The Thin End

Doctors warn new plans for severe NHS cuts are 'shrouded in secrecy' and will ‘cause uproar’ Health service leaders have refused to publish details of plans for severe cuts that could extend waiting times, reduce access to services, cut down on prescriptions and treatments, and even merge or close hospitals and facilities. The Capped Expenditure Process (CEP) was introduced in April 2017 and instructs NHS commissioners and providers in 13 areas across England with the largest budget deficits to make considerable cuts in order to achieve financial balance by next April1. The areas affected by the CEP are under intense pressure to drastically reduce spending by around £500m, and health leaders have been told to ‘think the unthinkable’ with regards to cuts. The 13 areas involved have submitted plans and NHS England chief executive Simon Stevens has now told commissioners and managers to get on with delivering the proposals – warning that more ‘difficult choices’ are on th...

Are UK farm animal welfare standards at risk in post Brexit trade deals? A parliamentary sub-committee warns of the potential fall in standards unless farm animal welfare is a key part of any post Brexit trade deals, particularly because many other countries have lower standards than in the UK, and in the rush for trade deals these may be sacrificed.     The EU Energy and Environment Sub-Committee today publishes its report on Brexit: farm animal welfare.  High standards of welfare The UK currently has some of the highest farm animal welfare standards in the world and there is cross-sector support for maintaining those high standards after Brexit. The greatest threat to farm animal welfare standards post-Brexit would come from UK farmers competing against cheap, imported food from countries that produce with lower standards than in the  the UK.  The sub-Committee warns that the Government's wish for the UK to become a global leader in fr...

Dog walking could be key to ensuring activity in later life A new study has shown that regularly walking a dog boosts levels of physical activity in older people, especially during the winter. Published in the  Journal of Epidemiology and Community Health,  the study used data from the EPIC Norfolk cohort study, which is tracking the health and wellbeing of thousands of residents of the English county of Norfolk.  The researchers from the University of East Anglia (UEA) and Centre for Diet and Activity Research (CEDAR) at the University of Cambridge found that owning or walking a dog was one of the most effective ways to beat the usual decline in later-life activity, even combatting the effects of bad weather. Dog owners were sedentary  for 30 minutes less per day , on average. More than 3000 older-adults participating in the study were asked if they owned a dog and if they walked one. They also wore an accelerometer, a small electronic device th...

Is it time to enforce minimum unit pricing for alcohol in the United Kingdom? The latest evidence provides further impetus to those campaigning to limit the sale of alcoholic drinks. Alcohol misuse is the biggest risk factor for death, ill-health and disability among 15-49 year-olds in the UK, and the fifth biggest risk factor across all ages, and alcohol related problems are estimated to cost the NHS around £3.5 billion annually. In 2015, there were over 8,000 casualties of drink driving accidents in the UK including 220 fatalities and 1,160 serious injuries. Alcohol kills. So does price matter? Alcohol is now 60% more affordable than it was in the 1980s, particularly because of big discounting of price in the major supermarkets. Responding to the latest findings that almost 63,000 people in England will die over the next five years due to alcohol misuse, Professor Dame Parveen Kumar, BMA board of science chair, said: “The BMA has repeatedly called for the introduction of...

The news of death threats sent to staff at Great Ormond Street Hospital is disturbing. Whatever the opinion held on the issues surrounding the care of baby Charlie Gard, it has to be acknowledged that these are complex. It would be easy enough to adopt the position that it should always be the parents choice to decide on the best treatment for their child, but this cannot always trump the legitimate concerns and responsibilities of doctors and nursing staff. It would of course be ideal if all choices on treatment, or of withdrawal of treatment and life support, could be made with agreement of both parents and doctors. But this cannot always be the case. In the most difficult cases where there is disagreement about life support it will inevitably be decided by judges and through the legal process. When the case was first heard I was asked as a medical ethicist to make a comment to the media. I chose not to do so because I could not know the full details of the case. This is...

As the population increases we would expect a concomitant rise in demand for health and social services. Good government would seek to meet that rising need, yet NHS funding has been essentially frozen over the last six years as part of austerity. This is despite the Tory claim in 2010 that they would 'ring fence' funding for the NHS. The latest data from NHS Digital reveal there were 58,492,541 patients registered at GP practices in England on 1 July 2017. There were 2,427,526 more registered patients on 1 July 2017 compared to (56,065,015 ) 1 July 2013. Yet, there has been an insufficient increase in funding for the NHS to cope with this increased demand. But the government not only denies cuts in funding, it says funding for the NHS has increased. It is a disingenuous defence. Of course funding for the NHS has risen, and funding is continuing to grow but at historically low rates and it is insufficient for services to meet increasing needs, and the rate of g...

Brexit, we were told, was about 'taking back control'.  What that meant specifically was taking back control of our borders and immigration.  This was probably the most significant issue swaying voters in the referendum.  It masked all other arguments. Now a parliamentary committee warns that the government has no clear data on migration and the government is working 'in the dark'. The Government will struggle to take control of immigration post-Brexit unless significant improvements are made to the quality of migration data upon which it currently relies, the Economic Affairs Committee says in its report into Brexit and the Labour Market. Commenting on the report, Lord Forsyth of Drumlean, Economic Affairs Committee Chairman, said: "The Government must have reliable statistics on migration before it formulates new policy, otherwise it will be making crucial decisions - of vital importance to the country's businesses - in the dark. "It will...

With rationing in the National Health Service there is a post-code lottery in treatment. An investigation by the British Medical Journal shows treatments available just a few months ago are no longer provided in some areas. This post-code lottery in available treatments is a shocking state of affairs, and is further evidence of a fragmenting health service. There is no doubt the NHS is now struggling to cope with increased demand with limited resources. Commissioners and providers have had to face difficult decisions about how to prioritise limited funding and to balance their budgets. Funding requests are a key marker of treatment rationing. An individual funding request can be made by clinician if they believe that a particular treatment or service that is not routinely offered by the NHS is the best treatment for their patient. As treatments become rationed or unavailable there is a concomitant increase in the number of funding requests. Normally, the vast majority of treat...

Could the release of carbon from the soil be accelerating global warming and climate change?  The answer from the latest research published in Nature appears to be a resounding 'yes.'  Perhaps it is not surprising given that the soil acts as a significant store of global carbon.  It isn't merely locked in place. Organic processes release it into the atmosphere.  Carbon is a vital ingredient of our living planet and plays a major role in the balance of our ecosystem. All life on earth is 'made' of carbon and carbon circulates. Carbon enters the atmosphere as carbon dioxide from respiration and combustion. It is absorbed by plants to make carbohydrates in photosynthesis using energy from the sun. Animals feed on the plants passing the carbon compounds along the food chain. Most of the carbon they consume is exhaled back into the atmosphere as carbon dioxide. The animals and plants eventually die, and these dead organisms get eaten by decomposers (microbes a...