NHS to provide more care at home
Department of Health, 18 February 2010
The Government has outlined a number of measures that it hopes “can have significant outcomes and save money” as it looks to enable more people to receive treatment at home. It argues that changes to the way in which long-term conditions are managed has delivered savings of £2.1bn to date.
Among the initiatives confirmed by the Health Secretary are those discussed below:
- Home dialysis treatment could be provided for up to 7,000 patients. This is expected to help reduce hospital admissions and the reliance of these individuals upon medication. Furthermore it has been estimated that home treatment could prove to be 25 per cent cheaper on an annual basis.
- The DH has published guidance on the provision of chemotherapy services in the community.
- In advance of the forthcoming publication of a National Framework for Children and Young People’s Continuing Care, the Government has offered some aspirations in this area. These include 24/7 access to Community Children’s Nursing Team, integrated care packages and a single lead health professional for each family.
- Andy Burnham also confirmed that the Government will be evaluating progress with regards to end of life care by 2013. Proposals on the right to choose to die at home are planned.
Change4Life one year on
Department of Health, 17 February 2010
The focus of the Change4Life campaign in its first year was families with children between five and 11 years old who had a high risk of becoming overweight or obese. This report looks at the results of the first year of the campaign and gives details of what is going to be the focus for the next 12 months.
All of the targets for year one were either matched or exceeded. For example there were almost two million responses to the campaign (including website hits, telephone calls and returned questionnaires) compared to a target of 1.5 million. Of those two million responses, almost 350,000 questionnaires were returned, compared to a target of 100,000. As a result of the campaign, the DH believes there is evidence starting to come through showing Change4Life is having an impact:
- Their tracking study shows that over one million mothers claim they have improved their children’s activity levels and diet because of Change 4Life.
- Initial evidence from commercial partners suggests that the campaign may be having an impact on the types of food purchased by families.
- 44 per cent of primary schools and a range of other organisations such as hospitals, libraries and GP surgeries advertised the campaign.
The DH are currently working to expand on initial findings by looking to produce evidence of behaviour change. They report that obesity levels in children appear to be beginning to “flatten out” and hope their campaign will increase the pace. As a next step they are producing messages for pregnant women and families with children under the age of two years, which will be branded Start4Life.
Marmot Inequalities Review: fair society, healthy lives
University College London, 11 February 2010
Professor Sir Michael Marmot, following his work chairing the WHO’s Commission on the Social Determinants of Health, was asked to advise the Government on a strategy to reduce health inequalities in England, and this report is the result. Marmot’s starting position is that ‘health inequalities that could be avoided by reasonable means are unfair’, and he strongly argues that current levels of inequality must not be maintained – where for example the average difference in disability-free life expectancy between richest and poorest areas of England is 17 years. Levels of income, education, and housing conditions map in a gradient to expected health and life expectancy. The current position means that between 1.3 million and 2.5 million years of life are lost due to premature death each year, and the unequal distribution of illness additionally accounts for productivity, tax and benefit losses of between £51bn and £65bn per year.
To help remedy the situation, Marmot calls for ‘proportionate universalism,’ where actions to improve health and the social and economic determinants of health must be applied to all, but with greater intensity to those towards the bottom of the gradient. Further, action is necessary not only in terms of health interventions, but across all the determinants of health, including inequities in power, money and resources. This should be backed up by a focus on measuring national wellbeing as a central societal goal, as important as measuring GDP. In this context, cutting public spending is ‘not an option.’ The ‘central ambition’ of the review is to ‘create the conditions for people to take control over their own lives’ where people have an equal ‘freedom to flourish.’
The report proposes six policy objectives to help bring this more equal society into being:
- ‘Giving every child the best start in life’: weight public spending more towards the early years, especially amongst the more disadvantaged, and provide a year of parental leave paid at minimum income for healthy living.
- ‘Enable all...to maximise their capabilities and have control over their lives’: especially through early elimination of inequalities in educational outcomes through a ‘whole child’ approach in schools and closer links between schools, families and communities; increase availability of lifelong learning.
- ‘Create fair employment and good work for all’: improve access to and availability of ‘good quality jobs’ and promote greater security and flexibility in work.
- ‘Ensure a healthy standard of living for all’: establish a ‘minimum income for healthy living’ (for good nutrition, exercise, medical care, housing, social interaction and transport); decrease tax rates for those on lower incomes as the current tax structure disadvantages the worst off; overhaul the benefit system to remove disincentives to work.
- ‘Create and develop healthy and sustainable places and communities’: build people’s participation in their local communities (social capital); policies to improve community sustainability and environment can also help reduce health inequalities (e.g. ‘active transport’, green spaces, energy efficient housing).
- ‘Strengthen the role and impact of ill health prevention’: four percent of the NHS budget is currently spent on prevention activities.
These objectives should be operationalised through central setting of expected outcomes, with local areas being free to decide how to achieve these. The Review suggests a framework of indicators to provide a starting point for local monitoring efforts, underpinned by national ‘aspirational targets’ such as life expectancy, health expectancy, readiness for school, young people not in education, employment or training, and proportion of households with an income sufficient for healthy living.
The report is supported by nine evidence reports about ‘what works’ to reduce health inequalities.