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Mental health still losing out in NHS funding, report finds

King’s Fund says physical health services are still getting bigger budgets, five years after ministers promised ‘parity of esteem’

Mental health


The King’s Fund has warned about the continuing inequality in funding. Photograph: Alamy Stock Photo

Mental health care providers continue to receive far smaller budget increases than hospitals, five years after ministers pledged to create “parity of esteem” between NHS mental and physical health services.

The disclosure, in a new report by the King’s Fund, has sparked concern that mental health patients are receiving poorer quality care because of the widening gap in income.

Budgets of NHS mental health trusts in England rose by less than 2.5% in 2016-17, far less than the 6% boost received by acute trusts and those providing specialist care.

It is the fifth year in a row that NHS bosses gave physical health services a larger cash increase, even though ministers have repeatedly stressed the need to give mental health services more money.

Mental health trusts in England received income increases of just 5.5% between 2012-13 and last year, whereas budgets for acute hospitals rose by 16.8% over the same period, new research by the thinktank shows.

The author Helen Gilburt, a fellow in health policy at the King’s Fund, warned that the continuing inequality in funding was preventing mental health trusts employing enough staff, which is damaging patient care.

“While the NHS is in a difficult position, the slow growth in mental health trust funding and the problem of not having enough staff are both having a real impact on patients, who are having to put up with services that are being stretched to the limit,” she said.

Paul Farmer, the chief executive of the charity Mind, said: “Mental health has been under-resourced for too long, with dire consequences for people with mental health problems.

“If people don’t get the help they need, when they need it, they are likely to become more unwell and need more intensive – and expensive – support further down the line.”

More positively, 84% of mental health trusts last year received a budget increase from NHS clinical commissioning groups (CCGs) – a rise on the 51%, 60% and 56% which had done so in the previous three years. The mental health investment standard, brought in in 2015-16, compels all CCGs to give mental health services an annual rise which at least mirrors their own budget increase.

Gilburt said, however, that “the [overall] funding gap between mental health and cute NHS services is continuing to widen. As long as this is the case, the government’s mission to tackle the burning injustice faced by people with mental health problems will remain out of reach”.

NHS England said funding for mental health services rose in 2016-17 by 6.3% to £9.7bn, compared with a smaller increase – of just 3.7% – in other parts of the health budget. It said mental health was also receiving a slightly larger share of overall CCG spending, at 13.6%.

Mental health still losing out in NHS funding, report finds

King’s Fund says physical health services are still getting bigger budgets, five years after ministers promised ‘parity of esteem’

Mental health


The King’s Fund has warned about the continuing inequality in funding. Photograph: Alamy Stock Photo

Mental health care providers continue to receive far smaller budget increases than hospitals, five years after ministers pledged to create “parity of esteem” between NHS mental and physical health services.

The disclosure, in a new report by the King’s Fund, has sparked concern that mental health patients are receiving poorer quality care because of the widening gap in income.

Budgets of NHS mental health trusts in England rose by less than 2.5% in 2016-17, far less than the 6% boost received by acute trusts and those providing specialist care.

It is the fifth year in a row that NHS bosses gave physical health services a larger cash increase, even though ministers have repeatedly stressed the need to give mental health services more money.

Mental health trusts in England received income increases of just 5.5% between 2012-13 and last year, whereas budgets for acute hospitals rose by 16.8% over the same period, new research by the thinktank shows.

The author Helen Gilburt, a fellow in health policy at the King’s Fund, warned that the continuing inequality in funding was preventing mental health trusts employing enough staff, which is damaging patient care.

“While the NHS is in a difficult position, the slow growth in mental health trust funding and the problem of not having enough staff are both having a real impact on patients, who are having to put up with services that are being stretched to the limit,” she said.

Paul Farmer, the chief executive of the charity Mind, said: “Mental health has been under-resourced for too long, with dire consequences for people with mental health problems.

“If people don’t get the help they need, when they need it, they are likely to become more unwell and need more intensive – and expensive – support further down the line.”

More positively, 84% of mental health trusts last year received a budget increase from NHS clinical commissioning groups (CCGs) – a rise on the 51%, 60% and 56% which had done so in the previous three years. The mental health investment standard, brought in in 2015-16, compels all CCGs to give mental health services an annual rise which at least mirrors their own budget increase.

Gilburt said, however, that “the [overall] funding gap between mental health and cute NHS services is continuing to widen. As long as this is the case, the government’s mission to tackle the burning injustice faced by people with mental health problems will remain out of reach”.

NHS England said funding for mental health services rose in 2016-17 by 6.3% to £9.7bn, compared with a smaller increase – of just 3.7% – in other parts of the health budget. It said mental health was also receiving a slightly larger share of overall CCG spending, at 13.6%.

Mental health still losing out in NHS funding, report finds

King’s Fund says physical health services are still getting bigger budgets, five years after ministers promised ‘parity of esteem’

Mental health


The King’s Fund has warned about the continuing inequality in funding. Photograph: Alamy Stock Photo

Mental health care providers continue to receive far smaller budget increases than hospitals, five years after ministers pledged to create “parity of esteem” between NHS mental and physical health services.

The disclosure, in a new report by the King’s Fund, has sparked concern that mental health patients are receiving poorer quality care because of the widening gap in income.

Budgets of NHS mental health trusts in England rose by less than 2.5% in 2016-17, far less than the 6% boost received by acute trusts and those providing specialist care.

It is the fifth year in a row that NHS bosses gave physical health services a larger cash increase, even though ministers have repeatedly stressed the need to give mental health services more money.

Mental health trusts in England received income increases of just 5.5% between 2012-13 and last year, whereas budgets for acute hospitals rose by 16.8% over the same period, new research by the thinktank shows.

The author Helen Gilburt, a fellow in health policy at the King’s Fund, warned that the continuing inequality in funding was preventing mental health trusts employing enough staff, which is damaging patient care.

“While the NHS is in a difficult position, the slow growth in mental health trust funding and the problem of not having enough staff are both having a real impact on patients, who are having to put up with services that are being stretched to the limit,” she said.

Paul Farmer, the chief executive of the charity Mind, said: “Mental health has been under-resourced for too long, with dire consequences for people with mental health problems.

“If people don’t get the help they need, when they need it, they are likely to become more unwell and need more intensive – and expensive – support further down the line.”

More positively, 84% of mental health trusts last year received a budget increase from NHS clinical commissioning groups (CCGs) – a rise on the 51%, 60% and 56% which had done so in the previous three years. The mental health investment standard, brought in in 2015-16, compels all CCGs to give mental health services an annual rise which at least mirrors their own budget increase.

Gilburt said, however, that “the [overall] funding gap between mental health and cute NHS services is continuing to widen. As long as this is the case, the government’s mission to tackle the burning injustice faced by people with mental health problems will remain out of reach”.

NHS England said funding for mental health services rose in 2016-17 by 6.3% to £9.7bn, compared with a smaller increase – of just 3.7% – in other parts of the health budget. It said mental health was also receiving a slightly larger share of overall CCG spending, at 13.6%.

Mental health still losing out in NHS funding, report finds

King’s Fund says physical health services are still getting bigger budgets, five years after ministers promised ‘parity of esteem’

Mental health


The King’s Fund has warned about the continuing inequality in funding. Photograph: Alamy Stock Photo

Mental health care providers continue to receive far smaller budget increases than hospitals, five years after ministers pledged to create “parity of esteem” between NHS mental and physical health services.

The disclosure, in a new report by the King’s Fund, has sparked concern that mental health patients are receiving poorer quality care because of the widening gap in income.

Budgets of NHS mental health trusts in England rose by less than 2.5% in 2016-17, far less than the 6% boost received by acute trusts and those providing specialist care.

It is the fifth year in a row that NHS bosses gave physical health services a larger cash increase, even though ministers have repeatedly stressed the need to give mental health services more money.

Mental health trusts in England received income increases of just 5.5% between 2012-13 and last year, whereas budgets for acute hospitals rose by 16.8% over the same period, new research by the thinktank shows.

The author Helen Gilburt, a fellow in health policy at the King’s Fund, warned that the continuing inequality in funding was preventing mental health trusts employing enough staff, which is damaging patient care.

“While the NHS is in a difficult position, the slow growth in mental health trust funding and the problem of not having enough staff are both having a real impact on patients, who are having to put up with services that are being stretched to the limit,” she said.

Paul Farmer, the chief executive of the charity Mind, said: “Mental health has been under-resourced for too long, with dire consequences for people with mental health problems.

“If people don’t get the help they need, when they need it, they are likely to become more unwell and need more intensive – and expensive – support further down the line.”

More positively, 84% of mental health trusts last year received a budget increase from NHS clinical commissioning groups (CCGs) – a rise on the 51%, 60% and 56% which had done so in the previous three years. The mental health investment standard, brought in in 2015-16, compels all CCGs to give mental health services an annual rise which at least mirrors their own budget increase.

Gilburt said, however, that “the [overall] funding gap between mental health and cute NHS services is continuing to widen. As long as this is the case, the government’s mission to tackle the burning injustice faced by people with mental health problems will remain out of reach”.

NHS England said funding for mental health services rose in 2016-17 by 6.3% to £9.7bn, compared with a smaller increase – of just 3.7% – in other parts of the health budget. It said mental health was also receiving a slightly larger share of overall CCG spending, at 13.6%.

Mindfulness boosts student mental health during exams, study finds

Mindfulness training helps build resilience in university students and improve their mental health, particularly during stressful summer exams, according to research from the University of Cambridge.

The study, which involved just over 600 Cambridge students, concluded that the introduction of eight-week mindfulness courses in UK universities could help prevent mental illness and boost students’ wellbeing at a time of growing concern about mental health in the higher education sector.

University mental health services have experienced a huge surge in demand, with the number of students accessing counselling rising by 50% between 2010 and 2015, exceeding growth in student numbers during the same period.

According to the study, published in the journal The Lancet Public Health, the prevalence of mental illness among first-year undergraduates is lower than among the general population, but it exceeds levels in the general population during the second year of university.

“Given the increasing demands on student mental health services, we wanted to see whether mindfulness could help students develop preventative coping strategies,” said Géraldine Dufour, one of the report’s authors and the head of Cambridge’s counselling service.

Mindfulness, an increasingly popular method of training attention on the present moment, has been shown to improve symptoms of anxiety and depression. Until now, however, there has been little robust evidence on its effectiveness in supporting students’ mental health.

The Cambridge students were randomly assigned to two groups. Both were offered access to the university’s usual support and counselling services, as well as NHS services. One of the two groups was also offered the mindfulness course, which consisted of eight weekly, group-based sessions, plus home practice including meditation, “mindful walking” and “mindful eating”.

Researchers found the mindfulness participants were a third less likely to score above the threshold commonly regarded as meriting mental health support. Even during the most stressful period of the year, summer exams, distress scores for the mindfulness group fell below their baseline levels, as measured at the start of the study. The students without mindfulness training became increasingly stressed as the academic year progressed.

Researchers also considered whether mindfulness had any effect on exam results, but their findings were inconclusive.

“This is, to the best of our knowledge, the most robust study to date to assess mindfulness training for students, and backs up previous studies that suggest it can improve mental health and wellbeing during stressful periods,” said Dr Julieta Galante, of Cambridge’s psychiatry department, who led the study.

“Students who had been practising mindfulness had distress scores lower than their baseline levels even during exam time, which suggests that mindfulness helps build resilience against stress.”

Prof Peter Jones, also from Cambridge’s department of psychiatry, added: “The evidence is mounting that mindfulness training can help people cope with accumulative stress.

“While these benefits may be similar to some other preventative methods, mindfulness could be a useful addition to the interventions already delivered by university counselling services. It appears to be popular, feasible, acceptable and without stigma.”

More US teens are vaping than smoking cigarettes, study finds

More US teenagers have tried vaping than smoking cigarettes, a new study shows, raising concerns among some researchers that vaping could become a new generation’s substance delivery system of choice.

The new nationally representative study showed that 35.8% of students in their final year of high school had tried vaping, versus 26.6% who had ever smoked a cigarette.


These findings emphasize that vaping has progressed well beyond a cigarette alternative

Richard Miech, principal investigator

Since vaping’s growth in popularity, debate has raged in public health circles about the role e-cigarettes should play. American researchers have largely taken a prohibitionist stance, arguing vaping does more harm than good, while British have researchers focused on the device’s potential benefits to current smokers.

“These findings emphasize that vaping has progressed well beyond a cigarette alternative,” said Richard Miech, the principal investigator on the annual Monitoring the Future survey, which involves tens of thousands of students. The government-funded research is now in its 43rd year, and considered the most authoritative national picture of teen drug use.

“Vaping has become a new delivery device for a number of substances, and this number will likely increase in the years to come,” said Miech.

Researchers only have three years of data on how many teens use the electronic devices, but the latest Monitoring the Future study found vaping is already widespread among high school students.

From its peak in the mid-1990s, the rate of all high school students who are smoking has dropped dramatically. For example in 1997, 65.4% of students in their final year of high school said they had ever smoked a cigarette. In 2017, 26.6% of the oldest high school students had smoked one.

However, in the last few years vaping has seen huge growth. Monitoring the Future did not measure teen vaping until 2015. By that time, 35.5% of 12th graders had used one before. That number rose slightly in 2017, to 38.8%.

E-cigarette smoking in California. The study also asked how often teens vaped marijuana.


E-cigarette smoking in California. The study also asked how often teens vaped marijuana. Photograph: Justin Sullivan/Getty Images

For the first time this year, Monitoring the Future asked teens how often they vaped nicotine, marijuana or only flavoring, though researchers warned the numbers are likely to skew low since teens may not know what is in a vaping product. They found one in four 12th graders had vaped nicotine, and 11.9% had vaped marijuana.

Vaping devices turn liquid flavorings laced with nicotine or marijuana into a vapor. In the US, they are largely unregulated. Although Congress passed a law meant to regulate the devices in 2009, nearly a decade later the Food and Drug Administration failed to issue regulations to guide manufacturers. They don’t expect to do so before 2021.

Those delays have followed heavy lobbying by tobacco companies such as RJ Reynolds and Altria (formerly Philip Morris USA), who fought against the 2009 law.

Koval also said evidence of vaping marijuana was worrying. Emerging research shows marijuana can be detrimental to the development of teens’ brains.

“But as concerns this audience, which are young people, it’s not a good idea for them to be consuming nicotine in any way, shape or form,” Koval said. “It’s concerning to see that.”

Researchers have conducted Monitoring the Future surveys among US high school students in their final year since 1975, adding lower grades in the 1990s. In all, approximately 50,000 students in about 420 public and private secondary schools are surveyed annually.

All forms of hormonal contraception carry breast cancer risk, study finds

All forms of the pill and other hormonal contraception carry a small risk of breast cancer, which lasts for about five years after women stop taking it, according to new research.

The increased risk has been known for some time, but there were hopes that newer forms of hormonal contraception – such as those which release progesterone only – would be safer. However, the new study in the New England Journal of Medicine confirms the 20% added risk that women run – although that is still very small for those not at high risk already.

Among women taking the pill for five years, the study suggests, there would be an extra one case for every 1500 women.

The study is very large, including 1.8 million women in Denmark who were followed up for nearly 11 years on average. The Danish researchers found that the risk of breast cancer was higher in women who used the pill or other forms of hormonal contraception, including IUDs, for longer. It was also higher in those who were older – most of the breast cancer cases were in women over 40.

In a commentary with the study, Professor David Hunter, of the Nuffield Department of Population Health, said that the small risks of the pill needed to be set against the benefits, which included not only preventing an unwanted pregnancy but also a “substantial reductions in the risks of ovarian, endometrial and colorectal cancers in later life”.

But he called for more effort to be invested in safer forms of the pill. “These data suggest that the search for an oral contraceptive that does not elevate the risk of breast cancer needs to continue. In the 1980s and 1990s, there was some optimism regarding the development of a formulation that would reduce a woman’s risk of breast cancer, but research into this possibility appears to have stalled,” he writes.

Kevin McConway, emeritus professor of applied statistics at the Open University, said the study found the increase in risk disappeared gradually over a few years once women stop taking the pill.

“Like most other studies on hormonal contraceptives and breast cancer risk, this one is observational, so it cannot prove conclusively that the hormonal contraception is definitely the cause of the increased risk. However, the researchers did allow statistically for most of the important factors that might also be involved, and they give good reasons why the differences in risk that they found are likely to be causally related to the contraceptives.

“I’m not a medical doctor, but my assessment is that this new evidence doesn’t make an important change to what was previously known about hormonal contraceptives and breast cancer risk. It just brings it further up to date and adds some detail. Certainly I’d advise anyone who is concerned about risks to talk to their doctor before making any changes in their contraceptive use.”

All forms of hormonal contraception carry breast cancer risk, study finds

All forms of the pill and other hormonal contraception carry a small risk of breast cancer, which lasts for about five years after women stop taking it, according to new research.

The increased risk has been known for some time, but there were hopes that newer forms of hormonal contraception – such as those which release progesterone only – would be safer. However, the new study in the New England Journal of Medicine confirms the 20% added risk that women run – although that is still very small for those not at high risk already.

Among women taking the pill for five years, the study suggests, there would be an extra one case for every 1500 women.

The study is very large, including 1.8 million women in Denmark who were followed up for nearly 11 years on average. The Danish researchers found that the risk of breast cancer was higher in women who used the pill or other forms of hormonal contraception, including IUDs, for longer. It was also higher in those who were older – most of the breast cancer cases were in women over 40.

In a commentary with the study, Professor David Hunter, of the Nuffield Department of Population Health, said that the small risks of the pill needed to be set against the benefits, which included not only preventing an unwanted pregnancy but also a “substantial reductions in the risks of ovarian, endometrial and colorectal cancers in later life”.

But he called for more effort to be invested in safer forms of the pill. “These data suggest that the search for an oral contraceptive that does not elevate the risk of breast cancer needs to continue. In the 1980s and 1990s, there was some optimism regarding the development of a formulation that would reduce a woman’s risk of breast cancer, but research into this possibility appears to have stalled,” he writes.

Kevin McConway, emeritus professor of applied statistics at the Open University, said the study found the increase in risk disappeared gradually over a few years once women stop taking the pill.

“Like most other studies on hormonal contraceptives and breast cancer risk, this one is observational, so it cannot prove conclusively that the hormonal contraception is definitely the cause of the increased risk. However, the researchers did allow statistically for most of the important factors that might also be involved, and they give good reasons why the differences in risk that they found are likely to be causally related to the contraceptives.

“I’m not a medical doctor, but my assessment is that this new evidence doesn’t make an important change to what was previously known about hormonal contraceptives and breast cancer risk. It just brings it further up to date and adds some detail. Certainly I’d advise anyone who is concerned about risks to talk to their doctor before making any changes in their contraceptive use.”

Sausage sandwich has two-thirds of daily salt allowance, study finds

The humble sausage sandwich could contain nearly two-thirds of an adult’s maximum daily recommended intake of salt – more than a McDonald’s double cheeseburger and large fries, a health group has warned.

Research by Consensus Action on Salt and Health (Cash) has revealed “shocking and excessively high” amounts of salt in well-known brands of the British banger – a favourite in the UK – but vegetarian options are just as unhealthy.

Cash said many companies had failed to reduce salt in their products with just three weeks left for them to reach 2017 targets set by Public Health England.

The British eat more than 175,000 tonnes of sausages each year, despite them being named by the World Health Organisation in 2015 as a likely cause of cancer.

The survey found that the average salt content of sausages was 1.3g per 100g, or 1.16g per typical portion of two sausages – a figure that has remained relatively unchanged since 2011, exceeding the salt reduction targets in place at that time. The maximum daily recommended intake for an adult is 6g.

The saltiest sausages were Iceland’s Jumbo Pork range, at 1.28g each, but that went up to 3.78g including the ingredients for a sandwich, compared with 3.22g for a McDonald’s double cheeseburger and large fries.

Researchers collected data for 212 chilled, frozen, vegetarian and meat sausages sold by all the major supermarkets, but excluding sausage rolls, cocktail sausages and frankfurters.

They found a wide range of salt levels across all sausages, from the highest in Richmond’s 12 Skinless Pork Sausages at 2.3g per 100g to the lowest in the Co-operative’s Irresistible 6 Sweet Chilli Sausages at 0.75g per 100g – a threefold difference in salt content per 100g.

They also uncovered large variations within supermarket own-brand sausages, with Asda’s Extra Special Bacon & Maple Syrup option containing 1.1g of salt per sausage – more than double the same retailer’s Extra Special Lincolnshire Pork Sausages.

Even going meat-free is not a healthy option, with Quorn’s vegetarian Best of British Sausages containing 1.9g of salt per 100g, or 2.2g in two sausages, which is more than the salt content of half a Pizza Hut Margherita pizza.

The worst offender overall is Richmond, whose full range of sausages tops other manufacturers for salt. In fact, the salt content of its sausages has remained consistently high since at least 2011, which Cash said suggested Richmond had made no effort to reduce it.

About 85% of meat sausages surveyed by Cash were also high in saturated fat – another cause of strokes and heart disease – while Sainsbury’s Taste The Difference Toulouse Inspired British Pork Sausages contained 12.2g of saturated fat per two sausages, more than half the recommended daily maximum intake of saturated fat for women.

Some of the biggest brands, including Richmond, Wall’s and Iceland, failed to provide traffic light labelling on their packaging, even using a portion size as one sausage, which Cash said was “completely unrealistic”.

“The UK has led the world on salt reduction but this survey clearly shows that many companies are not cooperating with the current voluntary policy,” said Graham MacGregor, a professor of cardiovascular medicine at Queen Mary University of London and chairman of Cash. “Public Health England, which is now responsible, must get tough on those companies not complying and set new mandatory targets to be achieved by 2020. Otherwise, thousands of people will die from unnecessary strokes and heart attacks every year.”

The Guardian contacted Richmond for comment.

A spokeswoman for Quorn said: “Quorn produces a range of sausages, with its bestselling Quorn Sausages being low in salt and highlighted on the front of pack. The range featured by Cash is Quorn’s Best of British Sausages, which offer slightly more indulgent sausages. While they are higher in salt, as clearly marked on pack, they are still low in saturated fat.”

Dr Alison Tedstone, Public Health England’s chief nutritionist, commented: “Our salt consumption has decreased over the last decade – a loaf of bread has 40% less than it used to. However, some products are still too high in salt and we know this can be reduced further.”

Sausage sandwich has two-thirds of daily salt allowance, study finds

The humble sausage sandwich could contain nearly two-thirds of an adult’s maximum daily recommended intake of salt – more than a McDonald’s double cheeseburger and large fries, a health group has warned.

Research by Consensus Action on Salt and Health (Cash) has revealed “shocking and excessively high” amounts of salt in well-known brands of the British banger – a favourite in the UK – but vegetarian options are just as unhealthy.

Cash said many companies had failed to reduce salt in their products with just three weeks left for them to reach 2017 targets set by Public Health England.

The British eat more than 175,000 tonnes of sausages each year, despite them being named by the World Health Organisation in 2015 as a likely cause of cancer.

The survey found that the average salt content of sausages was 1.3g per 100g, or 1.16g per typical portion of two sausages – a figure that has remained relatively unchanged since 2011, exceeding the salt reduction targets in place at that time. The maximum daily recommended intake for an adult is 6g.

The saltiest sausages were Iceland’s Jumbo Pork range, at 1.28g each, but that went up to 3.78g including the ingredients for a sandwich, compared with 3.22g for a McDonald’s double cheeseburger and large fries.

Researchers collected data for 212 chilled, frozen, vegetarian and meat sausages sold by all the major supermarkets, but excluding sausage rolls, cocktail sausages and frankfurters.

They found a wide range of salt levels across all sausages, from the highest in Richmond’s 12 Skinless Pork Sausages at 2.3g per 100g to the lowest in the Co-operative’s Irresistible 6 Sweet Chilli Sausages at 0.75g per 100g – a threefold difference in salt content per 100g.

They also uncovered large variations within supermarket own-brand sausages, with Asda’s Extra Special Bacon & Maple Syrup option containing 1.1g of salt per sausage – more than double the same retailer’s Extra Special Lincolnshire Pork Sausages.

Even going meat-free is not a healthy option, with Quorn’s vegetarian Best of British Sausages containing 1.9g of salt per 100g, or 2.2g in two sausages, which is more than the salt content of half a Pizza Hut Margherita pizza.

The worst offender overall is Richmond, whose full range of sausages tops other manufacturers for salt. In fact, the salt content of its sausages has remained consistently high since at least 2011, which Cash said suggested Richmond had made no effort to reduce it.

About 85% of meat sausages surveyed by Cash were also high in saturated fat – another cause of strokes and heart disease – while Sainsbury’s Taste The Difference Toulouse Inspired British Pork Sausages contained 12.2g of saturated fat per two sausages, more than half the recommended daily maximum intake of saturated fat for women.

Some of the biggest brands, including Richmond, Wall’s and Iceland, failed to provide traffic light labelling on their packaging, even using a portion size as one sausage, which Cash said was “completely unrealistic”.

“The UK has led the world on salt reduction but this survey clearly shows that many companies are not cooperating with the current voluntary policy,” said Graham MacGregor, a professor of cardiovascular medicine at Queen Mary University of London and chairman of Cash. “Public Health England, which is now responsible, must get tough on those companies not complying and set new mandatory targets to be achieved by 2020. Otherwise, thousands of people will die from unnecessary strokes and heart attacks every year.”

The Guardian contacted Richmond for comment.

A spokeswoman for Quorn said: “Quorn produces a range of sausages, with its bestselling Quorn Sausages being low in salt and highlighted on the front of pack. The range featured by Cash is Quorn’s Best of British Sausages, which offer slightly more indulgent sausages. While they are higher in salt, as clearly marked on pack, they are still low in saturated fat.”

Dr Alison Tedstone, Public Health England’s chief nutritionist, commented: “Our salt consumption has decreased over the last decade – a loaf of bread has 40% less than it used to. However, some products are still too high in salt and we know this can be reduced further.”