symptoms. The chemical ingredients found in instant potatoes and instant stuffing mixes affect the nervous system and often make brain fog and hyperactivity worse. They are loaded with preservatives such as sodium bisulfate, BHA/BHT, and MSG. They also contain hydrogenated “GMO” soybean oil and corn syrup, maltodextrin (sometimes wheat-derived, causing concern for people with gluten intolerance), and dairy. Instant mashed potatoes and stuffing also include high sodium content and artificial flavors.
Well known Food Babe blogger Vani Hari agrees. Her blog post about the chemical horrors in classic Thanksgiving meals discusses the harmful effects of Sodium Bisulfite, BHA and many of the other preservatives found in Betty Crocker’s Creamy Butter Potatoes, Hungry Jack’s Mashed Potatoes. She writes, “No one should be consuming BHA. It is linked to cancer, fertility issues and kidney problems. It is also considered a carcinogen by U.S. Health and Human Services. Yet the FDA still allows it in our food.”
As we can see, trying to save time and money is backfiring on us in a huge way. Our health is at risk. Not only causing mental health issues, but many diseases as well.
The Problem Continues
We then turn to potentially dangerous medication to address our symptoms. Medication that contains even more chemicals. This only adds to our toxic burden, which causes more symptoms. Thus, the vicious cycle continues. Therefore, it is important that we leap out of the confides of conventional thinking and begin exploring other options. We must learn the benefits of healthy eating, nutritional balancing, Eastern Medicine practices like acupuncture, juicing, and plant medicine.
In fact, most people don’t realize that all medications are derived from plants, trees, stems, roots and leaves. Scientists recreate nature in a lab, add chemicals and call it medication – Hence the side-effects. It is time we return to tradition.
The Solution
It is time to begin buying whole food ingredients and cooking healthy meals instead of relying on boxed food. Let’s start this Thanksgiving!
I challenge everyone that was planning on opening a box this Thanksgiving, to check out these easy homemade recipes instead. And, I also encourage everyone to read my book.
Healing Without Hurting is easy an easy read that uplifts and inspires. It offers non-pharmaceutical solutions that work. A finalist in in the 2015 USA Best Books competition in the category of Health: Alternative Medicine, and was rated #1 in New Releases – it is a must read.
One mom writes, “I bought this book and I couldn’t put it down. My son is now medication free and happy for the first time. He is now back in mainstream school thanks to this book.” Another mom writes, “These treatments significantly enhanced the life, health and happiness of my children, and their symptoms disappeared.”
“Pure excellence! If you are a family with a special needs child, this book will give you the answers you are looking for. A story of hope, a story of recovery – a story that should be shouted from the mountain tops. You can have your child back!” wrote Dr. Jared Skowron, Defeat Autism Doctor and best-selling author of 100 Natural Remedies for Your Child.
Healing Without Hurting: Treating ADHD, Apraxia, and Autism Spectrum Disorders Naturally & Effectively without Harmful Medication tells a true life success story and offers a well-researched, comprehensive step-by-step guide for parents, teachers, therapists and caregivers. It speaks directly to affected parents and provides natural and effective alternative solutions to toxic medications and focuses on the considerable impact of diet and nutrition.
Watch out for special deals on Black Friday and Cyber Monday promotions on Amazon and Barnes & Noble.
Soaring rates of multidrug-resistant tuberculosis have been found in west Africa, with the highest in the dense population of Lagos, Nigeria, suggesting the seriousness of the epidemic has been considerably underestimated.
Until now, the World Health Organisation has had to rely on estimates for MDR-TB in west Africa because the data has not been collected or reliable. But a new surveillance network across eight countries in the region has found that drug resistance is a much greater threat than had been assumed.
The WHO had estimated that up to 2% of new TB infections in west Africa were resistant to drugs, but the researchers found the true rate was 6%.
The rate among people who had already been treated for TB was much higher: the WHO had estimated 17% of these infections in west Africa were resistant to drugs, but the network has found the average is 35%.
The hotspots are in Lagos, Nigeria’s largest city, where 66% of people previously treated for TB have a drug-resistant strain. Among people treated for TB for the first time, nearly a third – 32% – had a drug-resistant strain.
In Mali, the researchers found that 59% of people previously treated for TB had drug resistance.
“It is a wake-up call for the ministries of health and the governments to take MDR-TB seriously,” said Prof Martin Antonio, principal investigator at the Medical Research Council unit in the Gambia. “I think it is a problem for the rest of the world as well. Ebola wasn’t just a west African problem.
“We recommend that efforts be put in place for containment of a potential west African TB epidemic at the earliest possible stage. This is especially important as west Africa, with its 245 million inhabitants, is one of the poorest regions globally, whose fragile health systems can easily be overwhelmed by infectious disease epidemics, as seen in the recent Ebola outbreak.”
TB normally takes six months to cure using a combination of antibiotics, but when the bacteria becomes resistant to them a new combination is needed. Photograph: Mick Tsikas/AAP
His unit is part of the West African Network of Excellence for TB, Aids and Malaria, funded by the European and Developing Countries Clinical Trials Partnership, which was set up to collect data on the three infectious diseases across the region.
The surveillance also picked up evidence of extensively drug-resistant tuberculosis (XDR-TB) in Togo and Ghana. These are strains that are resistant to second-line antibiotics used to treat MDR-TB.
The network has published its findings in the BioMed Central Medicine journal.
TB normally takes six months to cure using a combination of the antibiotics rifampicin and isoniazid, but when the bacteria becomes resistant to them a new combination is needed that is more expensive and involves longer treatment.
The latest report from the WHO found that drug-resistant cases had risen to more than 500,000 a year worldwide. The numbers of people with TB were also revised upwards, from 9.6 million to 10.4 million a year, after better data emerged from India.
Young barristers are heavily in debt and becoming vulnerable to depression, the chair of the Bar Council’s youth wing warns.
In an address to the organisation’s annual conference on Saturday, Louisa Nye will say many find it “difficult to stop worrying” at a time when lawyers are characterised in the media as a “scourge on society”.
Young barristers start their careers with accumulated debts of up to £70,000, she will go on, at a time when many are earning the “lowest of sums” for important work that is undervalued by society.
Nye, who is chair of the young barristers’ committee of the Bar Council of England and Wales, will admit that she herself had suffered from anxiety and depression.
“I have lost a close friend who took her own life, in part under the strain that this job and circumstances can place on people,” she will tell the conference.
“Today’s cohort of young barristers is in a particularly vulnerable position. They are financially vulnerable – as a consequence of tuition fees and increases in the [Bar Professional Training Course] fees, we now know that young barristers can have anywhere from £30,000-£70,000 debt when they start out in the profession.
“Many are making repayments over their first five years of practice, if not substantially longer. Young criminal and family barristers are receiving the lowest of sums for carrying out important work, and many are struggling to maintain a living.”
Nye, who is a member of Landmark Chambers in London, will add: “Parts of the media have reports almost daily where lawyers are criticised for the work they do and characterised as a scourge on society.
“Young barristers live in deeply uncertain and difficult times … And it is difficult against that background not to feel somewhat lost and somewhat depressed.”
She will point to the Wellbeing at the Bar report published last year which highlighted high levels of stress and anxiety felt by barristers.
Nye will say: “The survey found that one in three barristers finds it difficult to control or stop worrying. One in six barristers said that they felt low in spirits most of the time.”
Parts of the NHS “will implode” this winter, an expert has warned, as new figures show falling A&E performance over the past few months.
Dr Mark Holland, the president of the Society for Acute Medicine, said the days when summer used to provide a respite for busy emergency departments had gone, and instead the NHS faced an “eternal winter”.
The NHS was “on its knees” and a major increase in hospital admissions due to flu or the sickness bug norovirus could lead to collapse, he added.
Holland spoke out as new figures show that waiting times in A&E units in England this summer have been worse than for most winters stretching back more than a decade.
One in 10 patients waited more than four hours in A&E during June, July and August – worse than any winter in the past 12 years bar one, analysis by the BBC showed. Only last winter marked a worse performance since the target was launched in 2004.
Data from NHS England for the summer also showed hospitals are missing key targets for cancer cases, routine operations and ambulance response times. Delayed discharges – where patients are stuck in hospital despite being medically fit to leave – continued to rise, with a record high during August.
The Local Government Association has said a funding gap of at least £2.6bn is opening up for providing social care in the community. This affects discharges because care packages are not always in place for those leaving hospital.
Holland said: “The NHS is on its knees and, this winter, areas will implode around the country. There is no reserve left. We coined the phrase ‘eternal winter’ months ago in relation to increasingly poor performance and this data is clear evidence that is what we are now dealing with.
“Over the coming weeks and months, if we see a major increase in admissions due to flu or bed closures due to norovirus, we will collapse.
“The government has failed to acknowledge or address the scale of the crisis in social care and delayed discharges and, at present, I see no plan of action in place to prevent it derailing the health service. If we are unable to discharge patients and release pressure on our emergency departments and acute medical units at the front door, the system grinds to a halt.”
The Nuffield Trust chief executive, Nigel Edwards, said only a small handful of hospitals now hit the A&E target.
“We need to look at the underlying causes,” he said. “Our analysis of hospitals suggests that after years of squeezed bed numbers, there is not enough space left to move patients through at the rate we want. The practice of counting bed use at midnight misses the real crunch points during the day.
“On the frontline, leaders should work on better monitoring and control of patient flow minute by minute. Helping the longest staying patients to leave hospital sooner should be a priority, although it will be difficult with the social care system on its knees. Nationally, we should be realistic about what hospitals can do when they are this full, and how hard it will be to free up space again.”
The shadow health secretary, Jonathan Ashworth, said: “’The figures expose the Tories’ record of failure on the NHS.
“On Jeremy Hunt’s watch hospitals are now bursting at the seams with thousands of people waiting hours in overcrowded A&E departments and on hospital trolleys.
“These pressures are a direct consequence of the decisions Jeremy Hunt has taken. This government’s cuts to social care over the last six years have left councils struggling to provide basic support for older people in the community and the growing crisis in general practice is forcing many people to travel to A&E because they can’t get an appointment with their family doctor.”
Matthew Swindells, NHS England’s national director for operations and information, said: “While hospitals are continuing to look after more than nine out of 10 A&E patients within four hours, and A&E performance improved this month, today’s CQC [Care Quality Commission] report highlights the impact of rising social care pressures on emergency admissions and delays in people leaving hospital.
“As the CQC argues, if we are to solve these pressures, the transformation work kicking off this autumn led by local health and care organisations, is essential.”
A Department of Health spokeswoman said hospitals continued to perform well, seeing nine out of 10 people within four hours. “In the last 12 months, 175,000 more people were seen within this standard compared to the previous year,” she said.
“We are committed to delivering a safer seven-day NHS which is why we have invested £10bn to fund the NHS’s own plan to transform services for the future and crucially ensuring that the amount of money available to local authorities for social care is rising in future years of the parliament, reaching up to £3.5bn extra by 2020.”
A&E units are struggling to cope because social care services that help elderly people have been cut so much that they are reaching a “tipping point”, England’s care regulator is to warn.
Hospitals are ending up dangerously full and have seen “bedblocking” hit record levels because of a widespread failure to give elderly people enough support to keep them healthy at home, says the Care Quality Commission.
A worsening lack of at-home care services and beds in care homes are forcing hospitals to admit more patients as emergencies, which deepens their already serious financial problems. “What’s happening, we think, is that where people aren’t getting access to [social] care, and we are not preventing people’s needs developing through adult social care, is that they are presenting at A&E,” said David Behan, the CQC’s chief executive.
Figures contained in the commission’s annual report show that the number of hospital bed days lost through patients being unable to leave because social care was not available to allow them to be discharged safely soared from 108,482 in April 2012 to 184,199 in July this year – a 70% rise.
The fact that growing numbers of mainly frail, elderly people are being left without the help they need with basic chores such as washing, dressing and cooking “creates problems in other parts of the health and care system, such as overstretched A&E departments or delays in people leaving hospital,” he added. GP surgeries are also having to treat patients who became unwell or suffered an injury because they did not receive help they needed.
Behan urged ministers to give social care a higher priority and urgently find extra money for it to prevent its ongoing deterioration causing even worse problems. “We are becoming concerned about the fragility of the adult social care market, with evidence suggesting that it might be approaching a tipping point,” he said.
The CQC’s assessment of health and social care, called State of Care, adds that: “The difficulties in adult social care are already affecting hospitals. Bed occupancy rates exceeded 91% in January to March 2016, the highest quarterly rate for at least six years, and in 2015-16 we saw an increase in the number of people having to wait to be discharged from hospital, in part due to a lack of suitable care options,” the CQC’s annual report says.
The number of people in England receiving local council-funded social care services fell by 26% from 1.1m in 2009 to about 850,000 in 2013-14, at a time of Whitehall-driven cuts to town hall budgets. The number of people with unmet needs has risen from 800,000 in 2010 to more than 1 million last year, according to Age UK.
Growing unavailability of social care was a key driver of the 3% rise in emergency admissions to hospital last year and 11% rise in bed days lost to bedblocking. That was mainly due to patients having to wait for a package of care to be put in place to let them return home or for a place in a nursing home to become available. “The effect of these delays on the NHS is significant, costing hospitals £820m a year,” the National Audit Office says.
NHS bodies, health thinktanks and charities urged government to use next month’s autumn statement to inject extra funding into social care.
Simon Stevens, the chief executive of NHS England, has already called for any extra funding for the health service to instead be used to prop up social care. Jeremy Hunt, the health secretary, is understood to privately agree. On Monday Stephen Dorrell, the ex-Conservative health secretary, said that the government’s policy of giving social care less and less money was “insane economics and bad social policy” and undermined its claim to be backing the NHS.
Cuts to social care and also mental health and public health mean “the NHS is being stretched to the limit,” said Stephen Dalton, chief executive of the NHS Confederation, which represents hospitals. “Relying on political rhetoric that promises to protect the NHS but fails to acknowledge that a cut in social care results in a cost to the NHS, is an economic deception.”
The CQC also disclosed that about 800,000 patients are registered with a GP practice that its inspectors have judged to be inadequate on safety grounds. It is concerned that some surgeries deliver “unacceptable standards of care”. Safety failings include poor management of medicines, inappropriately trained staff and premises that are unsuitable.
The Department of Health welcomed the CQC’s findings that “the majority of the NHS, 72% of adult social care services and 87% of GP practices inspected are good or better – and that improvement is taking place all over the country”.
A spokeswoman said: “The NHS is performing well at a time of increasing demand. The government is investing £10bn to fund its own plan for the future, and crucially is ensuring that the amount of money available to local authorities for social care is rising in future years of the parliament, reaching up to £3.5bn extra by 2020.”
