What the papers say – weekly digest (09/02/24)

Your weekly digest of the top healthcare stories, covering news published from 05/02/2024 – 09/02/2024.

Daily Express

Thousands of fed-up family doctors plan to quit the NHS, plunging basic care into chaos. The crisis has seen millions of patients struggle to make routine appointments – but is set to become a national emergency by 2029. Damning figures reveal 37% of fully-qualified GPs are unlikely to still be working in five years. Many blame unmanageable workloads and the stress of life within powder keg surgeries. Professor Kamilla Hawthorne, of The Royal College of General Practitioners, representing more than 50,000 GPs. said: ‘’Our teams have been plagued by workforce and workload crises and our patients feel the impact most. The public are increasingly struggling to access our care and services. They recognise this is out of the control of GPs and our teams, who are trying to do our best in the most difficult of circumstances.’’ Over the past five years demand for doctors has soared, yet the number of fully qualified, full-time GPs has fallen, despite promises to boost the workforce by 6,000. Latest NHS figures show November was the busiest on record for GPs and their teams, who delivered more than 31 million appointments – a 30% increase on the same period in 2019. The average number of patients per GP in England is now 2,290. There are around 27,487 fully-qualified and full-time GPs in England staffing 6,355 practices. Yet half of them say it is financially unsustainable to do so. Just one quarter said running a surgery was financially stable, the lowest figure since 2016. Worryingly one in four GP partners and salaried doctors said they are so stressed they cannot cope at least once a week. Frustrated patients say accessing appointments has become also impossible with many surgeries suspending online booking and advance slots. It now leaves millions at the mercy of a daily 8am phone-line lottery and a slim chance of a same-day consultation. An average doctor will care for a patient who visits, on average, five times a year – meaning they plough through at least 10,000 appointments in 12-months. However, staffing black holes see a handful of GPs looking after tens of thousands of patients. In some cases, doctors deal with more than 60 a day.

The number of hospital cases of flu or norovirus in England has jumped sharply to hit a high for this season, figures show. Health chiefs have warned the service is ‘’in the thick of a challenging winter’’, with long delays for ambulance patients to be handed over to A&E teams and struggles to clear ‘’bed blockers’’. Now NHS England data show 2,226 patients were in hospital each day last week with flu on average, including 84 in critical care beds. It is a rise of 41% from 1,582 the previous week and up 70% from the start of the year. Flu is dominating at a later point this winter than in 2022/23, when cases peaked as early as Christmas. Instances of highly infectious norovirus are now at their peak for this season so far, with an average of 688 adult hospital beds filled last week by those vomiting or showing other symptoms. This is up 57% week-on-week from 438 beds and is an 82% increase since the start of the year. The figures also show 34% of hospital patients in England arriving by ambulance in the week to January 28 had to wait more than half an hour to be handed over to A&E teams. This is up from 32% in the prior week and is the joint highest share so far this winter, as well as being nearly double the 18% from this point in 2023. And a winter peak of 15% had to wait more than an hour, up from 14% the previous week.

Deaths from cancer in the UK are set to surge by more than 50% by 2050, driven by the ageing and expanding population, experts predict. The International Agency for Research Cancer and the World Health Organisation examined data from 115 countries. They said there were 454,954 new diagnoses of cancer in the UK in 2022. This is set to rise by 37% by 2050 to 624,582. Globally, new cases will increase by 77% to 35 million. The researchers also forecast that annual deaths in the UK due to the disease will jump 53% to 279,004 in 2050. And deaths worldwide are set to almost double to 18.5 million. Dr Panagiota Mirtrou, of the World Cancer Research Fund, said: ‘’UK governments’ failure to prioritise prevention and address key cancer risks factors like smoking, unhealthy diets, obesity, alcohol and physical inactivity has in part widened health inequalities. ‘’We know around 40% of cancer cases could be prevented. Now is the time to turn the tide.’’ And Dr Cary Adams, of the Union for International Cancer Control, said: ‘’Where someone lives should not determine whether they live.’’

The number of children being referred for emergency mental healthcare has risen by half. There were 32,521 referrals to crisis teams at Child and Adolescent Mental Health Services in England in 2022-23. This is a 53% increase on 2019-2020, when it was 21,242. The Royal College of Psychiatrists, which analysed the data, said many youngsters were suffering worsening mental health while on NHS waiting lists. Under-18s stuck in limbo after a GP referral for mental health problems have already waited on average five months and, in the worst case, almost two years. The college’s Dr Elaine Lockhart said: ‘’It’s unacceptable that so many children and young people are reaching crisis point before they are able to access care. We cannot allow this to become the new norm. Children who receive support quickly are less likely to develop long-term conditions that affect their education, social development and health later in life. Investing in children’s mental health will free up NHS time and resources while ensuring the country has a healthy, productive population.’’ The college welcomed a £5million injection from the Government but said up to £205million would be needed.

The battle against childhood cancer will be boosted by an expert taskforce to improve treatment, detection and research. Clinicians, charities and official patient representatives will evaluate the latest medical developments, including DNA testing, personalised therapies, use of AI and access to drug trials. Dame Caroline Dinenage, MP for Gosport, will lead the mission, the Government announced yesterday (Tuesday). Health Secretary Victoria Atkins said: ‘’Discovering your child has cancer is among the worst news a parent can receive. This taskforce will help bring together world-leading experts and those who have dedicated their lives to fighting cancer to discuss how we can go further faster, and drive progress in cancer care.’’

Daily Telegraph

Most women now have their first child from the age of 32, data from the Office of National Statistics (ONS) show. It is the first time that the majority of women are waiting until the age of 32 to have their first child, and continues a trend of women opting to become mothers later in life. The ONS said there had been a ‘’shift’’ in the age of first-time mothers over time, and it is now more than 10 years older than it was for those born in 1950. Experts have attributed the rise in the age of first-time mothers to factors including advances for women at work, the cost of raising children, and it taking longer to meet a suitable partner. Just 49 per cent of women born in 1992 had a child by the age of 31, the figures for 2022 show, which is down by four percent from two years earlier, suggesting the pandemic may have also had an impact on fertility rates. Meanwhile, the proportion of women born in 1991 with a first child by the age of 32 was 55 per cent, although this was also down, by three percent on the year before. The statistics for 2022 also reveal that a record number of women were childless at 30. Of those born in 1993, 56.5 per cent did not have children at 30, compared to 42 per cent of women born in their mother’s generation, around 1965. The average age a woman had their first child first hit 30 for those born in the 1970s, up from 26 in 1960. But it remained stable at around 30 to 31 until the latest data revealed the increase for women born in the early 1990s. Women are also leaving it later to have two children, if they choose to expand their family at all. The data, which only include women up to the age of 45, reveals the average number of children per mother is 1.94. A two-child family is still the most common unit, though, accounting for 38 per cent of families, the data show. For women born in 1950, 44 per cent had two children, compared to 38 per cent of those born in 1977. Similarly, the number with three children fell from 20 per cent to 17 per cent. There has also been a sharp rise in the number of women having children after the age of 50 – up by 15 per cent in three years, the ONS figures show. Between 2019 and 2021, 824 mothers over the age of 50 had a child, up from 701 in the three previous years. The latest data also showed seven babies had been born to mothers aged 60 and over, with two mothers having children at 65 and over.

GPs fear that patients will spot ‘’significant errors’’ in their medical records when they are given access, according to a study in the BMJ Open Journal. The majority of family doctors said that allowing patients access to their records would also make them ‘’worry more’’, be ‘’confused’’ and result in GPs spending more time explaining things. Most were ‘’sceptical’’ about the initiative as a result , researchers said. GP surgeries are now required to give patients access to any information being added to their records, which can be viewed via the NHS app or online. An international team of researchers, led by the Harvard Medical School and Uppsala University, Sweden, surveyed 400 GPs in England. The results revealed that just one third of the doctors thought it was a good idea, while six in 10 of them said patients would find ‘’significant errors’’ in their records. It found that 91 per cent believed access to medical records would make patients ‘’worry more’’, while 85 per cent thought their patients may find the records ‘’more confusing than helpful’’. Doctors also said that consultations would be longer than they currently are. A further three quarters of GPs said they would be ‘’less candid’’ in how they document patient appointments as a result, and 62 per cent said it would ‘’increase their litigation’’. However, some doctors did also see benefits to the scheme, including seven in 10 who thought it would help patients feel more in control of their care, while six in 10 said it would improve patients memory of their care plan. Data released in December showed that 81 per cent of GP Practices in England were giving patients access to their records online.

Dentists will be paid ‘’golden hellos’’ of £20,000 to move to rural areas where there is a shortage of NHS appointments under plans announced by the health service today (Thursday). Lump sums will be offered to 240 dentists willing to relocate to ‘’dental deserts’’ where patients cannot access care. Dentists will also be paid up to £50 for every NHS patient they see who has not had an appointment in the past two years. The latest figures suggest this is more than half of England – around 30 million people. Patients, meanwhile, will be forced to pay more for a check-up, with the minimum price set to increase from £23 to £28 unless they are exempt. There are around 2,300 people for every dentist in England, but they are not evenly distributed around the country. The scale of the crisis was highlighted on Monday as hundreds of people descended on a new dental practice in Bristol, the first in the city to offer NHS appointments for more than six months. Victoria Atkins, the Health Secretary, pledged to ‘’jump-start’’ NHS dentistry with the initiative, being funded by £200 million of government investment. The NHS predicts an extra 2.5 million appointments will be delivered over the next year under the plans. Nearly five million people have been denied an appointment with an NHS dentist in the past two years, according to research published in October. A quarter of children have rotting teeth by the age of five, according to a report published earlier this week, while 52,000 patients across England went to A&E with an abscess caused by tooth decay in 2022-23. Specialist dental vans will also be used in parts of the country where patients are struggling to access appointments. The vans will provide pop-up appointments and move around ‘’dental deserts’’ to tackle the backlog, including in rural and coastal areas such as the south-west of England, where fewer than 1 per cent of dental surgeries have been accepting new patients. Roving dental teams will also target schools and nurseries, while pregnant women will be targeted in a ‘’smile for life’’ initiative that will give advice and treatments to young children and parents. Ms Atkins said it would make oral hygiene part of a child’s routine before they start school, ‘’because it is not the job of primary school teachers to watch children brushing their teeth’’.

The Guardian

A test that can detect oesophageal cancer at an earlier stage than current methods should be made more widely available to prevent deaths, charities have said. The capsule sponge test, previously known as Cytosponge, involves a patient swallowing a dissolvable pill on a string. The pill then releases a sponge which collects cells from the oesophagus as it is retrieved. The test can detect abnormalities that form part of a condition known as Barrett’s oesophagus, which makes a person more likely to develop oesophagus cancer. About 9,300 people are diagnosed with oesophageal cancer a year across the UK, according to Cancer Research. The disease is difficult to detect because the symptoms of the cancer are not easily recognisable – and can be mistaken for indigestion – until it is at an advanced stage. The disease had a 10 year survival rate of 12%, a rate that rises to 55% if the cancer is detected early, at stage one. The capsule sponge test can detect the cancer at an earlier stage than current methods used to diagnose oesophageal cancer, such as an endoscopy. However, it is only currently available to higher-risk patients as an alternative to endoscopy as part of NHS pilot schemes. Cancer Research UK is working with the National Institute for Health and Care Research on a trial aiming to recruit 120,000 people to see if the capsule sponge test can reduce deaths. If successful, the test could be rolled out more widely. Mimi McCord, the founder of Heartburn Cancer UK, is calling for the wider adoption of the capsule sponge test in order for patients to be diagnosed earlier and given a better chance of survival.

Deeply ingrained medical misogyny and racial biases are routinely putting people in need of treatment at risk, the patient safety commission in England has warned. Dr Henrietta Hughes was appointed in 2022 in response to a series of scandals in women’s health. She outlined a ‘’huge landscape’’ of biases in need of levelling, citing examples ranging from neonatal assessment tools and pulse oximeters that worked less well for darker skin tones to heart valves, mesh implants and replacement hip joints that were not designed with female patients in mind. Hughes was appointed with a focus on improving the safety of medicines and devices, in response to the Cumberlege review into vaginal mesh, a hormonal pregnancy test, and an anti-epilepsy medicine that harmed unborn babies. The review painted a damning picture in which women’s concerns were consistently dismissed, leading to avoidable harm. Hughes said that positive progress was being made in the provision of specialist care for victims of complications from vaginal mesh procedures, and welcomed the tightening of prescribing rules for the anti-epilepsy drug, sodium valproate. However, she said that systemic biases were continuing to negatively affect outcomes for female and minority ethnic patients. She described the realisation that pulse oximeters, used to measure blood oxygen levels, worked less well for darker skin tones as a ‘’real shock to the system’’ when the problem was highlighted during the pandemic. More recently the NHS Race and Health observatory highlighted concerns around neonatal assessments. Hughes cited evidence that heart valves, most of which have been tested more extensively in male patients, could have less successful outcomes in women, whose hearts are smaller on average. And doctors did not always discuss risks relating to hip joints that specifically affected female patients, she said.

The minimum price of alcohol in Scotland is expected to rise by 30% under measures to control alcohol-related deaths and hospitalisations. Ministers in Edinburgh are expected to confirm the minimum unit price for alcohol will increase from 50p to 65p from early May, six years after Scotland became the first part of the UK to introduce the policy. Public Health Scotland said last year minimum pricing had been associated with a 13.5% fall in deaths wholly attributable to alcohol, compared with the expected death rate had minimum pricing not been in force. Yet Scotland has experienced a 25% rise in alcohol-related deaths over the past three years. The Wine and Spirit Trade Association is planning to call for minimum pricing to be scrapped entirely this week, arguing it is an ineffective and unfair way to combat alcohol abuse and unjustifiable in a cost of living crisis. Scottish Labour has called for an additional levy on retailers to tax the unearned profits from minimum pricing, with the proceeds going to the NHS and efforts to combat addiction.

The Times

Every NHS patient should have their health information digitally stored in one place so that any doctor treating them can access their records no matter where they are, The Times Health Commission has concluded. Eight in ten people support the creation of ‘’patient passports’’ that would provide a single system to keep track of medical records throughout a person’s life, and which could be accessed seamlessly across GPs, NHS hospitals, pharmacies and social care. The proposal is the first of ten recommendations in the Times Health Commission Report, which is being published after a year-long inquiry and amid widespread backing for a data revolution in healthcare. The commission, led by a panel of experts from across health and social care, spoke to more than 600 witnesses including senior doctors, hospital managers and politicians. It included that ‘’technology has the power to transform healthcare’’, with an urgent need to overhaul outdated and fragmented systems that prevent data being shared freely between different parts of the NHS. YouGove polling for the commission indicates that 81 per cent of the public back its key recommendation of NHS digital health accounts, called patient passports, with only 10 per cent against. Eighty-nine per cent said that patients should automatically be allowed to access their own medical records. The accounts could be accessed through the NHS App – acting as the gateway to the health service to book appointments, order prescriptions, view test results and contact doctors. Similar systems are in place in Spain, Singapore, Estonia, Israel and Denmark, empowering patients and freeing staff from bureaucracy. At present there are between ‘’40 and 60’’ different types of electronic patient records within the NHS, the commission was told, and about 10 per cent of hospitals are entirely paper-based. Under a universal patient passport system, medical records could be stored on people’s phones or medical cards, and pulled up on arrival at their hospital, GP surgery or pharmacy. Polling indicates that 56 per cent of the public agree that the convenience of being able to book appointments easily and access care outweighed any risk to the privacy or security of their medical records, compared with 22 per cent who disagree. Sixty-eight per cent of the public would be happy for the NHS to allow other medical staff or clinicians to access their records. The digital health record would also allow the NHS to make better use of its data for life-saving medical research, and 64 per cent said they would be willing for their own data to be used anonymously for research. Among its other evidence-based policy recommendations, the commission calls for student loans to be written off for doctors, nurses and midwives who stay in the NHS, to tackle chronic workforce shortages. It also calls for new weekend high-intensity theatre lists for planned operations, to drive down NHS waiting lists of 7.6 million.

Rishi Sunak has admitted that the government has failed to bring down NHS waiting lists despite it being one of his top pledges. The prime minister said ‘’we have not made enough progress’’ as the number of treatments waiting to begin was higher than when he first made the promise at the beginning of last year. In an interview with Piers Morgan on TalkTV, Sunak said the government had ‘’invested record amounts in the NHS’’ but he said: ‘’Industrial action has had an impact. In November we had a month where there were no strikes for the first time and you know what happened to the waiting list? It fell by almost 100,000.’’ Figures released by NHS England last month showed that 7.61 million treatments were waiting to be carried out in November 2023, relating to 6.39 million patients. That figure was down from 7.71 million treatments and 6.44 million patients at the end of October but waiting lists are still higher than when Sunak made the pledge to bring them down. When he made the promise at the start of last year waiting lists stood at 7.21 million. The Liberal Democrats said long waits for GP and hospital appointments were creating a mental health epidemic. A survey by the Office for National Statistics found that the mental health of almost a quarter of adults had been made worse by waiting too long to see a doctor. From a sample of almost 12,000 adults, 24 per cent reported poor mental health as a result of long waits for hospital or GP appointments and 18 per cent reported that their physical health had been affected. Sir Ed Davey, the Lib Dem leader, said: ‘’This Conservative government’s failure to tackle agonising waits for NHS treatment is creating a mental health epidemic. Millions of people are struggling to see their GP – because ministers have driven local health services into the ground.’’ Meanwhile a study from the Trades Union Congress found that GPs had become responsible for hundreds more patients over the past decade. It found that GP numbers in England had fallen by nearly 2,000 since 2015  and a ‘’toxic combination’’ of falling GP numbers and rising demand had piled pressure on the health service. A Department of Health and Social Care spokesman said: ‘’Cutting waiting lists is one of the government’s top five priorities and we have delivered 5,000 more permanent beds as part of the urgent and emergency care recovery plan, as well as 50 million more GP appointments per year. We’re going further and faster to transform our country’s mental health services.’’ The department also said that its workforce plan would provide 2,000 more GP training places a year by 2031.

The health secretary has criticised an ‘’old boys network’’ in the NHS, as she backs calls to radically improve working conditions for doctors and nurses. Victoria Atkins told The Times Health Commission that some of the male-dominated hierarchies in place when the NHS was set up in 1948 had ‘’stayed entrenched in the system over the following decades’’. She said it was vital to ‘’level the playing field’’ and remove barriers holding back female doctors, including by enhancing the shared parental leave system for consultants. Atkins said: ‘’If I can keep women in the workforce working full-time, we all win from that.’’ The year-long commission has concluded that the NHS is often a flawed employer. Bullying and sexual assault are rife, with nearly one third of female surgeons sexually assaulted by a colleague over the past five years. Hospital staff also face a poor working environment, which means they often struggle to access free parking, make a cup of tea or have a hot meal during busy shifts. Atkins called for wide-ranging reforms to ‘’ensure that the culture is respectful and dignified and caring, not just to patients, but to colleagues as well’’. She also called for hospitals to ‘’try to find a better way of helping doctors with working conditions’’, particularly when drawing up rotas, describing her shock at hearing how a doctor had been denied leave for their wedding. Reforms to working culture are seen as essential to tackling a chronic workforce crisis in the NHS, which has caused waiting lists to grow sharply and is putting patients at risk. The latest data shows that the health service in England is short of 121,000 staff, including 42,000 nurses. One of the health commission’s key recommendations is for a new ‘’student loan forgiveness scheme’’ that incentivises doctors and nurses to stay in the NHS after they qualify. It suggests that debt should be cut by 30 per cent for those staying three years, 70 per cent for seven years and 100 per cent for ten. This would help to halt an exodus of staff. At present, one in five nurses leave the NHS within two years, and a recent survey found that a third of UK medical students planned to work abroad. Analysis by the Nuffield Trust shows that the policy of writing off student loans would cost £230 million a year for nursing, midwifery and allied health professionals, and an extra £170 million for doctors. The commission concluded that this was highly affordable when set against the costs of the workforce crisis, with the NHS spending £3 billion a year on agency staff at present. Health unions endorsed the recommendation to write off student loan debt, but said higher pay was also important. Junior doctors and consultants are in dispute with the government  over pay and working conditions, and more than 1.3 million appointments have been cancelled over the past year due to industrial action by NHS staff.

Civil servants lost almost 1.9 million working days to long-term sickness in one year. The number of days lost to long-term sickness rose by a third over four years, with the Ministry of Justice the worst-affected department. Unions blamed the pandemic and high workloads. The number of people off work long term because of sickness is at a record 2.6 million nationwide, with an extra half a million signed off compared with before the pandemic, largely due to a rise in mental health problems. The rate in the civil service rose from 1.39 million in the year to March 2018 to 1.86 million in the year to March 2022, a 34 per cent rise. Over that period , the service grew from 430,075 to 510,080, a rise of 18.4 per cent. Christine Jardine, the Liberal Democrat MP who uncovered the data, said: ‘’These figures are deeply concerning and show there is a growing long-term sickness crisis at the heart of government.’’ Garry Graham, deputy general secretary of  the trade union Prospect, said the figures showed that civil servants were ‘’near breaking point’’. He said long Covid and deteriorating mental health were having an impact. Fran Heathcote, president of the Public and Commercial Services Union, said the lower a person was in the civil service hierarchy ‘’the higher their sick and death rates’’. Tackling long-term sickness has become a government priority, with the number of people unable to work due to illness, many stuck on NHS waiting lists, cited as stunting the economy. The government said: ‘’We expect sick leave to be managed with common sense. Steps are in place for employees to return to work as quickly as possible.’’

Infant mortality is worse in Britain than in most other developed countries and experts are warning of an ‘’appalling decline’’ in child health linked to obesity and deprivation. The Academy of Medical Sciences highlighted wide-ranging evidence of declining health among young children, particularly in poorer areas. This included a fall in childhood vaccinations, with uptake at its lowest for more than a decade, leading recently to a measles outbreak in Birmingham. It said in a report that the UK was 30th out of 49 Organisation for Economic Co-operation and Development countries for infant survival, the proportion of children who live until their first birthday. Reductions in infant mortality have stalled in recent years, linked to a rise in child poverty. A fifth of five-year-olds are overweight or obese and a quarter have tooth decay. Those living in the most deprived areas are twice as likely as those in affluent areas to be obese and the number of children living in extreme poverty tripled between 2019 and 2022. The report also warned of a surge in mental health problems among children since the pandemic. The academy, which represents researchers and academics in medicine, said worsening child health would ultimately cost Britain £16 billion a year. It urged reform to NHS family health services, including steps to provide more support for breastfeeding, increased vaccine uptake, improved access to dentists and measures to tackle obesity.

Wealthier adults in England are driving a sharp rise in demand for drugs used to treat a neuro-developmental condition previously associated with children, at a time when the medicines are in short supply globally. The number of prescriptions for attention deficit hyperactivity disorder (ADHD) medications grew at twice the rate for the least deprived 20 per cent of the population as for the most deprived 20 per cent, between May 2020 and September 2023, according to a Financial Times analysis. The NHS describes the condition as affecting people’s behaviour, which may make them seem restless, have trouble concentrating and have sleep and anxiety disorders. Patients on lower incomes are more likely to have ADHD, but the growing strain on NHS services has meant more affluent patients, who can afford private services with shorter waiting times, are getting quicker access to diagnosis and treatment, according to health experts. Demand for ADHD treatment is rising quickly in western countries as awareness and visibility of the condition improves, particularly among groups who have previously had low diagnosis rates. The number of prescriptions for ADHD drugs rose three times faster in England than expected over the past three years, according to NHS Business Services Authority, a public body that provides support services to the NHS. Total orders for ADHD and central nervous system stimulant drugs rose 60 per cent from May 2020 to September 2023 compared with expected growth of 22 per cent, given historical trends. Global shortages of the medication and a growing backlog of referrals are squeezing treatment provision just as demand is rising. Waiting times for new patients exceeded 10 years for some NHS England services in 2023, according to a Freedom of Information request by charity ADHD UK. Despite the surge in people seeking diagnoses, ADHD remains underdiagnosed in the UK, say health experts. About 0.5 per cent of the population had a diagnosis in 2018, UCL research found, far below official estimates that 3 to 4 per cent of adults have it. The Department of Health and Social Care has pledged to spend £2.3bn a year to expand mental health services in England by spring 2024 and it was committed to reducing delays and improving access to treatment. NHS England declined to comment.