Tag Archives: England

NHS hospitals across England hit by large-scale cyber-attack

A number of hospitals have been hit by a large scale cyber attack, NHS England has confirmed.

Hospitals across the country appear to have been simultaneously hit by a bug in their IT systems, leading to many diverting emergency patients. NHS England said it was aware of the problem and would release more details soon.

Meanwhile doctors have been posting on Twitter about what has been happening to their systems.

A screen grab of a instant message conversation circulated by one doctor says: “So our hospital is down … We got a message saying your computers are now under their control and pay a certain amount of money. And now everything is gone.”

If.ra (@asystoly)

Why would you cyber attack a hospital and hold it for ransom? The state of the world

Cancer symptoms often missed by GPs in England, study suggests

Thousands of people diagnosed with cancer in A&E every year have visited their GP three times or more with symptoms, research has shown.

The study found that 71% of all patients diagnosed in accident and emergency departments had seen their GP at least once with symptoms that turned out to be cancer. The remainder had never visited their GP.

Of the group that did see their GP with symptoms, 41% had sought help three or more times while 59% had seen their GP once or twice.

Some of these had difficult-to-spot cancers, such as lung cancer or multiple myeloma, and tended to be younger or female.

But the group also included people with common cancers such as breast cancer. The study found that 31% of patients with breast cancer had visited their GP three or more times, 41% with bowel cancer had visited three or more times, and 37% with prostate cancer had visited three or more times.

People who are diagnosed with cancer as an emergency have a worse prognosis than those diagnosed at an earlier stage. The quicker a cancer patient can get a diagnosis, the better their options for treatment.

The study, said to be the most comprehensive to date, was published in the British Journal of General Practice. The authors, including from University College London, the University of Cambridge and Public Health England, analysed 2010 data from 4,637 people diagnosed in A&E.

They found those patients who had never been to their GP tended to be older, male and living in the most deprived regions of England.

Patients in A&E diagnosed with common cancers who had visited their GP three times or more may be presenting with atypical symptoms, the authors said.

A previous study, including by three of the same authors, found those patients who saw a GP three or more times before being referred for cancer tests were more likely to be dissatisfied with their overall care.

They also have less confidence in the doctors and nurses who go on to treat them, that study found.

Dr Georgios Lyratzopoulos, one of the lead researchers based at UCL, said: “These findings tell us that some patients diagnosed as an emergency might not be acting on ‘red flag’ symptoms which could have prompted them to visit their GP.

“There’s also a host of other factors that may be at play. For example, many elderly patients may find it difficult to get to the surgery or have other conditions which would prevent them from seeking an appointment, such as dementia.

“This highlights the need to explore all the reasons why cancers are diagnosed late, including what happens outside GP surgeries.

“It also shows that late diagnosis is more complex than it’s often presented to be, as there are multiple reasons why cancers are spotted late.”

Dr Julie Sharp of Cancer Research UK said: “Campaigns like Be Clear on Cancer have boosted the public’s awareness of cancer signs and symptoms. But this study shows that there are multiple reasons that affect how and when a cancer diagnosis is made.

“We need to continue to increase awareness of cancer signs and symptoms and help break down the barriers preventing people from seeing their GP earlier. GPs need better access to the right tests and referral routes if we want to see this number reduced.”

Judith Brodie, acting chief executive of the charity Beating Bowel Cancer, said: “It’s concerning that the study shows 41% of bowel cancer patients who are diagnosed as emergencies had previously sought help from their GP three or more times.

“A bowel cancer patient’s chance of being successfully treated drops dramatically if they are not diagnosed until a late stage so more must be done to ensure that the public is aware of the symptoms and how important it is to get them checked out as soon as possible.

“Knowledge of the disease will also give them the confidence to persevere with their GP if they feel their symptoms are not being taken seriously enough.”

Electroconvulsive therapy on the rise again in England

The use of electroconvulsive therapy to treat serious mental health problems, a procedure long thought to be in steep decline, is on the rise again in England, a Guardian analysis indicates.

Exclusive data covering four-fifths of NHS mental health trusts in England shows that more than 22,600 individual ECT treatments were carried out in 2015-16, a rise of 11% from four years ago, when about 20,400 were carried out.

The number of patients treated also rose, albeit more modestly, to more than 2,200, suggesting that on average individuals undergo more ECT procedures than before.

The figures, obtained through freedom of information requests, show that despite being a crude, controversial treatment, which fell sharply out of favour around the turn of the millennium, ECT is enjoying a revival.

The procedure involves anaesthetising the patient and passing electricity through the brain to induce seizure. Despite ghoulish depictions in popular culture and a marked lack of science explaining how and why it works, treatments can prove effective. Patient stories range from life-changing benefits to tales of lives being ruined.

The data collected by the Guardian covers 44 NHS trusts that provided comparable data. Figures for private clinics are not included.

After considerable fluctuation over the last four years, a comparison of figures from 2012-13 and 2015-16 reveals an 11% rise when it comes to the number of ECT treatments. Almost two-thirds of NHS trusts reported a rise in the number of ECT treatments carried out over the four-year period. The average number of ECT treatments per patient also rose, from 9.6 in 2012-13 to 10.1 four years later.

The changes in ECT were more striking in some parts of the country than others. While the number of treatments carried out by Mersey Care NHS trust, for example, has remained fairly constant over the last four years, the figures for Lincolnshire Partnership NHS foundation trust show a 75% increase in treatments.

Experts and practitioners say a slew of factors could be responsible for the revival. Some say it is down to improved patient access, lack of credible alternatives for serious cases of mental illness and the fact that in many cases ECT does seem to make a difference.

“I think [ECT] should be on the increase because it has been underused for a number of years,” said Tim Oakley, chair of the ECT Accreditation Service (ECTAS) accreditation committee and a clinical director at the Northumberland, Tyne and Wear NHS foundation trust.

“There are some patients who would respond very well to ECT who perhaps don’t get it as quickly as they should or don’t get it at all for various reasons,” he said. “In terms of getting people better, particularly for depression where everything else fails, it is still the best treatment.”

Others point to the patchwork nature of provision – popular in some parts of the country, not in others – as a sign that it is down to local medical preferences.

“The decision about whether ECT is to be used or not is based on the quirks of the local psychiatrist,” said Richard Bentall, professor of clinical psychology at Liverpool University. “There are some places where psychiatrists think it works, and they just do it lots of times, and there are some places where people think: ‘Bloody hell, I don’t think the evidence for this is very good,’ so will only do it in absolutely desperate circumstances.”

He added: “My view is that ECT is a classic failure of evidence-based medicine. I don’t believe that there are adequate clinical trials of ECT to establish its effectiveness.”

While some, including Oakley, have argued that historical ECT trials do show a benefit from the treatment, Bentall believes their design was not up to scratch, and said the data obtained by the Guardian highlighted the need for large randomised placebo-controlled clinical trials – a proposal some proponents of ECT have argued would be unethical.

But Bentall said: “It is clearly unethical to pass electric shocks across people’s brains unless it is effective [and] helpful to do so and therefore there is an ethical requirement to show that treatment is effective.”

Others have suggested the increase in number of ECT treatments could be down to a change from bilateral to unilateral therapy, where the electrodes are applied to one side of the head, rather than at both temples.

“That has slightly fewer side-effects and is less likely to cause memory impairment,” said Andrew Molodynski, consultant psychiatrist at Oxford Health NHS foundation trust and national mental health lead of the British Medical Association’s consultant committee. “It is also slightly less powerful, so it might be that if more people are having that then they are needing slightly more treatments.”

“It is by far the most powerful treatment for depression,” he added. “As a treatment it is certainly not bad as long as it is done properly and for the right people, which is people with genuinely treatment-resistant depression.” While Molodynski added that he did not believe it would be ethical to carry out new clinical trials of the effectiveness of ECT, he thought studies into outcomes over prolonged periods would be valuable.

But Molodynski pointed out that the Guardian figures suggested either that the procedure was being used more freely, or that more people appeared to be falling into the category of those with treatment-resistant depression.

He said the increase should be viewed negatively if it was a result of people with less severe forms of depression not getting the care they needed. “Equally, if people are resorting to ECT for inpatients more quickly, because it works more quickly than antidepressants, in order to get them out of hospital because of our perpetual bed crisis, that would be a major concern.”

One ECT service manager from a London-based mental health trust, who asked not to be named, said the Guardian findings tallied with his own experience of a recent rise in ECT use, adding that the trend was likely to be linked to changes in practice and better regulations, with people becoming more accepting of the procedure. “Our trust treated more patients last year than they have ever treated before,” he said.

A 2014-15 survey which included clinical outcomes for 2,148 people, published by ECTAS and covering England, Wales, Northern Ireland and the Republic of Ireland, reported that 91.5% of patients had improved after the treatment, compared with 1.7% who had become worse.

The mental health charity Mind, however, warned of side-effects, pointing to a 2003 survey it carried out with patients who had undergone ECT who reported memory loss, difficulty concentrating and dizziness.

While the idea of inducing a seizure for therapeutic reasons was first recorded in 1785, ECT was not developed until the 1930s. It was subsequently introduced to England and was commonly used well into the 1960s and 1970s.

But its use waned towards the end of the 20th century. According to the Royal College of Psychiatrists: “Between 1985 and 2002, its use in England more than halved, possibly because of better psychological and drug treatments for depression.”

Dr Rob Chaplin, from the Royal College of Psychiatrists, said: “Previous data collection has shown a decline in ECT, but this appears to have plateaued, perhaps suggesting a change in attitude towards a therapy that has historically been poorly administered and badly misunderstood.

“Since the launch of our accreditation service for ECT in 2003, safety standards have doubled, making ECT in the UK one of the best in the world.

“There is unmistakable evidence that electroconvulsive therapy is an effective treatment for many depressive illnesses, and can act much faster than drugs.”

At present, the National Institute for Health and Care Excellence (Nice) advises that ECT be used only as a last resort for those with prolonged or severe manic episodes, who are in a catatonic state, or who have severe depression or moderate depression when other treatments have not worked.

The data

There is a dearth of information on how widely ECT is used, so the Guardian requested data from every English NHS mental health trust, as listed by the Care Quality Commission, under the Freedom of Information Act for a 10-year period between 2005-06 and 2015-16.

It quickly became clear that many trusts either did not hold or could not access relevant data for the decade covered by the request.

The vast majority could not provide data for the full 10-year period requested. The data presented here begins in 2012 for that reason: a number of trusts were unable to provide figures prior to that year.

Three trusts refused the request outright, saying the staff time required to comply with the request was too great, while seven trusts could not even provide consistent data from 2012-13 onwards. Some trusts admitted they were missing data over periods of months in certain years.

Two trusts provided data that turned out to be completely incorrect, only providing accurate figures after multiple contacts.

The majority of the trusts provided financial year data. However, in those cases where calendar year data was provided, the data was grouped with the closest financial year.

This project may have revealed an increase in ECT use in England but it has also uncovered a lack of properly collected data relating to the procedure.

Hundreds of children’s playgrounds in England close owing to cuts

Hundreds of children’s playgrounds have been closed or are being closed by cost-cutting local authorities across England, with councils blaming “unprecedented budget constraints” for the decision to get rid of parks and sports facilities.

A series of freedom of information requests to local authorities found that 112 playgrounds were closed in the 2014-15 financial year, and a further 102 in 2015-16.

Councils also revealed that they had 80 more closures in 2016-17, followed by plans for 103 in the current budget period and at least 51 closures planned for 2018.

But the more recent figures most likely understate the number of closures, because around a third of councils said they had not yet finalised their plans, according to the Association of Play Industries, which submitted the FOI requests.

Mark Hardy, chair of the API, said that government investment of around £100m would be required to reverse the trend in closures.

“With increasing childhood obesity and the health benefits of activity and play well known, now is not the time for community playgrounds to be closing. This action goes against the government’s clear intention to get children more active and needs to be stopped as quickly as possible,” Hardy said.

Gary Porter, the Conservative chair of the Local Government Association, said councils “want to do everything they can keep our parks and playgrounds intact but are doing this in the face of unprecedented budget constraints.

“Given ongoing funding reductions, many councils continue to have to make difficult decisions about which services are scaled back or stopped altogether. Decisions like this are never taken lightly and councils are exploring new ways to fund and maintain these facilities.”

A spokesperson for the Department for Communities and Local Government said: “Our historic four-year funding settlement means that councils have almost £200bn to spend over the course of this parliament – allowing them to prioritise the services that communities and local people value.”

Two in five GPs in south-west of England plan to quit, survey finds

About two in five GPs in the south-west of England are planning to quit, exposing a potential doctors’ crisis in the NHS. A survey of more than 2,000 GPs in the region revealed the impending healthcare problems.

Figures published last month showed there had been a drop in the number of GPs working in the NHS despite the government aim of recruiting 5,000 more by 2020.

The survey, carried out by the University of Exeter, also found that seven in 10 GPs intended to change their working patterns in a way that would mean less contact with patients. This included leaving patient care, taking a career break or reducing their hours.

The researchers said the data provided a snapshot of low morale which, if echoed in other regions, could point to a deeper and more imminent crisis than previously anticipated in relation to the worsening shortage of GPs nationwide.

John Campbell, a professor who led the research, which is published in BMJ Open, has called for a move away from “sticking plaster solutions” towards robust, joined-up, action to avert the crisis nationwide.

Campbell, a practising GP, said: “We carried out this survey because of a nationally recognised crisis in the shortage of GPs across the country, and our findings show an even bleaker outlook than expected for GP cover, even in an area which is often considered desirable, and which has many rural communities,.

“If GPs have similar intentions to leave or reduce their hours in other regions, as many are reporting, the country needs to take robust action more swiftly and urgently than previously thought.”

The research team sent surveys to 3,370 GPs across the region and received responses from 2,248, with 54% reporting low morale.

Campbell said: “We know that there’s an ageing workforce in general practice, with 30% of GPs being over 50 years old. Previous research has found that GP morale is low because of workload pressures, and many younger GPs do not want the financial risk and responsibilities of taking on a practice.

“Yet if the GPs we surveyed fulfil their intentions to leave or to cut back their patient contact, and no action is taken to address the issue, the south-west of England will experience a severe shortfall of GPs in the next five years.

“Whilst numerous government-led initiatives are under way to address recruitment, there is a need to address the underlying serious malaise which is behind this data.

“We are in a perilous situation in England, with poor morale of the current GP workforce, and major difficulties with recruitment and retention of GPs reflected in the stark overall reduction in the GP workforce. Reactive, sticking-plaster, approaches are not the answer.”

Campbell said GPs and their teams delivered nine in every 10 patient contacts with the NHS but attracted just seven pence in every pound of NHS spending.

“The government needs to work with the Royal College of General Practitioners, the British Medical Association and universities to obtain evidence on the causes of the problem, to develop and implement relevant strategy, and to effect fundamental change in healthcare resourcing and planning nationwide,” he said.

928 carers in England quit a day as social care system ‘starts to collapse’

More than 900 adult social care workers a day quit their job in England last year, figures reveal, as homecare providers warn the adult social care system has begun to collapse.

Analysis by the BBC of data released by a charity, Skills for Care, shows that in 2015-16 about 338,520 adult social care workers left their roles, equal to 928 people leaving their job every day. There were more than 1.3 million people employed in the adult social care sector in England in the period.

Of those leaving a job, 60% left the adult social care sector altogether, the figures showed, while there was an estimated shortage of 84,320 care workers, meaning about one in every 20 care roles remained vacant.

The average full-time frontline care worker earned £7.69 an hour, or £14,800 a year, according to the data, and one in every four social care workers was employed on a zero-hours contract.

The figures come as the UK Homecare Association wrote a letter to the prime minister warning of the crisis facing social care.

Mike Padgham, the chair of the UK Homecare Association, said: “My biggest fear is that we will soon run out of capacity to provide care to those who cannot fund themselves. I agree wholeheartedly with Age UK’s warning that the social care system will begin to collapse this year, but I would go further and say that the system has already begun to collapse.”

The Skills for Care figures show that the industry has a staff turnover rate of 27%, which is nearly twice the average for other professions in the UK, according to the BBC report.

The government has said it will spend an extra £2bn on the social care system and permitted local authorities to raise council tax bills in order to fund the gap in social care budgets.

The Department of Health said: “Social care jobs have increased at an average of 3% a year since 2010, but we want to see improvements in turnover rates, with talented staff attracted to a robust sector backed by an additional £2bn over the next three years.

“Meanwhile, we’re investing in the workforce of the future, with a total of 87,800 apprentices starting last year – up 37,300 compared to 2010.”

NHS England to expand provision of ‘gamechanging’ stroke treatment

Thousands of stroke patients will be saved from lifelong disability after NHS England decided to invest millions of pounds in a new treatment hailed as a “gamechanger”.

About 8,000 people a year who have a stroke will benefit from a massive expansion in the number of hospitals offering mechanical thrombectomy.

Currently only a few hundred patients a year receive the treatment and just a handful of hospitals in England offer it, despite its proved effectiveness. Stroke experts say the procedure can produce remarkable results, with patients who would otherwise have ended up in a wheelchair instead able to walk out of hospital within 48 hours of having it.

“Thrombectomy is a real gamechanger which can save lives and reduce the chances of someone being severely disabled after a stroke,” said Juliet Bouverie, the chief executive of the Stroke Association.

“This decision by NHS England could give thousands of critically ill stroke patients an increased chance of making a better recovery. It could also mean more stroke survivors living independently in their own homes, returning to work and taking control of their lives again as a result,” she added.

A thrombectomy is used to remove a blood clot in someone’s brain which has not dissolved despite the patient receiving clot-busting thrombolytic drugs. It involves a doctor putting a thin tube into a patient’s artery, usually through their groin, and then feeding it up through their body to where the clot is in their brain. Once there, a wire mesh tube called a stent – usually used in heart or vascular surgery – on the top of the tube is wrapped around the clot and it is then pulled out by a doctor called an interventional neuroradiologist.

Doing that restores normal blood flow to the brain and greatly reduces damage to brain tissue, which is what causes patients to suffer long-term, often serious damage to their physical and mental functions. Patients are either sedated or under general anaesthetic during the procedure, which must be carried out within six hours of the stroke occurring.

“This major national upgrade to stroke services puts the NHS at the leading edge of stroke care internationally,” said Simon Stevens, NHS England’s chief executive. “It’s another practical example of the NHS quietly expanding innovative modern care that will really benefit patients, but which tends to be invisible in the public debate about the NHS.”

Stevens is keen that the NHS follows the lead of Germany and France, which undertake 7,500 and 3,500 thrombectomies a year respectively. While the procedure can help 10% of the 90,000 people a year in the UK who are admitted to hospital following a stroke, fewer than 600 patients a year in England have one.

Although the procedure costs about £12,000 to perform, the big savings in medical and social care for patients who would otherwise have been left seriously disabled have convinced NHS England that it represents value for money.

St George’s in London is the only hospital in the UK to offer thrombectomy around the clock every day of the week. NHS England hope the massive expansion will lead to 24 NHS trusts which are centres of excellence in neuroscience operating on the same 24/7 basis as the NHS becomes more of a seven-day service.

Dr Jeremy Madigan, a consultant diagnostic and interventional neuroradiologist at St George’s, said: “Our patients are benefiting from the thrombectomy service we provide, with an 80-90% chance of opening up blocked vessels via this technique, compared to 30% with traditional clot-busting drugs.

“Providing a thrombectomy service at all times of day, as we do at St George’s, radically improves the range and mix of interventions available to us as clinicians.”

However, Bouverie said that creating 24 centres to perform the procedure would compel the NHS to centralise acute stroke services in fewer places, which would likely prove controversial.

It would also require a big increase in the number of interventional neuroradiologists the NHS employs – currently about 90 – especially if the service is to operate around the clock.

Quarter of adults in England ‘get less than half hour of exercise a week’

One in four adults in England get less than 30 minutes of exercise a week, with women more likely to be inactive, a report shows.

NHS Digital’s annual review of obesity in England also found high levels of obesity among adults and children, with only around a quarter of adults eating the recommended five portions of fruit and vegetables a day.

Twenty six per cent of all adults were classified as inactive (undertaking fewer than 30 minutes of physical activity a week), with women more likely to be inactive (27%) than men (24%).

People who are long-term unemployed or who have never worked are most likely not to take exercise (37%), compared with 17% of those in professional and managerial jobs.

Almost a third of people in South Tyneside, Leicester, Barking and Dagenham and Rochdale are deemed to be inactive, while the lowest rates of inactivity were found in Wokingham (13%) and Brighton and Hove (14%), the report said.

In 2015, 58% of women and 68% of men in England were overweight or obese. Obesity has risen from 15% of adults in 1993 to 27% in 2015.

The prevalence of morbid obesity has more than tripled since 1993, affecting 2% of men and 4% of women in 2015.

The report also revealed high numbers of overweight children, with more than one in five in reception class (aged four to five) being overweight or obese in 2015-16, rising to more than one in three for children in year 6.

On Thursday, Public Health England (PHE) published new voluntary targets for the food industry to reduce sugar levels by 20% by 2020 in nine categories of food popular with children.

The NHS Digital report found that only 26% of adults ate the recommended five portions of fruit or vegetables a day in 2015: 47% of men and 42% of women ate fewer than three portions a day. But 52% of 15-year-olds said they hit the recommended five a day.

The data also showed there were 525,000 hospital admissions in England in 2015-16 where obesity was recorded as a factor. Two in three patients, or 67%, were female.

The data revealed, too, that 6,438 weight-loss surgical procedures were carried out.

A spokesman for the Obesity Health Alliance, a coalition of more than 40 health charities, campaign groups and medical colleges, said: “As waistlines increase, so do the chances of developing life-threatening conditions like Type 2 diabetes, heart disease and cancer, putting further strain on our already overstretched health service.

“This data is a stark reminder of exactly why we need measures like the sugar reduction programme and the soft drinks industry levy to help create a healthier environment for all.”

Dr Justin Varney, Public Health England’s national lead for adult health and wellbeing, said: “We need many more adults and children to be more physically active. Little and often makes a big difference – just 10 minutes extra walking each day can improve a person’s health and their overall quality of life.”

Chris Allen, senior cardiac nurse at the British Heart Foundation, said: “Being inactive can dramatically increase your risk of having a deadly heart attack or stroke.

“But the good news is that it’s never too late to start being more active, which can help you control your weight, reduce blood pressure and cholesterol and improve your mental health.

“The recommended 150 minutes of physical activity a week may seem like a lot, but you can break it down into 10-minute sessions and gradually build up.”

NHS workers in England to get ‘derisory’ 1% pay rise

Health workers ranging from doctors, dentists, nurses and midwives to cleaners and porters are to receive a 1% pay rise, angering unions.

The government said it had accepted recommendations from Pay Review Bodies (PRB) for increases in the coming year.

Unions reacted with fury, saying the rise was “derisory”, especially as fuel, food and transport costs were increasing.

Christina McAnea, head of health at Unison, said: “This deal amounts to less than £5 a week for most midwives, nurses, cleaners, paramedics, radiographers and other healthcare staff. It’s a derisory amount in the face of soaring fuel bills, rising food prices and increasing transport costs.

“The government’s insistence on the 1% cap has tied the PRB’s hands. As the PRB itself admits, it can no longer prevent health employees’ pay falling way behind wages in almost every part of the economy.Without the cash to hold on to experienced employees, the NHS staffing crisis will worsen as people leave for less stressful, better rewarded jobs elsewhere.

“Today’s unfair settlement is yet more evidence of the government’s failure to invest in the NHS. Ministers must stop relying on goodwill, rethink this short-sighted pay policy and reward staff properly.”

Rehana Azam, of the GMB union, said: “Public sector workers desperately need a real pay rise, not the miserly and cruel decision being imposed on them by the government.

“Dedicated professionals are hurting and the quality of services is deteriorating for everyone else. Theresa May talks about helping those who are ‘just about managing’, but it’s clear that she doesn’t include over 5 million public sector workers. Imposing a 1% settlement is an insult to our selfless NHS staff and other public sector workers – who keep us safe day in, day out.”

Unison’s general secretary, Dave Prentis, said: “Day after day NHS staff are giving 100%, but getting just 1% in return. Low pay makes it tough for the NHS to hold on to experienced employees and recruit the next generation. And without enough staff, patient care will suffer. The pay of top judges and MPs has already breached the government’s 1% limit. It’s high time ministers stopped penalising NHS employees and gave them a decent pay rise.”

Jon Skewes, of the Royal College of Midwives, said: “It is extremely disappointing that the government is continuing with its disastrous policy of pay restraint for a seventh year. While we welcome that both the Scottish and Welsh governments will give a slightly higher award to lower paid staff, we want to see an inflationary increase given to all staff.

“As a result of below-inflation increases for the past seven years, midwives have seen their pay drop in value by over £6,000 since 2010. It is unsustainable for this to continue. There is currently a shortage of 3,500 midwives in the NHS, with many more midwives debating whether to leave midwifery because the pressures the service is currently under have created a situation in which midwives have never been so challenged in their ability to give high-quality, safe care to women and their families.

“Eighty percent of midwives who were intending to leave or have left the service told us they would be persuaded to stay if their pay was higher.”

Janet Davies, general secretary of the Royal College of Nursing, said the announcement was a bitter blow to nursing staff across England.

“The government will deter new people from joining the nursing profession at the very moment it is failing to retain staff and European colleagues in particular head for the door. The government is still refusing to keep nursing wages in line with inflation. The government has already cut nursing pay by 14% in real terms, leaving too many struggling and turning to food banks and hardship grants.

“Many nurses rely on working extra hours for the NHS as agency staff but, from next week, they will be forced to work through a ‘bank’ and accept lower rates of pay than they get in their normal NHS job. Ministers are ignoring the evidence that staff shortages put patient care and safety at risk. Tens of thousands of nursing jobs lie vacant today and the government missed the opportunity to stop that getting worse.”

A Department of Health spokesman said: “The dedication and sheer hard work of our NHS staff is absolutely crucial to delivering world-class care for patients. We are pleased to announce that all NHS staff will receive a 1% pay increase.”

Unite national officer Sarah Carpenter said: “What the PRB has proposed is woefully inadequate and means that the majority of NHS staff will have experienced a loss of income in real terms of about 17% since 2010.

“This won’t staunch the recruitment and retention crisis currently affecting many healthcare professions, which is exacerbated by the ugly Brexit shadow hanging over the future of the estimated 55,000 EU nationals working for the NHS. Health secretary Jeremy Hunt often speaks warm words in support of NHS staff, but the reality is that he has been quite content to see this serious erosion in NHS pay continue.”

Rural deprivation and ill-health in England ‘in danger of being overlooked’

Rural communities are in danger of being overlooked when it comes to poverty, deprivation and ill-health, warns a new report from Public Health England.

In England 9.8m people – or 19% of the population – live in rural settings ranging from coastal villages to market towns to large, open expanses like the Yorkshire Dales.

But experts caution that while on average people in rural areas have better health than those in cities, the popular idea of affluent bucolic life is a misconception.

Instead, they say, official statistics have failed to capture the reality that many residents scattered across rural communities face deprivation, poverty and poor health.

“Within a rural community there are significant inequalities between parts that actually are very wealthy and parts that are quite deprived,” said Dr Rashmi Shukla,
Public Health England’s regional director for the Midlands and East of England and lead author of the report.

Published by the Local Government Association (LGA) and Public Health England, the research sheds light on a number of issues affecting the health and wellbeing of rural communities, including low-paid work, unemployment of young people, high costs of housing and fuel poverty.

Access to health services is also of concern, the authors note, with GPs, dentists and other services further away than in urban areas. Indeed, while 97% of urban households lie within 8km of a hospital, the figure for rural households is just 55%.

In addition, rural areas often lack of public transport, while poor broadband and mobile phone network availability hinders communication and access to online health services, banking, and shopping.

“Even people who may not be materially disadvantaged may have difficulties connecting and may be more socially isolated as a consequence of that,” said Shukla.

Social isolation, she adds, is a particular problem for older people – a sector of society that is larger in rural communities, with 23.5% of residents over the age of 65, compared to 16.3% in urban areas.

An ageing rural population, the authors point out, brings a number of challenges. These include the fact that older people often have poorer health and greater care needs, issues compounded by the greater distances to healthcare services and poor public transport. “Financial poverty in rural areas is also highly concentrated amongst older people, with around one-quarter of those in poverty in pensioner households,” the authors add.

Izzi Seccombe, chairman of the LGA’s Community Wellbeing board, said that many of the services that could help tackle these issues have been under pressure.

“What local authorities have all seen is a reduction in government grant,” she said. “While they have tried to protect the services for vulnerable people, like social care, some of our other services that we deliver – which can be subsidised transport, can be library services, it can be grants to the voluntary sector – those have been squeezed.”

The report encourages local authorities to take action to improve healthcare for rural areas, urging them to look closely at the particular challenges facing different communities. The authors also highlight successful initiatives including the “Fish Well” health improvement project in Norfolk, that offered quayside health checks, advice and support to fishermen that they would otherwise have found difficult to access.

The authors also highlight the need for official statistics that look more closely at conditions experienced by those living in the countryside, and at different areas within it, pointing out that current approaches don’t pick up small pockets of deprivation, and tend use measures that are more relevant in urban areas, such car ownership.

“A lot more digging needs to be done to understand the level of deprivation within rural communities,” said Shukla. “Just under 10m of our population live in these communities and a proportion of them are under severe hardship. We need to address that,” she added.

Seccombe agrees. “We must not forget our vulnerable people in more isolated communities,” she said.