The BGS Education and Training Committee are in the process of reviewing the higher specialty grid topics and providing more detailed guidance. The guidance on competencies for community practice is now published here. We hope to be publishing guidance on palliative care and old age psychiatry in due course.
The External Affairs team have today launched the RCP’s new policy report Underfunded, underdoctored and overstretched – the NHS in 2016. The report draws on the experiences, views and concerns of consultant and trainee physicians, which, added to national evidence, highlights the many challenges the NHS faces. •
- The NHS is struggling to cope under with increasing patient need and inadequate funding, resulting in workforce pressures which risk patient outcomes. The RCP are committed to working with parliamentarians, health professionals and the public to find solutions to these challenges; solutions that will build a truly integrated, high quality healthcare system for patients now and in the future. The RCP believe the NHS needs:
- Increases to NHS funding: Realistic targets for efficiency savings, protected funds for transformation and investment in sustainability.
- More doctors: Increases in the number of medical students and doctors in training to be hospital specialists and incentives for doctors to work in challenging areas of medicine.
- A supported and valued workforce: Hydration facilities in hospitals and management and leadership opportunities for trainees.
Reported by the National Health Executive (20 September)|: Support for older patients after they were discharged from hospital led to a reduced rate of readmission and improved patients’ welfare, new research shows.
The ‘Hospital to Home’ service in Leicester and Leicestershire led to 9.2% of patients aged over 75 being readmitted within 30 days, against 15% nationally.
The pilot scheme, from Leicestershire County Council, was staffed by 143 Royal Voluntary Service volunteers, who offered six weeks of practical and emotional support to patients aged over 55 who lack a social network.
David McCullough, chief executive of the Royal Voluntary Service, said: “A stay in hospital can be disorientating and it’s particularly hard to settle back into your home if you have no one there to give you a word of encouragement, make you a cup of tea or check you’ve got your medication.
“These are all simple things but this analysis proves just how vital that support is to the recovery of an older person who has been in hospital. No one should have to go home alone unless they choose to and it’s in no one’s benefit that they do, not the older person nor the NHS as they are more likely to be readmitted if they are not given the support they need after leaving hospital.”
Among patients who took part in the programme, 70% said their social contact had improved, 52% said it had boosted their confidence and 47% said it had increased their happiness levels.
See also: Call for cross-party commission into NHS and social care 'crisis' (Nursing Times)
Reported in Care Management Matters (20 September): A new care home dementia study has identified a failure to reduce antipsychotic prescribing. A study by five universities found that there was no sustained reduction in the prescribing of antipsychotics to dementia patients in UK care homes, following the Government’s 2009 National Dementia Strategy (NDS), which recommended a review of their use in light of potentially serious side effects.
The research – led by Professor Ala Szczepura at Coventry University and published in the medical journal BMJ Open – examined prescribing data between 2009 and 2012 from over 600 care homes across the country. It concluded that there was no significant decline in antipsychotic prescribing rates over the four-year period.
Antipsychotics were originally developed for use in patients with schizophrenia or psychosis, but the study shows that ‘off-label’ prescribing of these drugs to treat the behavioural and psychological symptoms of dementia is a common practice in care homes.
The 2009 Banerjee Report, commissioned by the Department of Health as part of the NDS, examined the use of antipsychotics for people with dementia, concluding that the drugs had a ‘substantial clinical risk’ associated with them and that their overuse ‘must not be allowed to continue’. However, researchers from the universities discovered that – although dosages were usually acceptable – prescribing levels did not reduce over the four years, and length of treatment was ‘excessive’ in over 77% of cases by 2012, up from 69.7% in 2009 (meaning it exceeded not only the recommended six-week course, but also the maximum advised treatment length of 12 weeks).
See also: "Chemical cosh" of powerful drugs still routinely used to knock out dementia patients in care homes (Telegraph)
Reported in the Guardian (21 September): Long delays caused by NHS drive for ‘efficiency savings’ causing misery for mainly elderly patients, charity says. Patients in England are having to wait up to 15 months to have cataracts removed from their eyes amid increasing rationing linked to the NHS’s deepening financial woes, a new report has revealed.
People in the north London borough of Enfield face the longest wait – 467 days – between being referred for cataract surgery and actually having it, according to research by the charity RNIB published on Wednesday. That is more than double the longest delay – 222 days – the RNIB found when it first examined waiting times for the procedure in England in 2013. That occured in Heywood, Middleton and Rochdale in greater Manchester.
Other areas with notably long waits include those covered by the GP-led NHS clinical commissioning group (CCG) in Swindon (180 days), Havering in Essex (176 days) and Southampton (174 days).
See also: Patients wait up to 15 months for cataract ops, in 'devastating' lottery (Telegraph)
Reported in the Guardian (21 September): UK care sector’s reliance on EU workers means they must be given right to remain in any future arrangements, charities say.
Social services for older and disabled people face crisis because post-Brexit migration restrictions could cause a massive shortage of care workers, leading care organisations have said. The 1.4-million-strong UK care sector’s reliance on European migrant workers means it is vital they are given the right to remain in any future migration arrangements, the charities Independent Age and the International Longevity Centre UK (ILC-UK) said.
Currently about 84,000 care workers – equivalent to one in 20 of England’s growing care workforce – are from European Economic Area countries. About 90% do not have British citizenship and their future immigration status remains uncertain.
Reported in The Telegraph (15 September): The editor of the BMJ has written to the government's Chief Medical Officer asking for an independent review of statins following years of controversy.
Dr Fiona Godlee has asked Dame Sally Davies to intervene after medical journal The Lancet published a review claiming the drugs were safe and effective and warning that their harms had been exaggerated. The Lancet said that thousands of people had been misled into stopping their medication after two articles appeared in the BMJ questioning their use and warning of side-effects.
However, critics have since questioned the findings of the review, claiming some of the trials included were funded by drugs companies making statins and individual patient data was not available.
Dr Godlee said it was now time for an independent body to weigh up the evidence so that the public could be sure about the benefits and harms of statins.
Reported in the Telegraph (16 Sept): Unprecedented walkouts by thousands of junior doctors over a new contract could be averted by a High Court case next week, medics say.
Up to 50,000 doctors have been asked by unions to take part in week-long strikes, starting next month, despite concerns that the actions could cost lives.
On Monday, the Health Secretary will face a judicial review application over the way the contract is being introduced.
A group of junior doctors has accused Jeremy Hunt of over-reaching his powers, saying he had no power to impose the deal. They also claim that the Government’s “seven day” NHS policy is irrational, and lacks evidence to support changes to doctors’ contracts.
Ministers say new terms and conditions are required to improve levels of medical cover at weekends. They say the contract must be imposed next month, because of the failure to reach agreement during four years of talks. The hearing, opening on Monday, will consider whether the Government has followed legal processes correctly.
Dr Ben White, one of five junior doctors behind campaign group Justice for Health, said a court victory for the medics could mean union plans for weeks of strike action are abandoned. Without it, thousands of junior doctors were likely to agonise over whether to join strikes, with many likely to defer decisions until days or hours before the first strike, due to start on October 5, the group said. The planned strikes – billed as the “trade union dispute of this century" – have caused deep divisions among junior doctors and within the British Medical Association (BMA).
See also: Doctors urge inquiry into Jeremy Hunt's NHS 'weekend effect' claims (Guardian)
Reported in Community Care (15 September): Councils in England will struggle to meet basic statutory social care duties over the next five years, a report by the Kings Fund and the Nuffield Trust has warned.
The report said the funding outlook was “bleak” and government measures would not meet the widening gap between needs and resources, which is set to reach at least £2.8bn by 2019. This means “the potential for most local authorities to achieve more within existing resources is very limited and they will struggle to meet basic statutory duties,” the report said.
The research, which looked at the impact of changes to local authority spending on social care for older people, found 26% fewer older people were receiving support from their council in 2013-14, compared to 2008-9. Six consecutive years of budget cuts had created a social care system ‘increasingly unable’ to meet the needs of older people, the report said, and this was leaving rising numbers of older people who have difficulty completing living tasks with no support at all. An “unacceptable burden” has also been placed on unpaid carers, it said.
The research confirmed the ‘unprecedented’ pressure on social care providers, citing reduced councils fees, below inflation increases, staff shortages, higher regulatory standards and the introduction of the national living wage in April 2016 as factors behind this.
Home care services were ‘in a critical condition everywhere’ due to workforce shortages, the report said, and this was threatening to undermine policies to support people at home. “The possibility of large-scale provider failures is no longer a question of ‘if’ but ‘when,’” it said. The situation for older people has also been compounded by pressures in the NHS, the research found, with overstretched GPs, community nurses and an uneven distribution of intermediate care beds all cited as factors by interviewees. The most obvious sign of pressures on health and care budgets was the ‘rapid growth’ in delayed discharges.
Reported by the BBC: Gathering dust on a shelf in the Department of Health's London headquarters is a plan for reform of the care system for the over-65s in England. It is the much heralded cap on care costs, which was a key part of the 2015 Tory manifesto .
It was meant to have launched in April. But last summer ministers announced it was to be postponed until 2020 amid concerns it would not work given the pressures in the system.
Officially it still remains policy, but many doubt it will ever see the light of day - even former Care Minister Norman Lamb, one of the architects of the plan, is in this camp. Instead, they believe it is destined to go down on the long list of failed changes to the system.
See also: Five things you should know about the cost of care (BBC)
My father “lost his fight against cancer”. The truth is he didn’t even try to fight it, so one must assume that my father was “a loser”. David Bowie recently died from cancer too and danced his way to death.
Bowie went quietly. There was not a lot of talk about it; and rather than focusing on death, he chose to focus on life. Ever the consummate performer, he steeled “every nerve and sinew” to sing and dance till the end. That was my father’s choice too, as he was efficiently investigated and found to be palliative. He chose a low tech, minimal intervention death at home. He wanted to maximise his time with his loved ones and limit contact with NHS facilities.
My brother was the human hoist; my sister the eternal optimist; and I, the realist. I would ask helpful questions like: “Do you wish you were dead now, dad?”
Nursing Times: A free training package aimed at educating health and social care staff about dementia has been launched by Health Education England.
The training package was launched today by Health Education England through a collaboration with the University of Bedfordshire, Oxford Brookes University, University of Northampton and University of West London. It provides an introduction to dementia and how it affects people and their loved ones. Part of it included a review of existing dementia awareness training, with the findings then used to develop the subsequent training package.
Melsina Makaza, senior lecturer in mental health nursing and dementia lead at Bedfordshire, jointly led a pilot of the package involving 1,500 clinical and non-clinical staff from a variety of health and social settings in 2015.The package can be delivered to any health and social care staff group, including doctors, nurses, GPs, midwives, social workers, porters, administrative staff and cleaners, according to HEE. It also includes videos featuring the lived experiences of people who have dementia, talking about their experience and how the dementia affects them.
The package is free to access and it has been designed with busy health and social care staff in mind.