The Department of Health in England is scrapping its controversial data sharing project – known as Care.data.

The programme, which was due to launch in 2014, faced widespread criticism – including fears the public had been left in the dark about it.

The announcement comes as Dame Fiona Caldicott and the Care Quality Commission published two reviews on data security in English healthcare.

Their reports put forward a series of proposals to safeguard data in the NHS:

• They call for stronger government sanctions for malicious or intentional data breaches, together with tougher criminal sanctions against those who use any anonymised data to re-identify individuals.
• Meanwhile, out of date computer software and hardware should be replaced urgently, they say.
• The reviews recommend an opt-out system so patients can say no to confidential or personal health data being used for anything beyond their direct care.
• But this could be overridden for mandatory requirements such as fraud investigations or situations of public interest such as epidemics, they suggest.
• And patients could give explicit consent for specific research studies, even if they had opted-out.

Responding in a written statement to Parliament, the Department of Health said it has launched a public consultation on the option of opt-outs, alongside 10 security standards that Dame Fiona suggests NHS organisations must meet.

Officials also say they support stronger criminal sanctions for misuse of anonymised data and are working with suppliers to ensure IT systems are up-to-date.

Meanwhile, the Department of Health said though it had taken the decision to close the Care.data programme it was “committed to realising the benefits of sharing information”.

The Care.data project, led NHS England, together with the Health and Social Care Information Centre, was designed to bring health and social care information from different settings together to see what was working well and what could be done better.

It was due to launch two years ago, but was paused after concerns a public information campaign explaining its use was not clear enough and did not reach everyone.

Whilst Health Direct is pleased that this discredited IT system is being closed, one wonders with the Chilcott enquiry and Wales football game dominating the news agenda whether yesterday was a good day to bury bad news.

About a third of cancer cases in the UK could be prevented if people ate healthily, exercised more and cut down on alcohol according to new research.

Exercise is an important way of keeping fit and cutting body fat, which is linked to the risk of developing cancer.

Data from the World Cancer Research Fund suggests that 20,000 cases of breast cancer and about 19,000 cases of bowel cancer could be stopped each year with small changes in lifestyle.

In 2013, there were more than 351,000 new cases of cancer in the UK. The WCRF said 84,000 could have been prevented.

Head of research Dr Rachel Thompson said simple changes to diet and lifestyle could make “a huge difference” in the battle against cancer.

“Even minor adjustments, like 10 to 15 extra minutes of physical activity each day, cutting down on alcohol, or limiting your intake of high calorie foods and sugary drinks, will help decrease your cancer risk,” she said.

She said that after cutting out smoking, being a healthy body weight was the most important thing people could do to cut their risk of getting cancer.

“There is strong evidence that being overweight or obese increases the risk of 10 cancers,” she said.

The link between a healthy lifestyle and the risk of developing cancer is well known, and this new data looks at preventable cases in 13 of the UK’s most common cancers.

For example, among men, 9% of cases of advanced prostate cancer could be prevented every year if men were not overweight or obese.

Lung cancer cases could be cut by 15,000 (33%) by getting people to stop smoking.

And 38% of breast cancer cases could be prevented, particularly in postmenopausal women, by increasing physical exercise and reducing body fat.

The WCRF also said that 2,200 cases of kidney cancer and 1,400 cases of pancreatic cancer could be prevented if people adopted a healthier lifestyle.

Prof Kevin Fenton, director of health and wellbeing at Public Health England, said the UK was currently behind on cancer survival rates compared with other European countries.

He said one major factor was that cancer prevention was not in the public consciousness.

“The link between tobacco and cancer is widely known and readily accepted by the public, but many are not yet fully convinced that healthy eating, regular exercise and not drinking alcohol, can lower your cancer risk.”

From: https://www.fithealthylives.com/2016/06/healthier-lifestyles-could-cut-cancer-cases-by-a-third-2/

Two leading public health organisations have called for the possession and personal use of all illegal drugs to be decriminalised in the UK.

The Royal Society for Public Health and the Faculty of Public Health said the government’s approach to drugs policy had failed.  There should be a greater focus on treatment and education, they added.

The report, called Taking A New Line On Drugs, said criminal sanctions failed to deter illegal drug use, undermined people’s life chances and could act as a barrier to addicts coming forward for help.

It called for a “sea change in approach” and said the UK should adopt the Portuguese system under which people caught using drugs were offered treatment and support rather than being punished. However, dealers and suppliers would still be prosecuted.

The report also suggested that drugs education be made mandatory, and that responsibility for drugs policy be moved from the Home Office to the Department of Health.

Royal Society for Public Health chief executive Shirley Cramer said: “For too long, UK and global drugs strategies have pursued reductions in drug use as an end in itself, failing to recognise that harsh criminal sanctions have pushed vulnerable people in need of treatment to the margins of society, driving up harm to health and wellbeing even as overall use falls.

“On many levels, in terms of the public’s health, the ‘war on drugs’ has failed.”

“The time has come for a new approach, where we recognise that drug use is a health issue, not a criminal justice issue, and that those who misuse drugs are in need of treatment and support – not criminals in need of punishment.”

Baroness Molly Meacher, speaking on behalf of the All-Party Parliamentary Group for Drug Policy Reform, welcomed the report.

She said the current system “criminalises some users of psychoactive drugs whilst very harmful psychoactive drugs including alcohol and tobacco remain legal”.

A Home Office spokesman said: “The UK’s approach on drugs remains clear – we must prevent drug use in our communities and support people dependent on drugs through treatment and recovery.

“At the same time, we have to stop the supply of illegal drugs and tackle the organised crime behind the drugs trade.”

The spokesman said there had been a drop in drug misuse over the past decade and more people were recovering from dependency now than in 2009-10.

Health Direct has for a long time noted the costly failure that is the current policy on drugs. On August 02, 2006 in Risks of taking drugs compared- Scientific review of dangers of drugtaking- Drugs, the real deal we reproduced the first ranking based upon scientific evidence of harm to both individuals and society.

It was devised by government advisers – then ignored by ministers because of its controversial findings. The analysis was carried out by David Nutt, the then senior member of the Advisory Council on the Misuse of Drugs, and Colin Blakemore, the chief executive of the Medical Research Council.

The growing crisis in healthcare professionals’ morale is a greater risk to the NHS than the financial problems it is grappling with.

Nigel Edwards, chief executive of the Nuffield Trust think tank, warned staff shortages, disputes with government and bullying were creating a “toxic mix”.

He said if the problems persisted, the affinity staff felt for the NHS could be irreparably broken.

The warning comes amid growing tensions between the healthcare workforce and government ministers.

This year has seen a series of strikes by junior doctors in England, while nurses and midwives have been protesting about plans to scrap the bursaries they receive while they are studying.

Mr Edwards said this industrial unrest was happening at a time when there were looming shortages – last month, a report by the Public Accounts Committee warned the NHS was short of about 50,000 staff out of a front line workforce of just over 800,000.

The most recent staff survey – published earlier this year – also highlighted the problem, with only 31% of respondents saying there was enough staff for them to do their jobs properly.

The Nuffield Trust also pointed to feedback it had received from health managers warning about deteriorating morale and uncontrollable growth in workload.

One manager said there was a “creeping sense of inevitability and acceptance that failure will happen at some point”.

Mr Edwards said the care and compassion of health workers was underpinned by a “psychological” contract.

He said while financial problems – last month it was revealed NHS trusts had overspent by a record £2.45 billion in 2015-16 – could be rectified in time, deteriorating morale was harder to fix.

“Once the psychological contract with staff is broken, it may be impossible to reverse,” he added.

Siva Anandaciva, of NHS Providers, which represents NHS trusts, said he shared the concerns. “This is a pivotal time for the NHS, with extreme financial and capacity challenges putting extra pressure on staff,” he said. “Perhaps inevitably, staff morale can take a battering.”

A Department of Health spokeswoman said there were signs in the staff survey that some measures were improving.

She added: “Good leadership is the single most critical ingredient to raising morale in any team. We also see that the best hospitals combine tight financial grip, an unrelenting focus on improving patient care and high levels of staff engagement.”

Health Direct notes frequent HR research which finds that levels of staff morale inversely correlates with managements’ staff appreciation in many organisations- the NHS is no expection Mr Hunt.

A potential deal in the long running dispute over a new junior doctors’ contract has been agreed.

Government negotiators and the British Medical Association leadership have reached an agreement after eight days of talks at conciliation service Acas.

Health Secretary Jeremy Hunt said the deal was a “significant step forward”, while the BMA said it represented the “best and final way” to end the row.

The offer will now be put to a vote of over 40,000 BMA members.

That means it could still end up being rejected, but the fact the union and government have agreed a deal to end the stalemate is a major breakthrough.

These talks were seen as the last chance to get an agreement and were set up after a series of strikes, including the first ever full walk out by doctors.

It comes after the government announced in February it would be imposing the contract from this summer after previous talks failed.

The details released this week include several major changes:

• the basic pay rise is to be reduced from 13.5% to between 10% and 11%
• weekends will no longer be divided up between normal and unsocial hours, instead a system of supplements will be paid which depend on how many weekends a doctor works over the course of a year
• extra pay for night shifts is to be reduced from 50% to 37%
• extra support will be made available for doctors who take time out, such as women who go on maternity leave, to enable them to catch up on their training and thus qualify for pay rises – after claims women were being unfairly penalised
• junior doctors will get an enhanced role in advising and liaising with the independent guardians who keep an eye on the hours doctors work
• the deal remains cost neutral, which means the government is not putting in extra money

The fact that something has been agreed is a major breakthrough. But this dispute is still a long way from being over. The BMA has promised its 40,000 members a vote on the agreement. That will be carried out in June and there are no guarantees the membership will give it the green light.

Junior doctors have been incredibly united throughout. Some 98% voted in favour of taking strike action last autumn and whenever union leaders have taken soundings since, the overwhelming sense has been that they have wanted to fight on.

If this hadn’t been the case the leadership would probably have agreed a deal long before now. What will be interesting, and perhaps crucial, is just how strongly the BMA leadership tries to sell the agreement to members in the coming weeks.

BMA junior doctor leader Dr Johann Malawana said he was pleased to have reached a deal after “intense but constructive talks”, adding it was the “best and final way” of resolving the dispute.

“Junior doctors have always wanted to agree a safe and fair contract, one that recognises and values the contribution junior doctors make to the NHS, addresses the recruitment and retention crisis in parts of the NHS and provides the basis for delivering a world-class health service.”

“What has been agreed today delivers on these principles, is a good deal for junior doctors and will ensure that they can continue to deliver high-quality care for patients.”

He said he would be recommending the deal to junior doctors ahead of the vote of BMA members, which will be run in June.

Bad planning and cost cutting have left the NHS in England short of 50,000 vital front line staff MPs are warning.

The Public Accounts Committee said the shortfall in doctors, nurses and midwives could even get worse if ministers did not get a “better grip”.

The group also warned there had been “no coherent attempt” to work out the staffing needed for a seven day NHS.

The cross party group of MPs acknowledged the NHS budget is expected to have risen by just over £8 billion in its report, but cast doubt on how far that would stretch given that ministers are trying to increase the availability of staff and services at weekends.

The report looks at clinical staff – those who provide care, including doctors, nurses, midwives and ambulance crews. These account for more than 800,000 jobs – two thirds of the entire NHS workforce.

It said working out the exact shortfall was difficult, but said estimates made two years ago suggested the NHS was short by about 50,000 professional health staff.

The report was published as it emerged that emergency surgery at a Nottinghamshire hospital has been suspended because of a shortage of junior doctors. Surgical patients at Bassetlaw Hospital are now being transferred to Doncaster Royal Infirmary – almost 20 miles away.

The MPs were scathing of the health leadership provided by the government and national bodies, such as Health Education England, in recent years.

It said NHS trusts had been given conflicting messages – being urged to cut overheads to save money, while investing in staff in the wake of the Stafford Hospital scandal.

This has created a situation whereby the NHS had reduced the number of training posts available for core groups such as nursing, while struggling to retain staff, despite increases in demand for services.

The report said the high level of spending on agency staff seen in recent years was “largely the consequence” of this bad planning.

While NHS leaders have been quick to blame “rip-off” fees, prompting them to introduce a cap on how much can be charged, the report pointed out that most of the rise was a result of the NHS needing locum staff to fill gaps.

Committee chairman Labour’s Meg Hillier said there were “serious flaws” in the approach of government.

“Front line staff are the lifeblood of the service yet the supply of these staff in England is not keeping pace with demand. This poor workforce planning means patients face the possibility of longer waiting times and a greater cost to the public purse.”

British Medical Association leader Dr Mark Porter said this is a “disastrous” situation.

And Royal College of Nursing general secretary Janet Davies added: “What we have seen so far is how short term decisions and budget cuts lead to nothing but lowered standards of care which could so easily have been avoided.”

Following one from Health Direct’s Jeremy Hunt- lies bullshit and poisoned statistics post yesterday.

Health secretary Jeremy Hunt and the claim he made about doctors’ contracts

So, is it true? Do 6,000 people — or 11,000 — die needlessly in NHS hospitals because of poor weekend care? Nobody knows for sure; Jeremy Hunt certainly does not. It’s not enough to show that people admitted to hospital at the weekend are at an increased risk of dying there. We need to understand why — a question that is essential for good policy but inconvenient for politicians.

One possible explanation for the elevated death rate for weekend admissions is that the NHS provides patchy care and people die as a result. That is the interpretation presented as bald fact by Jeremy Hunt. But a more straightforward explanation is that people are only admitted to hospital at the weekend if they are seriously ill. Less urgent cases wait until weekdays.

If weekend patients are sicker, it is hardly a surprise that they are more likely to die. Allowing non-urgent cases into NHS hospitals at weekends wouldn’t save any lives, but it would certainly make the statistics look more flattering. Of course, epidemiologists try to correct for the fact that weekend patients tend to be more seriously ill, but few experts have any confidence that they have succeeded.

A more subtle explanation is that shortfalls in the palliative care system may create the illusion that hospitals are dangerous. Sometimes a patient is certain to die, but the question is where — in a hospital or a palliative hospice? If hospice care is patchy at weekends then a patient may instead be admitted to hospital and die there.

That would certainly reflect poor weekend care. It would also add to the tally of excess weekend hospital deaths, because during the week that patient would have been admitted to, and died in, a palliative hospice. But it is not true that the death was avoidable.

Does it seem like we’re getting stuck in the details? Well, yes, perhaps we are. But improving NHS care requires an interest in the details. If there is a problem in palliative care hospices, it will not be fixed by improving staffing in hospitals.

“Even if you accept that there’s a difference in death rates,” says John Appleby, the chief economist of the King’s Fund health think-tank, “nobody is able to say why it is. Is it lack of diagnostic services? Lack of consultants? We’re jumping too quickly from a statistic to a solution.”

“When one claim is discredited, Jeremy Hunt’s office simply asserts that another one can be found to take its place”

This matters — the NHS has a limited budget. There are many things we might want to spend money on, which is why we have the National Institute for Health and Care Excellence (Nice) to weigh up the likely benefits of new treatments and decide which offer the best value for money.

Would Jeremy Hunt’s push towards a seven-day NHS pass the Nice cost-benefit threshold? Probably not. Our best guess comes from a 2015 study by health economists Rachel Meacock, Tim Doran and Matt Sutton, which estimates that the NHS has many cheaper ways to save lives. A more comprehensive assessment might reach a different conclusion but we don’t have one because the Department for Health, oddly, hasn’t carried out a formal health impact assessment of the policy it is trying to implement.

This is a depressing situation. The government has devoted considerable effort to producing a killer number: Jeremy Hunt’s “6,000 reasons” why he won’t let the British Medical Association stand in his way. It continues to produce statistical claims that spring up like hydra heads: when one claim is discredited, Hunt’s office simply asserts that another one can be found to take its place. Yet the government doesn’t seem to have bothered to gather the statistics that would actually answer the question of how the NHS could work better.

This is the real tragedy. It’s not that politicians spin things their way — of course they do. That is politics. It’s that politicians have grown so used to misusing numbers as weapons that they have forgotten that used properly, they are tools.

From: http://www.ft.com/cms/s/2/2e43b3e8-01c7-11e6-ac98-3c15a1aa2e62.html

On the first day of the all out junior doctors strike Health Direct reposts a Financial Times review of Jeremy Hunt’s use of poisoned statistics.

We have more data — and the tools to analyse and share them — than ever before. So why is the truth so hard to pin down?

Thirty years ago, the Princeton philosopher Harry Frankfurt published an essay in an obscure academic journal, Raritan. The essay’s title was “On Bullshit”. (Much later, it was republished as a slim volume that became a bestseller.) Frankfurt was on a quest to understand the meaning of bullshit — what was it, how did it differ from lies, and why was there so much of it about?

Frankfurt concluded that the difference between the liar and the bullshitter was that the liar cared about the truth — cared so much that he wanted to obscure it — while the bullshitter did not. The bullshitter, said Frankfurt, was indifferent to whether the statements he uttered were true or not. “He just picks them out, or makes them up, to suit his purpose.”

Statistical bullshit is a special case of bullshit in general, and it appears to be on the rise. This is partly because social media — a natural vector for statements made purely for effect — are also on the rise. On Instagram and Twitter we like to share attention-grabbing graphics, surprising headlines and figures that resonate with how we already see the world. Unfortunately, very few claims are eye-catching, surprising or emotionally resonant because they are true and fair. Statistical bullshit spreads easily these days; all it takes is a click.

On July 16 2015, the UK health secretary Jeremy Hunt declared: “Around 6,000 people lose their lives every year because we do not have a proper seven-day service in hospitals.  You are 15 per cent more likely to die if you are admitted on a Sunday compared to being admitted on a Wednesday.”

This was a statistic with a purpose. Hunt wanted to change doctors’ contracts with the aim of getting more weekend work out of them, and bluntly declared that the doctors’ union, the British Medical Association, was out of touch and that he would not let it block his plans: “I can give them 6,000 reasons why.”

After negotiations between the Government and the British Medical Association lasting four years failed to reach a final agreement on February 11 2016 in London, Jeremy Hunt then announced in the House of Commons that new contracts would be imposed on Junior Doctors from August 1st 2016.

Despite bitter opposition and strike action from doctors, Hunt’s policy remained firm over the following months.

Yet the numbers he cited to support it did not.

In parliament in October, Hunt was sticking to the 15 per cent figure, but the 6,000 deaths had almost doubled: “According to an independent study conducted by the BMJ, there are 11,000 excess deaths because we do not staff our hospitals properly at weekends.”

Arithmetically, this was puzzling: how could the elevated risk of death stay the same but the number of deaths double? To add to the suspicions about Hunt’s mathematics, the editor in chief of the British Medical Journal, Fiona Godlee, promptly responded that the health secretary had publicly misrepresented the BMJ research.

Undaunted, the health secretary bounced back in January with the same policy and some fresh facts: “At the moment we have an NHS where if you have a stroke at the weekends, you’re 20 per cent more likely to die. That can’t be acceptable.”

All this is finely wrought bullshit — a series of ever-shifting claims that can be easily repeated but are difficult to unpick. As Hunt jumped from one form of words to another, he skipped lightly ahead of fact checkers as they tried to pin him down.

Full Fact concluded that Hunt’s statement about 11,000 excess deaths had been untrue, and asked him to correct the parliamentary record. His office responded with a spectacular piece of bullshit, saying (I paraphrase) that whether or not the claim about 11,000 excess deaths was true, similar claims could be made that were.

Part two is reproduced by Health Direct tomorrow: Jeremy Hunt- lies bullshit and poisoned statistics pt 2 .

The Royal College of Surgeons found a third of local NHS health bosses put restrictions on surgery for smokers and the obese.

The Royal College of Surgeons (RCS) has been increasingly alarmed about the rationing of surgery in the NHS in the tough financial climate. However, some local NHS groups criticised in the report say their polices are based on good evidence.

Its report is based on freedom of information returns from nearly all of the 209 clinical commissioning groups in England and all seven health boards in Wales.

While some CCGs have voluntary policies in place, where patients are encouraged to stop smoking or lose weight, others have introduced mandatory policies, which means patients have to meet fixed criteria before surgery.

The college says mandatory policies are “a cause for concern” and it fears patients with a high body mass index (BMI) or who smoke are becoming “soft targets” for NHS savings.

The report reveals 31% of CCGs and one health board in Wales have at least one policy requiring people to lose weight or stop smoking before they can be referred for routine surgery.

The report suggests one in five CCGs has mandatory policies on BMI levels before hip and knee replacement surgery, while 4% have mandatory policies on getting patients to stop smoking before hip and knee replacement surgery.

Of the CCGs that responded, 22% reported having at least one “voluntary” policy in place.

The Royal College of Surgeons said any blanket ban on surgery based on a patient’s weight or whether they smoked was wrong and not supported by national guidance.

Instead, president RCS Clare Marx said, patients should be encouraged to sign up to programmes to help them stop smoking and manage their weight while awaiting surgery.

“NHS surgical treatment should be based on clinical guidance and patients should be dealt with on a case-by-case basis,” she said.

“In some instances, a patient might need surgery in order to help them to do exercise and lose weight. While it is difficult to categorically prove such policies are aimed at saving money, it is unlikely to be a coincidence that many financially challenged CCGs are restricting access to surgery.”

She added National Institute for Curbing Expenditure (NICE) guidance did not support these mandatory bans for routine surgery.

British Orthopaedic Association president Tim Wilton said there was no clinical or financial justification for refusing to fund hip or knee replacements.

“Good outcomes can be achieved for patients regardless of whether they smoke or are obese, even at BMIs of over 50, and these surgeries are highly cost effective, typically delivering sustained pain relief for a cost that equates to just £7.50 a week,” he said.

“Hard and fast rules also undermine the NHS’s ability to involve patients in decisions about their own care, and are a distraction from the task at hand: making sure patients receive the best possible advice and care, to enable them to make the best possible decisions for their health – including losing weight and stopping smoking where appropriate.”

Surgeons want new laws to protect patients undergoing cosmetic surgery

The Royal College of Surgeons (RCS) has called on the government to introduce legislation in the next Queen’s Speech to protect patients undergoing cosmetic surgery, as the organisation and the General Medical Council (GMC) publish new standards on cosmetic procedures.

The RCS’s new Professional Standards for Cosmetic Surgery are intended to improve patient safety and standards in the industry, by stipulating that only surgeons with the appropriate training and experience should undertake cosmetic surgery, as well as the ethics and behaviour expected of them.

They supplement new guidance the GMC has published today for all doctors who carry out cosmetic interventions, including non-surgical procedures such as Botox and hair transplants, and are intended to be read alongside it.

However, to help make the regulation of cosmetic surgery as robust as possible, the RCS believes the government should also give the GMC a new regulatory power to highlight to the public and employers which surgeons have been certified by the RCS to carry out cosmetic surgery.

Mr Stephen Cannon, Chair of the Cosmetic Surgery Interspecialty Committee and Vice President of the Royal College of Surgeons, said:

“Cosmetic surgery is a booming industry, but the law currently allows any doctor – surgeon or otherwise – to perform cosmetic surgery in the private sector. This can make it difficult for patients to identify an experienced, highly trained surgeon from someone who should not be practising.

“To correct this, we will launch a new system of certification later this year which will help patients to find a certified surgeon, who has the appropriate training, experience and insurance to carry out a procedure – such as a tummy tuck or nose job.

Today’s new Professional Standards for Cosmetic Surgery will underpin the new system of certification. By adhering to the RCS’s new Professional Standards for Cosmetic Surgery, surgeons will ensure that the needs of individual patients are at the centre of the consultation discussion, and that they are fully informed about the potential risks and likely outcome of the procedure.

The proposed cosmetic surgery guidelines recommend that:

• Surgeons performing cosmetic surgery should be certified in the area in which they practise.
• The operating surgeon should lead the consultation with the patient to outline the risks of the procedure, likely outcome and to provide the information that will help them decide whether or not to undergo surgery.
• The operating surgeon must also obtain written consent from a patient themselves – and not delegate it to a colleague.
• Patients should be offered a cooling off period of at least two weeks before they consent to an operation to give them time to reflect on a decision.
• Surgeons must make sure they have appropriate indemnity insurance to cover the procedures they are undertaking.
• Surgeons should refrain from using financial inducements such as time-limited offers and discounts.

Health Direct approves of anything that will end botched and unethical healthcare procedures. These guidelines appear to be an overdue common sence step in that direction.