Category Archives: Asthma

World Rugby criticises call for scrum and tackle ban in school sport

World Rugby has criticised the claims in a study calling for tackling and scrums to be banned in school sport.

Allyson Pollock and Graham Kirkwood from the Institute of Health at Newcastle University argued in the British Medical Journal that most injuries in youth rugby occur due to the collision elements of the game.

The pair called for “harmful contact” to be prohibited on school playing fields. Removing collision from school rugby is likely to “reduce and mitigate the risk of injury” in pupils, they said.

However, in a statement, the sport’s governing body questioned the data on which the claims were based.

“World Rugby and its member unions take player safety very seriously and proactively pursue an evidence-based approach to reduce the risk of injury at all levels,” the statement said.

“These claims are not based on like-for-like injury statistics and the conclusions are not supported by the available data.

“It is well documented that, for most sports, injury rates increase with age, but the quoted research mixes 9-12 with 18-20 age groups.

“Indeed, within the published studies where injury has been properly defined and monitored, suggest the risk for pre-teens is not unacceptably high compared to other popular sports.”

Pollock and Kirkwood called on the UK chief medical officers to advise the British government to remove harmful contact from the game.

In 2016, the nation’s most senior medics rejected a call for a ban on tackling in youth rugby.

But Pollock, who has been researching injuries and rugby injuries for more than 10 years, and senior research associate Kirkwood said that under United Nations conventions, governments have a “duty to protect children from risks of injury”.

“We call on the chief medical officers to act on the evidence and advise the UK government to put the interests of the child before those of corporate professional rugby unions and remove harmful contact from the school game,” they wrote.

“Most injures in youth rugby are because of the collision elements of the game, mainly the tackle.

“In March 2016, scientists and doctors from the Sport Collision Injury Collective called for the tackle and other forms of harmful contact to be removed from school rugby. The data in support of the call is compelling.”

That call was rejected by a range of former players and officials working within the game as well as World Rugby, however.

Nigel Owens MBE (@Nigelrefowens)

They will want to ban walking to school next. And only rubber pens and pencils to be used in class. What is the world coming too. https://t.co/CYMmk6WSgt

September 26, 2017

Dr Willie Stewart, a consultant neuropathologist who has been working in the field of brain injury for more than 15 years and sits on World Rugby’s Concussion Advisory Body, tweeted: “The health crisis facing Britain’s children is not #concussion but obesity and lack of exercise.”

Peter Robinson, the father of Ben Robinson, who died at 14 from second impact syndrome following a school game, and who worked with Stewart in helping to inspire a change in concussion guidelines, added on Twitter: “Banning tackling at schools not the answer. Mismanagement of Concussion is the greatest risk in the game.”

Citing previous research into sports injuries in youngsters, Pollock and Kirkwood had argued in the article that rugby, along with ice hockey and American football, have the highest concussion rates.

They said that rule changes in collision sports can make a difference, highlighting the Canadian ban on “body checking” – where a player deliberately makes contact with an opposing player – in ice hockey for under 13 year olds.

Meanwhile, in the UK “teacher training in the skills of rugby are lacking, as is concussion awareness training,” the pair wrote.

The researchers called on the UK chief medical officers to advise the British government to remove harmful contact from the game. They pointed to a history of concussion being associated with the “lowering of a person’s life chances” across a number of measures including low educational achievement and premature death. Meanwhile, a head injury is linked to an increased risk of dementia.

Commenting on the article, Prof Tara Spires-Jones, UK Dementia Research Institute programme lead and deputy director of the Centre for Discovery Brain Sciences at the University of Edinburgh, said: “Very strong, reproducible evidence supports a greater risk of dementia in people who have head injuries in their lifetimes, which urges caution in games where there is a significant risk of head injury.

“However, the data on specifically whether playing rugby or other contact sports in school increases your risk of dementia are not as robust yet due to a lack of large prospective studies. It is also very clear that there are many health risks of leading a sedentary lifestyle.”

Hospital bosses forced to chant ‘we can do this’ over A&E targets

Hospital bosses were forced to chant “we can do this” by a senior NHS official in an effort to improve their accident and emergency performance in advance of what doctors have warned will be a tough winter for the NHS.

Hospital trust chief executives say they were left feeling “bullied, patronised and humiliated” by the incident last week at a meeting attended by Jeremy Hunt, the health secretary, and Simon Stevens, the head of the NHS in England.

The leaders of about 60 trusts which NHS national bodies deemed to have the worst record on meeting the politically important four-hour A&E treatment target were called into a meeting held in London on Monday 18 September.

Chief executives present say that they were divided into four regional groups, covering the south and north of England, London, and the Midlands and east of the country, each of which held a separate session with a senior NHS England official.

Paul Watson, NHS England’s regional director for the Midlands and east of England, then encouraged those in the group he was leading to chant “we can do it” as part of a renewed effort to improve their A&E performance. Hunt and Stevens are not thought to have been at that session; nor was Jim Mackie, chief executive of health service regulator NHS Improvement, who jointly convened the meeting with Hunt and Stevens.

One chief executive said: “It was awful – the worst meeting I’ve been at in my entire career. Watson said: ‘Do you want the 40-slide version of our message or the four-word version?’ Everyone wanted the four-word version, obviously.

“He then said ‘I want you to all chant ‘we…can…do…this’. It was awful, patronising and unhelpful, and came straight after the whole group had just been shouted at over A&E target performance and told that we were all failing and putting patient safety at risk.”

According to the Health Service Journal, which revealed what had happened at the meeting, Watson told trust bosses that they were initially chanting too quietly and that they should chant the slogan again but louder, and “take the roof off” with the noise.

Watson’s use of the tactic has prompted complaints from within the NHS that the chanting was “Bob the Builder for NHS leaders”, after the children’s TV character Bob the Builder with his “Can we fix this? Yes we can” catchphrase. Another HSJ reader posted a comment on its website saying: “More akin to North Korea than the NHS”.

Anger and ridicule directed at Watson have prompted him to apologise for and explain his behaviour in messages he posted on the HSJ website since it published the story.

“If anyone found my session on Monday inappropriate in any way then I can only apologise – it was meant as light relief rather than brainwashing,” said Watson.

“As I said at Monday’s event, this can be done. If that seems cheesy or patronising then so be it but it does have the merit of being true – Paul”, he added.

He also repeated his claim that inadequate A&E performance endangered patients’ safety.

“It’s good to let off steam but let’s remember what’s at stake here: 1 Urgent care is the most basic service the NHS provides; 2 A badly run, crowded ED [emergency department] is a miserable experience for our patients; 3 These patients are often frail, elderly and frightened as well as very ill; 4 A crowded ED can be dangerous.”

If other trusts could provide excellent A&E services despite the rising demand for care, why could the 60 represented at the meeting not do that, he asked. He also angered trust bosses by saying that “the biggest single determinant of whether a struggling service is turned round is the confidence, optimism and determination of local leadership to do this and follow it through”.

The Guardian has approached NHS England and the Department of Health for comment.

Hospital bosses forced to chant ‘we can do this’ over A&E targets

Hospital bosses were forced to chant “we can do this” by a senior NHS official in an effort to improve their accident and emergency performance in advance of what doctors have warned will be a tough winter for the NHS.

Hospital trust chief executives say they were left feeling “bullied, patronised and humiliated” by the incident last week at a meeting attended by Jeremy Hunt, the health secretary, and Simon Stevens, the head of the NHS in England.

The leaders of about 60 trusts which NHS national bodies deemed to have the worst record on meeting the politically important four-hour A&E treatment target were called into a meeting held in London on Monday 18 September.

Chief executives present say that they were divided into four regional groups, covering the south and north of England, London, and the Midlands and east of the country, each of which held a separate session with a senior NHS England official.

Paul Watson, NHS England’s regional director for the Midlands and east of England, then encouraged those in the group he was leading to chant “we can do it” as part of a renewed effort to improve their A&E performance. Hunt and Stevens are not thought to have been at that session; nor was Jim Mackie, chief executive of health service regulator NHS Improvement, who jointly convened the meeting with Hunt and Stevens.

One chief executive said: “It was awful – the worst meeting I’ve been at in my entire career. Watson said: ‘Do you want the 40-slide version of our message or the four-word version?’ Everyone wanted the four-word version, obviously.

“He then said ‘I want you to all chant ‘we…can…do…this’. It was awful, patronising and unhelpful, and came straight after the whole group had just been shouted at over A&E target performance and told that we were all failing and putting patient safety at risk.”

According to the Health Service Journal, which revealed what had happened at the meeting, Watson told trust bosses that they were initially chanting too quietly and that they should chant the slogan again but louder, and “take the roof off” with the noise.

Watson’s use of the tactic has prompted complaints from within the NHS that the chanting was “Bob the Builder for NHS leaders”, after the children’s TV character Bob the Builder with his “Can we fix this? Yes we can” catchphrase. Another HSJ reader posted a comment on its website saying: “More akin to North Korea than the NHS”.

Anger and ridicule directed at Watson have prompted him to apologise for and explain his behaviour in messages he posted on the HSJ website since it published the story.

“If anyone found my session on Monday inappropriate in any way then I can only apologise – it was meant as light relief rather than brainwashing,” said Watson.

“As I said at Monday’s event, this can be done. If that seems cheesy or patronising then so be it but it does have the merit of being true – Paul”, he added.

He also repeated his claim that inadequate A&E performance endangered patients’ safety.

“It’s good to let off steam but let’s remember what’s at stake here: 1 Urgent care is the most basic service the NHS provides; 2 A badly run, crowded ED [emergency department] is a miserable experience for our patients; 3 These patients are often frail, elderly and frightened as well as very ill; 4 A crowded ED can be dangerous.”

If other trusts could provide excellent A&E services despite the rising demand for care, why could the 60 represented at the meeting not do that, he asked. He also angered trust bosses by saying that “the biggest single determinant of whether a struggling service is turned round is the confidence, optimism and determination of local leadership to do this and follow it through”.

The Guardian has approached NHS England and the Department of Health for comment.

The male contraceptive pill? Bring it on | Angela Saini

Tomorrow is World Contraception Day, a perfect time to remember just what a radical difference birth control, and particularly the pill (60 years old this year), has made to women’s lives. What you may not know is that contraception is also about to experience a revolution: we are on the cusp of – wait for it – a new male contraceptive.

Allow me to recap. In October last year, a team of international scientists announced that they had developed a hormone injection (so, not a pill) for men that is almost 96% effective at preventing pregnancy in their partners. This makes it about as reliable as condoms when they are used correctly, which frequently they’re not.

Sadly, there’s a caveat to this happy story. Clinical trials had to be stopped after some men pulled out due to side-effects including mood changes, depression and acne. And there, quite abruptly, the revolution ends.

For as long as anyone can remember, contraception has been largely a woman’s burden. Despite promises of a male contraceptive, it looks as though unless something painless, simple and largely free of side-effects is invented for men, it will probably remain a woman’s responsibility.

To be fair, making a male pill isn’t easy. The female pill mimics the natural hormone fluctuations of a woman’s monthly cycle. Reproducing an equivalent chemical process in men is technically more difficult, although not impossible.

In the meantime, women continue to sample from the cornucopia of sometimes uncomfortable and occasionally risky birth control options. Please, take a seat while I scroll through the menu. There’s the diaphragm, cap, coil, sponge, patch, rod and ring. If you’re willing to live on the wild side, there are helpful apps to tell you where you are in your fertility cycle. There are also injections. Even more drastically, there’s sterilisation.

And then there’s the female pill. It has been six decades since it was approved by the United States Food and Drug Administration, and it remains the most popular form of female contraception in the UK, with about 3 million women taking it. But given the array of newer alternatives, does it make sense for women to continue opting for the pill, or should we – like men – be giving it the cold shoulder in favour of something better?

The side-effects and risks associated with the combined pill, which is a mix of oestrogen and progesterone, and is the most commonly prescribed type, are fairly small. The older the pill gets, the more data scientists have about its health impacts. A Danish study published in November 2016 linked women who use hormonal contraceptives with higher rates of depression. Researchers at the University of Copenhagen followed more than a million women between the ages of 15 and 34, and found that those taking oral contraceptives were 23% more likely to take antidepressants.

For most women, however, the main problem with the pill, when it’s weighed up against newer alternatives, is that it’s just not as effective as it should be. Women often skip doses, intentionally or by accident. It’s a hassle to remember to take it. The situation is complicated by government funding cuts to the NHS, which have had an impact on sexual health services. Implants and intrauterine devices need to be fitted by a health professional, unlike the pill, which needs only a prescription. Julia Bradley, a lead nurse and education manager at the British Pregnancy Advisory Service, says that, until a few years ago, long-acting reversible contraceptives enjoyed a push from government, but now “with the pressure on GP practices, women are finding it really hard to get a GP appointment”. She knows of one patient who had to wait a month to get a coil fitted. “In that time, accidents can happen,” she says.

Let’s not forget that contraceptives such as these are a medical intervention we make that isn’t medically necessary. We choose to introduce discomfort, pain and health risks into women’s lives because there are few other options if we want to avoid pregnancy. Bradley recalls instances of older female patients who have taken the contraceptive pill for decades finally asking their male partners to have vasectomies after they have had all the children they want. When men refuse, she says, “it does sometimes feel unfair”.

With abortion such a heavily politicised issue, it’s surprising that more isn’t made of the birth-control burden that women are expected to shoulder as a matter of course. This is the story of our lives. Period pain? Get on with it. Heavy bleeding? Stick on a fresh pad and carry on. Hormonal migraines, mood swings or depression? Suck it up. Anxious about the pain of childbirth? “More women should be prepared to withstand pain,” said senior midwife Dr Denis Walsh in 2009, suggesting women forgo epidurals. It’s hardly a surprise that when offered an imperfect contraceptive pill, women just swallow it. Absorbing pain is expected of us.

But I’m inclined to hold out for something better, the contraceptive that causes me no pain or side-effects. The kind I never even have to think about. By that, of course, I mean the male pill.

Inferior: How Science Got Women Wrong and the New Research That’s Rewriting the Story, by Angela Saini, is published by Fourth Estate. To order a copy for £11.04 (RRP £12.99) go to bookshop.theguardian.com or call 0330 333 6846. Free UK p&p over £10, online orders only. Phone orders min p&p of £1.99.

Mental health data shows stark difference between girls and boys

A snapshot view of NHS and other data on child and adolescent mental health reveals a stark difference along gender lines.

As reported earlier this week, the results of a study by University College London and the University of Liverpool show a discrepancy between the emotional problems perceived by parents and the feelings expressed by their children. Researchers asked parents to report signs of emotional problems in their children at various ages; they also presented the children at age 14 with a series of questions to detect symptoms of depression.

Graph showing that there is a discrepancy between self-expressed emotional problems in teens and problems reported by their parents


The study reveals that almost a quarter of teenage girls exhibit depressive symptoms. Data from NHS Digital, which examines the proportion of antidepressants prescribed to teenagers between 13 and 17 years old, shows that three-quarters of all antidepressants for this age group are prescribed to girls.

More than two-thirds of antidepressants prescribed to teenagers are for girls


Eating disorders are one of the most common manifestations of mental health problems, and are in some cases closely related to depression. A year-by-year breakdown of hospital admissions for eating disorders indicates that, while eating disorders in both boys and girls are on the rise, more than 90% of teens admitted to the hospital for treatment are girls.

Graph showing the difference between girls and boys admitted to hospital for eating disorders

Records also show hospital admissions dating back to 2005 for individuals under 18 years old who committed self-harm. While the numbers for boys have seen a smaller amount of variation with a general upward trend, the figure for girls has climbed sharply during the last decade, with the most significant jump occurring between 2012/13 and 2013/14.

Hospital admissions for self-harm are up by two-thirds among girls


Two of the most common methods of self-harm are poisoning and cutting. Self-poisoning victims are about five times as likely to be girls, and the number of girls hospitalised for cutting themselves has quadrupled over the course of a decade.

Most self-harm admissions involve cases of self-poisoning, which has risen drastically among girls
Self-harm hospitalisations involving girls cutting themselves have quadrupled since 2005


Although self-harm, depression, and other mental health problems are more commonly reported and identified in girls, suicide rates are far higher among boys. This data is consistent with research on differences found between men and women in methods used to commit suicide, the influence of alcohol, and other social or cultural factors.

Teenage boys are more than twice as likely to kill themselves as girls
  • In the UK the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international suicide helplines can be found at www.befrienders.org.

Get up, stand up: including exercise in everyday life healthier than gym, says study

Incorporating physical activity into our everyday lives, from taking the stairs to holding “walkaround” meetings in the office, is more likely to protect us from heart disease and an early death than buying a gym membership, according to the author of a major new global study.

The study, published in the Lancet medical journal, found that one in 20 cases of heart disease and one in 12 premature deaths around the globe could be prevented if people were more physically active. It compared 130,000 people in 17 countries, from affluent countries like Canada and Sweden to some of the least affluent, including Bangladesh and Zimbabwe.

While 30 minutes of exercise per day for five days a week, which most guidelines recommend, reduces heart disease and deaths, one to two hours a day is the optimal amount of physical activity, said lead author Professor Scott Lear, of Simon Fraser University’s faculty of health sciences in Vancouver, Canada.

Most people will think they cannot incorporate that much physical activity into their life, he said. “They will think ‘I’m stressed out and have to make dinner – and then do exercise for two hours!’” he said.

But the study showed that those people who have the highest activity levels are those for whom it is part of their everyday working lives. In developing countries, more people still have physically taxing jobs but as they become more economically prosperous, their activity levels fall.

“They are going from sweeping the floor to buying a vacuum,” said Lear.

He does not advocate selling the vacuum cleaner, but we could all incorporate more activity into our lives rather than relying on occasional forays to the gym or swimming pool. “It becomes routine as opposed to an endeavour,” he said. “Sitting for hours is not good for hearts or the physical body. Getting up every 20 to 30 minutes for a walk around is beneficial. I have a cooking timer.

“We spend a lot of time in meetings. If it is just two or three people, why not have a walkaround meeting?”

He also suggests playing with children in the park rather than sitting watching them, increasing the walk to work by getting off the tube or bus early and taking the stairs rather than the lift.

The authors found that the more physically active people were, the lower their risk of heart disease or an early death.

“Participating at even low physical activity confers benefit and the benefit continues to increase up to high total physical activity,” says the study. People who did more than 750 minutes of brisk walking or equivalent activity per week reduced their risk of death by 36%.

But the study notes that “the affordability of other CVD [cardiovascular disease] interventions such as consuming fruits and vegetables and generic CVD drugs is beyond the reach of many people in low-income and middle-income countries; however, physical activity represents a low-cost approach to CVD prevention.”

While the amount of physical work people do in low income countries reduces heart disease, their chances of surviving if they do have a heart attack or stroke are lower because their health services are not as advanced.

The World Health Organisation recommends that adults aged 18-64 years old do at least 150 minutes of moderate-intensity aerobic physical activity throughout the week, as well as muscle strengthening exercises at least two days a week. But it is thought that almost a quarter (23%) of the world’s population are not meeting physical activity guidelines.

The study is the first to compare physical activity and heart disease levels in countries of varying affluence.

“The clear-cut results reinforce the message that exercise truly is the best medicine at our disposal for reducing the odds of an early death,” said Dr James Rudd, a senior lecturer in cardiovascular medicine at the University of Cambridge.If a drug company came up with a medicine as effective as exercise, they would have a billion-dollar blockbuster on their hands and a Nobel prize in the post.”

“There is a trend for more heart disease in lower income groups both within and between populations,” said John Martin, professor of cardiovascular medicine at University College London. “In the UK it has been shown that lower social class is associated with more heart disease. Walking is easy and cheap. This study should encourage governments to rebalance health budgets away from high tech treatment of heart disease to promoting simple strategies of prevention like walking.”

Professor Metin Avkiran, associate medical director at the British Heart Foundation said: “In an age where we’re living increasingly busy but often sedentary lives in the west, weaving physical activity into our daily routines has never been more important, not only to improve our physical health but also overall well-being. Increased physical activity could have an even greater beneficial impact in lower income countries, due to its low its cost and the high incidence of heart disease in those countries.”

Reeling in the years: dementia-friendly screenings make cinema accessible to all

It’s a little after 1.30pm on a Wednesday and a crowd has gathered outside the Rio cinema in Dalston, east London. The first film of the day will not start for another hour, but regulars to the monthly classic matinee are eager to grab their favourite seats.

The matinee is aimed at the community’s senior citizens and all the screenings are dementia-friendly. Cinemagoers are greeted warmly by the familiar faces of the Rio’s staff, who take their orders for tea, coffee and cake – all free with the £2 ticket.

The auditorium is adapted to be as calming and comfortable as possible. Seats can be removed to make space for wheelchairs, lights are dimmed so people can move around, the volume is slightly lower, and chatting or singing along is not met by pleas for silence.

A leaflet for the classic matinees at the Rio from the 1980s.
A leaflet for the classic matinees at the Rio from the 1980s. Photograph: Rio Cinema

For some visitors, this is their one trip out in the month, says Emma Houston, duty and community manager at the Rio Dalston.

“We don’t open the doors this early for other screenings, but they like to come early to chat and meet each other,” Houston adds. With 40% of the 850,000 people living with dementia in the UK saying they feel lonely [pdf], community events such as this are crucial.

The screenings began in 1983 as the Hackney Pensioners Project, and eventually became the Classic Matinee in 1990. Aimed at older residents, the needs of those with dementia have always been at the forefront of programming.

“The idea for people with dementia, is that they recover their childhood memories through cinema, so the Hackney Pensioners Project started with classic Hollywood movies,” says Houston.

Today, with a different generation in the audience, the Rio shows movies from the 60s and 70s as well as newer comedies, dramas and family films – anything that’s uplifting and easy to watch.

The Rio has also developed links with care homes in the area and residents have been invited to watch this month’s matinee of Steel Magnolias.

“One resident we brought in today is partially-sighted so she’s been able to talk all the way through, asking questions about what’s going on,” says Vanessa Edwards, a lifestyle coordinator at Lennox House care home in Islington. “Another resident, who is usually not that quiet, has been engrossed the whole time. I think seeing Dolly Parton on the screen has taken her back to years before.”

Recalling memories is not unusual in a place like the Rio. The art deco building is more than 100 years old and the auditorium has barely changed in that time. “Last year, a woman who hadn’t been since she was a child came to one of the screenings,” says Houston. “We took her up to the circle and as soon as the lights went down, she burst into tears. She remembered coming to the Saturday morning kids’ club when she was young.”

The Rio’s screening is just one of many across the UK this month as part of World Alzheimer’s Month.

“Dementia-friendly events are growing and we know there are pockets of activity in cinemas across the UK. We wanted to bring all that together and mark the significant change in how people with dementia can experience cinema,” says Hana Lewis, strategic manager of Film Hub Wales, one of nine BFI Film Audience Network hubs providing dementia-friendly guidance, training and support to cinema operators.

Cinemagoers attend a dementia-friendly film screening at the Barry Memo arts centre in Wales.


Cinemagoers attend a dementia-friendly film screening at the Barry Memo arts centre in Wales. Photograph: Jon Pountney

Alongside dementia-friendly screenings, cinemas across the UK are hosting reminiscence therapy activities, such as memory walks, guided tours and opportunities to handle special objects such as photographs, old coins and ticket stubs.

The most fundamental way cinemas can provide a dementia-friendly space is in the way staff interact with the audience and their carers.

“Making sure cinema staff support people before they arrive is really important; reassuring them about the facilities available, such as accessible toilets, changing places and available parking,” says Emma Bould, programme partnerships project manager at Dementia Friends.

At the Rio, front of house staff are aware that one person’s journey through the cinema might be different to someone else’s. “They know not to rush people, to make sure they talk to the older person directly rather than to their carer,” says Houston. “They know not to assume that people either need help or don’t need help.”

To improve other cinemas’ offerings, the BFI Film Audience Network, the UK Cinema Association and the Alzheimer’s Society have created a dementia-friendly screenings guide.

“Any cinema can pick it up and get guidance on reaching isolated people with dementia,” says Bould. The guide, launching next month, will also be part of the Film Audience Network’s upcoming online portal, aiming to build a wider, more diverse UK cinema audience. It will pull together toolkits from cinemas across the UK on ways to include anyone who might feel marginalised, unrepresented or unable to access cinema.

The Rio hopes to open up the cinema to more people in the area, and is fundraising to create a second, 30-seat screen to host additional community events. “We could organise more regular or specialised screenings – perhaps something directly with the Alzheimer’s Society for smaller groups of people,” says Houston. “There’s lots more we can do.”

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Adult social care is in crisis mode. We need a clear long-term plan | Joel Charles

This party conference season, all political parties will use their platforms to set out a post-election vision. Adult social care was one of the big general election issues, and the government has indicated that an adult social care green paper is likely next year. The next few months are critical for capturing the views of the public, the health and care sectors and charities working to support older people.

At Future Care Capital, we have launched a new policy report about the challenges facing our ageing society and the implications for every generation. Addressing three key themes – intergenerational fairness and the economics of ageing, health and care futures, and planning ahead – we invited leaders from the public, private and third sectors to contribute. They considered how policies and spending decisions that impact health and care outcomes could better reflect the challenges and opportunities we can expect in the next five, 10 and 15 years.

Our report also calls for a more concerted effort to in the short-term to adapt homes and public spaces for age and mobility, as well as recognition of the contribution of carers to the economy and measures to improve their work-life-care balance.

What’s striking is the consensus that there is no long-term plan for health and adult social care and that the result is a growing care deficit. Our health and care services are facing a perfect storm; the country’s population is getting older and the number of care workers is insufficient to meet future demand. At the same time, 10% of people already identify as unpaid carers, which has implications for their work-life-care balance and the wider economy. Tackling the problem in isolation is not an option. The government needs to collaborate with communities, service commissioners and providers, and charities and innovators to forge a way forward.

A new settlement for health and care or a “care covenant”, underpinned by our future care guarantees, could offer greater security to everyone. These guarantees call on the government to introduce a new funding formula for health and care services, to champion independent living by investing in pre-care measures and education to build a bigger care workforce.

One key issue is a general lack of understanding among the public about the scope of state-funded adult social care services and who should pay for them.

Some 67% of 16 to 75-year-olds agree that people should be required to plan and prepare financially for later life, while 49% agree they should have to plan and prepare financially for adult social care services they might need, according to a survey we conducted with Ipsos Mori.

In addition, it found many people support a range of income tax rises to increase the amount of funding available for adult social care. Raising the additional rate from 45p to 50p was supported by 58% of those surveyed, increasing the higher rate from 40p to 43p by 57%, and half backed a raise in 1p of the basic rate.

What’s more, 76% of those surveyed said increasing the number of health and social care workers would ease pressure on the system, and 71% thought that providing greater support for unpaid carers would be effective.

Our ageing society represents one of the biggest human challenges of our time – every family is affected. We need political consensus on our direction of travel – a long-term plan to guide the policies of successive governments to improve health and care outcomes and enable people to plan ahead. Otherwise, we will remain in fire-fighting or crisis mode. The government’s forthcoming green paper affords it a prime opportunity to act now and build health and care provision fit for everyone in our society.

Joel Charles is deputy chief executive of Future Care Capital

Join the Social Care Network for comment, analysis and job opportunities, direct to your inbox. Follow us on Twitter (@GdnSocialCare) and like us on Facebook. If you have an idea for a blog, read our guidelines and email your pitch to us at socialcare@theguardian.com.

If you’re looking for a social care job or need to recruit staff, visit Guardian Jobs.

Surgeons lacked caution in use of vaginal mesh implants, doctor admits

The corporate giant Johnson & Johnson says it acted “ethically and responsibly” in developing and selling its controversial transvaginal mesh implants, which have left hundreds of Australian women with chronic and debilitating pain.

A Senate inquiry is currently examining the impact of transvaginal mesh products, which are used to treat urinary incontinence and pelvic prolapse, common complications of childbirth.

The devices have caused life-altering complications in many cases, leaving women in severe pain and unable to have sexual intercourse.

The inquiry heard from two women whose lives have been destroyed by post-surgery complications – Gai Thompson, who had her surgery in 2008, and Joanne Maninon, who had the device implanted in 2012.

Both struggled with tears as they spoke of the impact the devices have had on their lives.

Maninon said she was told the mesh would make her feel like a “16-year-old virgin” and that she would be back at the gym in 10 days.

“To this day, I can’t sit upright on a chair for longer than 15 minutes at a time due to the searing, burning pain that travels across my lower abdomen and into my pelvis,” she said.


I describe my pain as being cut open and set alight

Joanne Maninon

Maninon was completely bedridden for 14 weeks due to the agonising pain. She wasn’t able to leave the house for months. To get to the doctor, Maninon lay down on a mattress in the back of a station wagon.

“I describe my pain as being cut open and set alight,” Maninon said. “A deep burning, searing ache that intensifies with movement.”

Later on Monday, the inquiry heard from Gavin Fox-Smith, the managing director of Johnson & Johnson Medical Australia and New Zealand.

Fox-Smith offered an apology to “patients who have not experienced a successful outcome from their treatment”.

But he said he believed the current Australian class action against the company would vindicate its actions.

“We believe the evidence will show we have acted ethically and responsibly in the research, development, and supply of the products that are the subject of the proceedings,” Fox-Smith said.

Asked whether the victims’ stories had affected him personally, Fox-Smith replied:

“Thats a pretty personal question senator, so I’ll give you a personal answer,” Fox-Smith said.

“It’s really, really hard to even conceptualise the challenge that the patients are facing. And for me, honestly I’ve had the privilege of working in this industry for 30 years. Our job is to make patients better, so for me it’s really tough, it’s nowhere near as tough as what the patients have to deal with,” he said.

Earlier, Urogynaecological Society of Australasia director, Jenny King, told the inquiry there had been a lack of caution around the use of the devices. Surgeons, she said, thought they were “magic”.

But King labelled any attempt to ban the controversial devices as “hysterical”, saying they had positive outcomes for women who were unable to undergo other major surgery. She instead said doctors should be more careful in their use, avoiding operations on younger and healthy women.

“The impacts that these have had on these women – we have seriously let them down,” King said.

“But what phases me about this is the suggestion that the solution is to ban vaginal mesh products so that other people don’t suffer,” she said.

“I don’t want to defend all of my colleagues, but we’re not really callous. We don’t like it when we can’t fix everyone, we’re really bad at that.”

Estimates vary on the number of women who have experienced problems with the implant. King said about 5% of cases caused problems. Other estimates suggest a higher rate of 10-15%.

The use of the mesh had dropped by 90% in recent years, since concerns became public.

King said the controversy had made her “timid” in her use of the devices. She regretted not using the mesh in some circumstances, because it required women to eventually undergo multiple surgeries.

The cases, seen across the western world, have prompted significant criticism of manufacturer, pharmaceutical giant Johnson & Johnson. The company is currently being sued in a class action in Australia.

The Australian trial has heard the company embarked on an aggressive marketing campaign to sell the products to surgeons, promising they were easy to insert, inexpensive and therefore lucrative. Advertisements associated the products with Lamborghinis and trips to the Swiss Alps.

The risks of the devices were downplayed and controlled trials were either nonexistent or insufficient, the court has heard.

The court also heard the company tried to stop French health authorities publishing a report warning against the use of its untested pelvic mesh devices, two years after they began giving them to Australian women.

Senator Derryn Hinch, who has campaigned against the mesh devices, asked King if Australian surgeons were offered incentives to use the devices.

“No love, truly I’ve never seen anything like that,” she responded. “Nobody’s ever given me one. I would hate to think that had happened, and I don’t know of it, truly.”

The inquiry is considering several courses of action on the mesh. One is to ban the device outright. Another is to introduce a mandatory reporting regime, which forces doctors to report adverse impacts on patients. The inquiry heard there was significant under reporting of adverse consequences on women.

A third is a credentialing system, which would ensure surgeons were appropriately qualified to conduct such surgeries.

It is also considering a recommendation to build a tracking database to monitor the use of different mesh products on patients.

This week it was revealed that Johnson & Johnson pulled two controversial pelvic mesh devices from the Australian market.

The decision came after Australia’s Department of Health required further evidence of the devices’ safety.

Poor diet is a factor in one in five deaths, global disease study reveals

Poor diet is a factor in one in five deaths around the world, according to the most comprehensive study ever carried out on the subject.

Millions of people are eating the wrong sorts of food for good health. Eating a diet that is low in whole grains, fruit, nuts and seeds and fish oils and high in salt raises the risk of an early death, according to the huge and ongoing study Global Burden of Disease.

The study, based at the Institute of Health Metrics and Evaluation at the University of Washington, compiles data from every country in the world and makes informed estimates where there are gaps. Five papers on life expectancy and the causes and risk factors of death and ill health have been published by the Lancet medical journal.

It finds that people are living longer. Life expectancy in 2016 worldwide was 75.3 years for women and 69.8 for men. Japan has the highest life expectancy at 84 years and the Central African Republic has the lowest at just over 50. In the UK, life expectancy for a man born in 2016 is 79, and for a woman 82.9.

Diet is the second highest risk factor for early death after smoking. Other high risks are high blood glucose which can lead to diabetes, high blood pressure, high body mass index (BMI) which is a measure of obesity, and high total cholesterol. All of these can be related to eating the wrong foods, although there are also other causes.

causes of death graphic

“This is really large,” Dr Christopher Murray, IHME’s director, told the Guardian. “It is amongst the really big problems in the world. It is a cluster that is getting worse.” While obesity gets attention, he was not sure policymakers were as focused on the area of diet and health as they needed to be. “That constellation is a really, really big challenge for health and health systems,” he said.

The problem is often seen as the spread of western diets, taking over from traditional foods in the developing world. But it is not that simple, says Murray. “Take fruit. It has lots of health benefits but only very wealthy people eat a lot of fruit, with some exceptions.”

Sugary drinks are harmful to health but eating a lot of red meat, the study finds, is not as big a risk to health as failing to eat whole grains. “We need to look really carefully at what are the healthy compounds in diets that provide protection,” he said.

undernourishment graphic

Prof John Newton, director of health improvement at Public Health England, said the studies show how quickly diet and obesity-related disease is spreading around the world. “I don’t think people realise how quickly the focus is shifting towards non-communicable disease [such as cancer, heart disease and stroke] and diseases that come with development, in particular related to poor diet. The numbers are quite shocking in my view,” he said.

The UK tracks childhood obesity through the school measurement programme and has brought in measures to try to tackle it. “But no country in the world has been able to solve the problem and it is a concern that we really need to think about tackling globally,” he said.

Today, 72% of deaths are from non-communicable diseases for which obesity and diet are among the risk factors, with ischaemic heart disease as the leading cause worldwide of early deaths, including in the UK. Lung cancer, stroke, lung disease (chronic obstructive pulmonary disorder) and Alzheimer’s are the other main causes in the UK.

The success story is children under five. In 2016, for the first time in modern history, fewer than 5 million children under five died in one year – a significant fall compared with 1990, when 11 million died. Increased education for women, less poverty, having fewer children, vaccinations, anti-malaria bed-nets, improved water and sanitation are among the changes in low-income countries that have brought the death rate down, thanks to development aid.

People are living longer but spending more years in ill health. Obesity is one of the major reasons. More than a billion people worldwide are living with mental health and substance misuse disorders. Depression features in the top 10 causes of ill health in all but four countries.

“Our findings indicate people are living longer and, over the past decade, we identified substantial progress in driving down death rates from some of the world’s most pernicious diseases and conditions, such as under age-five mortality and malaria,” said Murray “Yet, despite this progress, we are facing a triad of trouble holding back many nations and communities – obesity, conflict, and mental illness, including substance use disorders.”

In the UK, the concern is particularly about the increase in ill-health that prevents people from working or having a fulfilling life, said Newton. A man in the UK born in 2016 can expect only 69 years in good health and a woman 71 years.

“This is yet another reminder that while we’re living longer, much of that extra time is spent in ill-health. It underlines the importance of preventing the conditions that keep people out of work and put their long term health in jeopardy, like musculoskeletal problems, poor hearing and mental ill health. Our priority is to help people, including during the crucial early years of life and in middle age, to give them the best chance of a long and healthy later life,” he said.