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15th November 2024
Folic acid will be added to non-wholemeal flour in the UK from the end of 2026 to prevent birth defects, the Government has announced, making the country the first in Europe.
Ministers said the UK-wide legislation would prevent around 200 cases of neural tube defects every year and improve health of pregnant women.
It has been estimated that the move to include folic acid in flour will reduce neural tube defects by 20% in the saving the NHS £20m over 10 years and boosting the economy by more than £90m.
NHS recommendations that women who are trying to conceive a baby take folic acid supplements for around three months before getting pregnant and for at least 12 weeks after will remain in place.
But with around half of all pregnancies in the UK being unplanned, it is hoped the new regulations will help to provide women with a higher baseline intake of folic acid.
The move follows a public consultation in 2022 on the amount of folic acid that should be added to flour.
Flour is already fortified with calcium, niacin, thiamine and iron to improve public health, the Government added.
But experts said the measures were too ‘timid’ and did not go far enough to prevent more cases of anencephaly and spina bifida.
Andrew Gwynne, minister for public health and prevention, said: ‘Shifting care from sickness to prevention is one of the leading ambitions in our 10 Year Health Plan, as we work to make our NHS fit for the future.
‘These measures are a simple and effective intervention to improve health outcomes in babies, giving them the best start in life.’
Professor Chris Whitty, England’s chief medical officer, said: ‘The fortification of flour is a simple and effective way to help to reduce cases of neural tube defects, although it is important that women who are pregnant or intending to become pregnant continue to take folic acid supplements before and during the first 12 weeks of pregnancy.’
Professor Ian Young, chair of the Scientific Advisory Committee on Nutrition, said they welcomed the move having consistently recommended folic acid fortification since 2006.
Professor Sir Nicholas Wald, professor of preventive medicine at University College London, who conducted the original 1991 study that showed folic acid deficiency to be a leading cause of neural tube defects, said the decision was ‘good news’.
‘However, more could be done to prevent an estimated 800 cases [of neural tube defects] instead of 200 if all flour and rice were fortified (unless labelled as unfortified) and the level of fortification mandated by the Government were increased,’ he said.
Dr Jonathan Sher, former deputy director of Queen’s Nursing Institute Scotland, said fortification was long overdue but the plans in their current form were ‘timid, unscientific and will predictably fail to prevent most of the harm currently caused by neural tube defects’.
Professor Neena Modi, professor of neonatal medicine at Imperial College London, said the good news was tempered by the decision to restrict fortification to non-wholemeal flour only ‘as this will disadvantage groups such as women who are sensitive to gluten, eat rice in preference to bread, and products made from wholemeal flour, excluding them and their babies from benefiting, and thus add to the considerable health inequities that already exist in the UK’.
A version of this article was originally published by our sister publication Pulse.
14th November 2024
The UK health secretary has promised to cut long hospital waiting times back down to the NHS 18-week target via financial incentives and performance league tables.
In a speech at the NHS Providers conference in Liverpool, Wes Streeting said there will be a ‘zero tolerance’ policy for failure and underperforming hospitals will no longer be rewarded, with a ban on senior managers receiving pay rises at these Trusts.
Under the plans, ‘persistently failing’ NHS managers will be replaced and ‘turnaround teams‘ sent to support improvement, Mr Streeting said, while Trusts deemed to be high-performing will be given greater freedom over funding to invest where they see fit, such as modernising buildings, equipment and technology.
Meanwhile, NHS England will carry out a review of hospital performance across the country, resulting in a league table that will be made public and regularly updated.
The Government is hoping that keeping hospitals to account financially will reduce waiting times for patients.
Mr Streeting said: ‘We are announcing the reforms to make sure every penny of extra investment is well spent and cuts waiting times for patients.
‘There’ll be no more turning a blind eye to failure. We will drive the health service to improve, so patients get more out of it for what taxpayers put in.
‘Our health service must attract top talent, be far more transparent to the public who pay for it, and run as efficiently as global businesses.
‘With the combination of investment and reform, we will turn the NHS around and cut waiting times from 18 months to 18 weeks.’
NHS England chief executive Amanda Pritchard said: ‘While NHS leaders welcome accountability, it is critical that responsibility comes with the necessary support and development.
‘The extensive package of reforms, developed together with Government, will empower all leaders working in the NHS and it will give them the tools they need to provide the best possible services for our patients.’
The NHS Oversight Framework, which sets out how Trusts and integrated care boards are best monitored, will be updated by the next financial year ‘to ensure performance is properly scrutinised’.
However, the Royal College of Emergency Medicine (RCEM) has warned that league tables and incentivising hospital performance could ‘take away focus from deeper systemic issues affecting urgent and emergency care’.
Dr Adrian Boyle, president of the RCEM, said: ‘Measuring poor performance is challenging as hospitals have been merged into multi-site Trusts. For example, you might have a Trust that runs multiple emergency departments, and this can be difficult to compare. That is one of the reasons we are asking for data for each individual hospital to be made available. This would easily create the transparency that the secretary of state desires.
‘There is also the risk of short-term target chasing instead of focusing on wider systemic issues needed such as improvements in social care capacity, crumbling estate and poor IT.
‘We know that A&E staff are already working at maximum capacity in extremely challenging conditions, and we are worried this focus on performance could lead to recruitment and retention issues in already struggling hospitals.‘
He added: ‘We welcome to focus on giving more power to local health boards, but no amount of performance incentive can replace the need for more beds and staff. We hope these changes will be accompanied by the whole system improvements promised by the new Government.‘
Further plans to be put forward for consultation in the coming weeks include stopping NHS staff resigning and then immediately offering their services back to the health service through a recruitment agency.
The consultation will also include a proposal banning NHS Trusts from using agencies to hire temporary entry level workers in band 2 and 3, such as healthcare assistants and domestic support workers.
The Labour Party’s manifesto had pledged to ‘cut NHS waiting times’ with ‘40,000 more appointments every week’, including via greater use of the private sector.
At the Labour Party conference September, Mr Streeting announced a ‘Formula 1 pit stop’ strategy for UK operating theatres to tackle waiting lists in areas with the ‘highest numbers of people off work sick’.
A version of this article was originally published by our sister publication Pulse.
13th November 2024
Two doctors would need to assess terminally ill adults who wish to end their lives under proposed assisted dying legislation for England and Wales.
The bill, which will be subject to a ‘free vote’ among MPs on 29 November, states that doctors are not under ‘any duty’ to raise assisted dying with patients or to ‘participate in the provision of assistance’ if they do not wish to.
Published this week, the bill sets out the eligibility criteria for adults wishing to end their lives as well as requirements for doctors involved in the process.
The proposed legislation stipulates the involvement of both a ‘coordinating doctor’ and an ‘independent doctor’ who can attest to the person’s eligibility.
After confirmation from both doctors, as well as a ‘declaration’ from the person themselves, the High Court must then make a decision, and must ‘hear from’ at least one of the doctors.
Only adults whose death from terminal illness ‘can reasonably be expected’ within six months would be eligible to receive assistance to end their life.
But the definition for terminal illness does not include ‘mental disorders’ or ‘disabilities’, under the proposed legislation.
The process must also take at least three weeks, with ‘reflection’ periods built in for the person between clinical assessments and after the High Court’s decision.
Doctors must ensure that persons wishing to end their own life:
The draft legislation makes clear that a doctor providing assistance ‘in accordance’ with the requirements is not guilty of any criminal offence, nor do their actions ‘give rise to civil liability’.
However, if a doctor ‘induces another person’ by ‘dishonesty, coercion or pressure’ to make declarations or to self-administer a substance, this would be an offence punishable by a prison term of up to 14 years.
The bill also stipulates that employers ‘must not subject an employee to any detriment for exercising their right’ not to participate in assisted dying processes.
The new bill, put forward as a private members bill by Labour MP Kim Leadbeater, follows a Health and Social Care Select Committee inquiry looking into the current law and at international examples of assisted dying becoming legal.
Following the introduction of this bill to Parliament last month, the UK’s most senior medical leaders advised that it is ‘entirely reasonable’ for doctors to take part in the public debate around assisted dying.
However, the UK’s chief medical officers also warned doctors against ‘implying’ that they speak for the entire medical profession rather then ‘expressing their personal views’.
Over 3,400 doctors, nurses and other healthcare professionals have signed a letter to the Prime Minister to warn that assisted dying cannot be introduced safely while the NHS is ‘broken’, according to The Telegraph.
Organised by campaign group Our Duty of Care, the letter states: ‘The NHS is broken, with health and social care in disarray. Palliative care is woefully underfunded and many lack access to specialist provision. The thought of assisted suicide being introduced and managed safely at such a time is remarkably out of touch with the gravity of the current mental health crisis and pressures on staff.’
Health secretary Wes Streeting said in October that he was worried about palliative and end-of-life care ‘not being good enough to give people a real choice’ on Good Morning Britain, saying he would vote against changing the law on assisted dying.
Last autumn, a survey of General Medical Council-registered doctors revealed that nearly half of UK doctors think that a physician-assisted dying law ‘would negatively impact the medical profession’.
A version of this article was originally published by our sister publication Pulse.
15th July 2024
The new UK health secretary Wes Streeting has announced an ‘independent investigation’ into the ‘state of the NHS’ to be led by Professor Lord Ara Darzi.
The findings of this ‘rapid’ investigation, which will be published in September, will feed into a new 10-year plan ‘to radically reform’ the NHS, for which patients and staff will be consulted ‘soon’.
Writing for The Sun, Mr Streeting repeated his claim that the NHS is ‘broken’ and said an investigation is needed to ‘diagnose the problem’.
Lord Darzi, a former Labour minister who Mr Streeting described as a ‘one of the NHS’s leading experts’, has been asked to produce a ‘raw and honest assessment’ of the state of the NHS.
The health secretary said the NHS and the Department of Health and Social Care (DHSC) have been ‘instructed’ to share ‘whatever information’ Lord Darzi needs.
Mr Streeting also argued that ‘sticking-plasters’ will not fix the NHS, and rather ‘fundamental reform’ is required.
The 10-year plan will be led by Sally Warren, who will be leaving her position as policy director at the leading health think tank The King’s Fund, to join DHSC.
During his time as health minister, Lord Darzi led an influential national review of the NHS entitled ‘High Quality Care for All‘, which aimed to improve accountability in clinical practice.
He also worked on Labour’s GP ‘polyclinic’ model – known as Darzi centres – which was later scrapped by the Coalition Government in 2011.
One of Labour’s manifesto promises was to trial ‘neighbourhood health centres’, which seem to resemble the Darzi model, with the aim of improving out-of-hospital care.
Lord Darzi, a surgeon who holds the Paul Hamlyn chair of surgery at Imperial College London, has also previously argued that the GP partnership model is out of date and that GP services should be brought ‘into the fold’ to ‘finally complete the NHS’.
In a statement, Mr Streeting promised that the Government ‘will be honest about the challenges facing the health service’.
He continued: ‘This investigation will uncover hard truths and I’ve asked for nothing to be held back. I trust Lord Darzi will leave no stone unturned and have told him to speak truth to power.
‘I want a raw and frank assessment of the state of the NHS. This is the necessary first step on the road to recovery for our National Health Service, so it can be there for us when we need it, once again.’
Lord Darzi said that the ‘first step’ to tackling any health problem is to establish a ‘proper diagnosis’, and that this investigation will help to reinstate ‘quality of care as the organising principle of the NHS’.
‘My work will analyse the evidence to understand where we are today – and how we got to here – so that the health service can move forward,’ he added.
The Royal College of Emergency Medicine (RCEM) has pledged its support to the new Government’s aim of ‘fixing’ the NHS but have warned that ‘efforts must be targeted to where they are most needed‘.
Calling the independent report ‘a step forward for transparency‘, Dr Ian Higginson, vice president of RCEM, said: ‘The health secretary was right, the NHS is broken, and the effects are seen nowhere more starkly than in emergency departments. RCEM has been clearly articulating the real picture for years, and it is refreshing to see a pragmatic and honest assessment of where we are and the scale of the challenge.
He added: ‘To make a significant improvement bed capacity needs to increase, and the beds that we do have need to be used more effectively. People need to be able to leave hospital as soon as they are well enough and there needs to be appropriate social care support there for them when they do.
‘There can be no quick fix in undoing what has been years in the making, but we remain committed to working with the new Government to resuscitate emergency care and restore public confidence in the NHS.‘
The new health secretary has also met with the British Medical Association’s junior doctors committee to reopen talks in a bid to bring an end to strike action.
A version of this article was originally published by our sister publication Pulse.
5th October 2023
‘Serious discussions’ must resume between the Government and doctors to end strike action ahead of winter, NHS England bosses said today.
At this afternoon’s board meeting, NHS England chair Richard Meddings stressed that winter pressures ‘impossible to manage’ if also impacted by strike action.
And chief executive Amanda Pritchard noted talks between the Government and doctors needed to urgently resume.
Following months of strike action, consultants and junior doctors have jointly been striking for three full days this week, with ‘Christmas Day’-level cover.
Mr Meddings told the board that it is ‘simply not sustainable to continue to operate with this amount of disruption’.
He said: ‘There’s simply not enough staff on “Christmas Day cover” days to complete the usual tasks while also dealing with business-as-usual levels of demand.
‘It would be impossible to manage this coming into the winter period. But we will continue of course to do all we can to keep caring for patients, putting them first but we urgently need to see a clear path to resolution and for all parties to work together to do the right thing by patients and to find an agreement to this dispute.’
Ms Pritchard said that the focus of NHS England’s discussions with both unions and Government regarding the strike action continues to be patient safety.
She added: ‘We all want to see serious discussions resume between unions and Government and with winter approaching that cannot happen soon enough.’
The Department of Health and Social Care declined to comment and instead pointed towards a previous statement.
This saw health secretary Steve Barclay urging unions ‘to end their relentless strike action’ and argued that doctors ‘have received a fair and reasonable pay rise – as recommended by the independent pay review body, which we’ve accepted in full’.
The BMA has repeatedly asked the Government to return to the negotiating table, with consultants saying this week that they are willing to involve reconciliation service ACAS and revive strike action discussions.
Yesterday NHS England told the British Medical Association (BMA) in a formal warning letter that ‘cumulative’ impact of doctor strikes are now causing ‘significant disruption and risk to patients’.
However the BMA argued that patient safety is being put at risk due to strike planning failures by NHS England.
BMA council chair Professor Phil Banfield said that the union has always been open to discussing ways to maintain patient safety.
BMA Cymru Wales has announced it will ballot junior doctors in Wales for strike action for six weeks from the 6 November. If successful, it will lead to a 72-hour full walk-out by participating junior doctors in Wales.
This comes following ’the Welsh Government’s failure to make any effort to restore junior doctors’ pay, which has left BMA Cymru Wales with no choice but to enter a trade dispute and ballot for strike action’, it said.
A version of this story was originally published by our sister publication Pulse.
3rd October 2023
The UK health secretary Steve Barclay has announced a £30m fund to speed up adoption of new health technology in the NHS.
Addressing the Conservative Party Conference today, he also announced ‘three new medical schools’.
However, the Labour Party and the BMA both pointed out all three schools already exist and two of them already train medical students.
The new tech fund will be open to applications from ICSs for projects that meet an ‘unmet need’ and bring ‘tangible benefits’ for patients or ‘improve productivity or staff experience’, the Government said.
The funding will be made available this calendar year, with projects expected to complete before the end of the financial year.
In his speech, the health secretary suggested projects could focus on artificial intelligence or cancer diagnosis.
He said: ‘Cutting-edge technology like AI has the potential to transform our healthcare but we need to roll out these innovations faster so that patients receive the benefits as quickly as possible.
‘That is why today I am announcing the creation of a new £30m Health Technology Adoption and Acceleration Fund, enabling clinicians to adopt proven technologies that can improve patient care in their local area.
‘This fund, resulting from a long-term decision by the Government to build a brighter future for the NHS, will provide new tools to help detect cancer sooner, enable people to receive treatment in the own homes and increase productivity.’
On medical schools, the health secretary announced that the new schools will be at the University of Worcester, the University of Chester and Brunel University in Uxbridge, west London.
According to the Government, this will provide a further 205 undergraduate places from September 2024.
Mr Barclay said: ‘I’m delighted to announce today that we are making more than 200 medical school extra places available at universities for next September.
‘Most of these places will be going to three new NHS medical schools, meaning hundreds of additional doctors working on the wards in the years to come.
‘This will help ensure the NHS is set for the future and that patients get the care they need when they need it.’
But Dr Emma Runswick, BMA council deputy chair, said: ‘With more than 10,800 doctor vacancies in England’s hospitals alone, these additional 205 places a year are a drop in the ocean. The health secretary is fooling no one if he thinks this is the answer to the NHS’s medical workforce crisis – while he simultaneously refuses to talk with the doctors we already have.
‘We desperately need to attract and recruit more doctors, but most crucially we need to keep the doctors working in the NHS right now, and to do that we need to ensure they’re valued appropriately. You can’t fill a leaky bucket without plugging holes in the bottom.’
This article was originally published by our sister publication Pulse.
29th June 2023
The UK Government’s latest scheme to increase access to the anti-diabetic drug semaglutide is designed to reduce levels of obesity and related complications. But past evidence suggests it is doomed to fail. Clinical writer Rod Tucker finds out more.
A two-year pilot scheme, backed by investment up to £40m, is to be launched in the UK to increase accessibility to the anti-obesity treatment semaglutide outside of hospital settings.
Obesity is a leading cause of conditions such as cardiovascular disease, diabetes and cancer, and was reported to be a factor in more than one million admissions to NHS hospitals in 2019/20. According to information released by the Department of Health and Social Care, obesity has an annual cost to the NHS of £6.5bn.
On the face of it, the rationale for widening access to the anti-diabetic treatment appears sensible. Any approach that leads to a reduction in the level of obesity should give rise to a commensurate decrease in the number of individuals developing obesity-related conditions and requiring interventions such as knee and hip replacements. If obesity levels drop, so would the waiting list for these complications. Its a win-win situation.
But there are two other relevant considerations. Firstly, does wider access to semaglutide align with current recommendations for the drug, and secondly, how likely is it that the pilot scheme will be successful?
In March 2023, NICE recommended semaglutide as an option for weight management in adults, alongside a reduced-calorie diet and increased physical activity. However, there were several caveats attached to this recommendation.
Firstly, use of the drug was restricted to a maximum of two years and it could only be prescribed at a specialist weight management service. Secondly, patients were required to have at least one weight-related comorbidity and body mass index (BMI) of at least 35.0 kg/m2, although patients could access the drug if they had a BMI of 30.0 kg/m2 to 34.9 kg/m2 and met the criteria for referral to specialist services.
By broadening access to semaglutide, the pilot scheme is therefore at variance to the NICE guidance. While NICE is sponsored by the Department of Health and Social Care, and purported to be independent of the UK Government, it has been argued that the organisation is not, and indeed cannot be, truly independent of the Government.
To date, NICE has remained silent on the Government’s latest initiative, probably because it goes against everything that was outlined in its draft guidance. The Government has argued that its latest scheme is merely a pilot project to explore if and how the anti-diabetic drug can be made safely available outside of a hospital settings. This will happen, it says, alongside NHS England’s work to implement NICE’s recommendations to make this new class of treatment available to patients through established specialist weight management services.
The evidence for semaglutide is convincing, but it is important to acknowledge that the drug only works when used as an adjunct to diet and exercise. Moreover, it is likely to require life-long use despite the two year restriction imposed by NICE. It is now clear that significant weigh re-gain occurs once patients stop taking the anti-diabetic drug, and another study shows how mean body weight increased by 6.9% after cessation of treatment.
A further barrier to the potential success of the pilot scheme is the growing recognition that obesity is a complex condition and that hypothalamic neuro-inflammatory responses play an important role. As a result, obesity management requires a multi-interventional approach.
Commenting on the pilot scheme, the UK health and social care secretary Steve Barclay said: ‘This next generation of obesity drugs have the potential to help people lose significant amounts of weight when prescribed with exercise, diet and behavioural support.’
But how effective is a primary-based weight management service likely to be? An insightful analysis of GP and nurse practitioner habits in response to a mock scenario, makes for interesting reading. Published in 2020, the study found that overall only 24% of respondents would refer patients to a weight management service. The most common response, in over 80% of cases, was to provide either diet or exercise-based advice.
Despite this, evidence from the US offers some hope that behaviour-based weight-loss interventions, either with or without weight loss medications, result in more weight loss than usual care conditions.
The potential for greater access to an effective anti-diabetic weight-loss drug is to be welcomed. Nevertheless, it can only ever serve to address the consequences and not the root causes of obesity. A huge amount of evidence also makes it abundantly clear that obesity is inextricably linked to socioeconomic and demographic factors. Overweight and obesity are far more prevalent in deprived areas, in those of black ethnicity and in the least well educated. In fact, someone living in the most deprived area is nearly twice as likely to be obese as someone in the least deprived area.
With past behaviour seen as the best predictor of future behaviour, the evidence over the last 30 years does not augur well for the current pilot scheme. A recent analysis has shown how obesity policy in England has involved 14 strategies, published from 1992 to 2020, which contain 689 wide-ranging policies. The authors suggested that the continued failure to reduce the prevalence of obesity in England for almost three decades may be due to either weaknesses in the policies’ design, or to failures of implementation and evaluation.
Obesity represents a growing problem, with 25.9% of adults in England obese and 37.9% overweight. Moreover, we live in an obesogenic environment that is influenced by the availability and affordability of foods, together with varying access to opportunities for physical activity. Consequently, it is perhaps too simplistic to label obesity as an individual’s problem: obesity is an environmental problem that requires a wholesale change with regulatory interventions directed at reducing intake of ultra-processed food and acknowledgement of the impact of socioeconomic factors. Such a change requires additional funding, and considerably more that the currently allocated £40m.
Greater access to the anti-diabetic drug semaglutide is unlikely to single-handedly solve the problem of obesity. Nonetheless, if provided through an adequately funded weight management services as part of a comprehensive package that includes behavioural support, access to exercise facilities and nutritional advice, it might have a noticeable effect on levels of obesity and its health-related consequences.
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