The smoking ban has led to a sharp fall in heart attacks

Major research suggests that the introduction of a smoking ban has resulted in a 40 per cent fall in the number of people suffering from heart attacks as the result of passive smoking.

Major research suggests that the introduction of a smoking ban has resulted in a 40 per cent fall in the number of people suffering from heart attacks as the result of passive smoking
Heart attack rates in the UK have fallen by up to 42 per cent since the 2007 smoking ban, major research suggests.

A review of 77 studies found that reduced exposure to passive smoking has caused a “significant reduction” in heart problems across the population.

Several of the studies found that non smokers and ex-smokers gained most the benefits.

The Cochrane study examined a range of health outcomes in 21 countries, including the UK, which have introduced bans in recent years.

Researchers concluded that there was strong evidence that reduced exposure to passive smoking reduced the number of people suffering from cardiac problems.

The studies examined included a Liverpool study of 57,000 hospital patients. This found admissions for heart attacks fell by 42 per cent among men and 43 per cent among women in the five years since the ban was introduced in 2007.

And US research reviewed found a 14 per cent reduction in strokes in counties which introduced a ban, compared with those which did not.

Some 33 out of the 44 studies reviewed on heart disease found a “significant reduction” following the introduction of smoking bans.

Researchers said the studies took account of other trends over the period – such as a large increase in rates of statin prescribing, to protect against heart disease.

Review author, Professor Cecily Kelleher, from University College, Dublin, said: “The current evidence provides more robust support for the previous conclusions that the introduction of national legislative smoking bans does lead to improved health outcomes through a reduction in second hand smoke exposure for countries and their populations.”

Professor Peter Weissberg, medical director of the British Heart Foundation, said: “This review strengthens previous evidence that banning smoking in public places leads to fewer deaths from heart disease and that this effect is greatest in the non-smoking population.

He said the studies were observational and all had their limitations, but it would be difficult to study the effects of passive smoking in a more robust scientific way.

Researchers said the evidence was less clear about whether the introduction of bans had actually helped people to give up smoking.

Nonetheless, smokers seemed to benefit from some reduction in exposure to passive smoke.

One Scottish study, which found no fall in smoking rates after a ban was introduced in 2006, found a 14 per cent reduction in hospital admissions for heart problems among smokers, and a 21 per cent reduction in admissions among non-smokers.

The research found the impact of the ban on respiratory health, and conditions such as asthma, was less clear cut, though seven of 12 studies on asthma found reduced hospitalisations since the ban.

Overseas nurses denied NHS jobs

Thousands of overseas nurses were denied permission to work in England last year, despite hospitals facing staff shortages.

The Royal College of Nursing (RCN) has found that the refusals have hit high profile hospitals in Cambridge, Newcastle and Manchester.

A Freedom of Information request to the Migration Advisory Committee (MAC) found more than 2,341 refusals.

The RCN asked for the number of applications to allow overseas (non-European Union) nurses to work in England between April and November 2015 and the number refused.

It found that East Lancashire Hospitals NHS had the highest number of refusals with 300 out of 300 applications.

The research found that Brighton and Sussex University Hospitals and North Cumbria University Hospitals both had about 240 refusals.

Nursing was temporarily placed on the MAC shortage occupation list (allowing more overseas nurses) in December.

Janet Davies, chief executive of the RCN, said: “These figures show that when nursing is not on the list, many trusts are unable to recruit enough nurses, which could have an impact on patient care.”

Catherine Morgan, director of nursing at The Queen Elizabeth Hospital in King’s Lynn, said that she had been prevented from recruiting a number of overseas nurses.

“It is frustrating because we are running a hospital and do want it to be safe, and we had the opportunity to recruit from India and the Philippines and we had nurses keen to come over but haven’t been able to bring them over,” she said.

A Department of Health spokesman said: “The MAC is currently reviewing the shortage occupation list. Staffing is a priority and there are already more than 8,500 more nurses on our wards since 2010 and 50,000 more nurses in training.

“We want more home-grown staff in the NHS and our recent changes to student funding will create up to 10,000 more nursing, midwifery and allied health professional training places by 2020.”

Dementia patients face Russian roulette in hospital

Dementia patients admitted to hospital in England play “Russian roulette” with their health, a charity is warning.

Dementia patients admitted to hospital in England play "Russian roulette" with their health, a charity is warning.

The Alzheimer’s Society said it had found “shocking” evidence of poor and variable care during its review.

The report, based on Freedom of Information (FOI) requests, found problems with falls, night-time discharges and readmissions, and said standards needed to improve urgently.

The Department of Health said the disease was a key priority as one in four hospital beds is believed to be occupied by a person with dementia.

The Alzheimer’s Society called for all hospitals to publish an annual statement of dementia care, to include information on satisfaction, falls, readmissions and staff training as part of its campaign to improve standards.

The charity received responses to their FOI request from half of the 163 hospital trusts in England; however, for some of the questions the figures were based on a fifth of trusts as not all hospitals could provide answers to all the questions.

Its report showed:

  • more than one in four people over the age of 65 who fell had dementia, but in some trusts it topped 70%
  • people with dementia stay five to seven times longer than other patients over the age of 65 in the worst-performing hospitals
  • one in 10 people over 65 who were discharged overnight had dementia – with the numbers rising to nearly four in 10 in the worst trusts
  • more than half of over-65s readmitted within 30 days – a sign of inappropriate care – had dementia in the worst-performing trust.

The Alzheimer’s Society also carried out a survey of dementia patients. It found examples of patients being treated with excessive force, not being given enough help with meals and drinks and being left in wet or soiled sheets.

Nine in 10 said hospitals were frightening and only 2% felt all staff understood the needs of people with dementia.

The charity described these findings as unacceptable and a sign that dementia patients were not getting the standard of care they should.

Alzheimer’s Society chief executive Jeremy Hughes said: “In the worst cases, hospital care for people with dementia is like Russian roulette. People with dementia and their carers have no way of knowing what’s going to happen to them when they are admitted.

“In many cases they are well looked after but, as our investigation shows, too often people with dementia fall and injure themselves, get discharged at night or are marooned in hospital despite their medical treatment having finished.”

A Department of Health spokesman said the disease was a key priority and in recent years £50m had been spent on making hospitals and care homes more “dementia friendly”, while 500,000 staff had received extra training.

“People with dementia and their carers deserve the very best support,” he added.

NHS trust failed to investigate hundreds of deaths

The NHS has failed to investigate the unexpected deaths of more than 1,000 people since 2011 according to a new report.

The NHS has failed to investigate the unexpected deaths of more than 1,000 people since 2011 according to a new report.

It blames a “failure of leadership” at Southern Health NHS Foundation Trust and that the deaths of mental health and learning disability patients were not properly examined.

Southern Health said it “fully accepted” the quality of processes for investigating and reporting a death needed to be better, but had improved.

The trust is one of the country’s largest mental health trusts, covering Hampshire, Dorset, Wiltshire, Oxfordshire and Buckinghamshire and providing services to about 45,000 people.

The investigation, commissioned by NHS England and carried out by Mazars, a large audit firm, looked at all deaths at the trust between April 2011 and March 2015.

During that period, it found 10,306 people had died. Most were expected. However, 1,454 did not.

Of those, 272 were treated as critical incidents, of which just 195 – 13% – were treated by the trust as a serious incident requiring investigation (SIRI).

The likelihood of an unexpected death being investigated depended hugely on the type of patient.

The most likely group to see an investigation was adults with mental health problems, where 30% were investigated. For those with learning disability the figure was 1%, and among over-65s with mental health problems it was just 0.3%.

The average age at death of those with a learning disability was 56 – over seven years younger than the national average.

Even when investigations were carried out, they were of a poor quality and often extremely late, the NHS England report says.

Repeated criticisms from coroners about the timeliness and usefulness of reports provided for inquests by Southern Health failed to improve performance, while there was often little effort to engage with the families of the deceased.

Key findings from the report

  • The trust could not demonstrate a comprehensive systematic approach to learning from deaths
  • Despite the trust having comprehensive data on deaths, it failed to use it effectively
  • Too few deaths among those with learning disability and over-65s with mental health problems were investigated, and some cases should have been investigated further
  • In nearly two thirds of investigations, there was no family involvement

The reasons for the failures, says the report, lie squarely with senior executives and the trust board.

There was no “effective” management of deaths or investigations or “effective focus or leadership from the board”, it says.

Even when the board did ask relevant questions, the report says, they were constantly reassured by executives that processes were robust and investigations thorough.

The culture of Southern Health, which has been led by Katrina Percy since it was created in 2011, “results in lost learning, a lack of transparency when care problems occur, as well as lack of assurance to families that a death was not avoidable and has been properly investigated,” the report says.

NHS health data sharing project scrapped

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

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.

NHS health staff crisis is worse than cash woes

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

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.

Agreement in sight for Junior doctors’ contract deal

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

AgreementGovernment 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.

NHS understaffed by 50,000 due to bad health planning

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

Bad planning and cost cutting have left the NHS in England short of 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.”

Jeremy Hunt- lies bullshit and poisoned statistics pt 2

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

Following one from Health Direct's Jeremy Hunt- lies bullshit and poisoned statistics post yesterdayHealth 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

Jeremy Hunt- lies bullshit and poisoned statistics

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.

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 statisticsWe 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 .