Casebook is a monthly service for members of the Rural Health and Care Alliance. It summarises 5 current news stories, along with other relevant content.

April 2019 Edition

In this edition of Casebook: the negative experiences facing low income families in terms of nutrition, its getting increasingly expensive to go to the dentist as Government contributes less and we are required to pay more, rural isolation and its impact and the palliative consequences of dance and more widely social prescribing. In “Other Stuff” a consultation, a conference and the outcomes of session 3 of our Parliamentary Inquiry into Rural Health and Care.

News

Children in low-income families suffer 'shame and social exclusion'

There is a real challenge facing children in poor rural families many of whom are widely dispersed and don’t show up as prominently as their peers in urban settings. This story tells us:

Children in low-income families suffer social exclusion and a sense of shame because they do not have enough food to eat, according to research published by the Child Poverty Action Group (CPAG).

Many do not qualify for free school meals; even when they do, the lunches can be insufficient for teenagers, and some children from families who have no recourse to public funds (NRPF) because of their parents’ immigration status do not eat at all during the school day.

The UCL study, Living Hand to Mouth: Children and Food in Low-income Families, includes conversations with 51 children from low-income families in south-east England who describe their experiences of food at home, school and in social settings.

The interviews, which form part of a larger European study of food poverty among children and families in Portugal, Norway and the UK, offer a rare insight into children’s lived experience of food poverty.

Some told how schools identify children on free school meals (FSM) by restricting the food options that they can select, causing children embarrassment. Around a quarter went hungry at times despite sacrifices by their parents, and just over half the young people did not have money to spend on food with their friends.

Full details:
https://www.theguardian.com/society/2019/apr/02/children-in-low-income-families-suffer-shame-and-social-exclusion

NHS dentist charges rise by 5% in England

This report identifies a drop in core funding by £500million in real terms for dentistry since 2010. It tells us:

An inflation-busting hike in dentistry fees mean NHS patients in England will pay £1.10 extra for a routine check-up.

The new charges, which begin on Monday, will also see the cost of a set of dentures rise by £12.80 to nearly £270.

Dentistry leaders say charges are increasingly being relied on and in the future dentistry could end up as an NHS service "in name only".

But the government said charges were important to help keep services sustainable.

The new charges are:

• Band 1 treatment (examination, X-rays and scale and polish) £22.70
• Band 2 treatment (fillings and root canal work) £62.10
• Band 3 treatment (crowns, dentures and bridges) £269.30

Analysis by the British Dental Association shows patient charges are increasingly being used to fund the service.

They account for nearly 30% of the budget, up from just over 20% in 2010.

The government currently invests £2bn a year in the service - a drop of £500m in real terms since 2010.

It means England is behind the rest of the UK when it comes to public funding.

Full details:
https://www.bbc.co.uk/news/health-47724076

Jump in antidepressant prescriptions in England

A total of 70.9 million prescriptions for antidepressants were dispensed in England in 2018.

Rural isolation and loneliness are key challenges facing the health and well-being people in rural settings this article shows:

NHS Digital figures show that the number of drugs issued - for conditions like depression and anxiety - went up from 67.5 million in 2017.

The total is almost double the number dispensed in 2008.

The figure includes all items issued by the NHS in England, except those given out in hospitals or on private prescriptions.

Figures published in Scotland last year showed a similar trend, with 6.6 million items dispensed in 2017-2018, compared with 3.8 million items in 2007-2008 — an increase of 73.7%.

In Wales, the number of items dispensed rose by 168% between 2002 and 2017 to 5.6 million

In Northern Ireland, 3.1 million prescriptions were dispensed in 2017-18 - up from 2.4 million in 2013-14.

An NHS England spokesman said: "While antidepressants play an important role for some patients, an attitude of 'a pill for every ill' can mean not only do some people end up taking medicine they don't need to, but taxpayer funding is spent on avoidable prescriptions."

Prof Helen Stokes-Lampard, who chairs the Royal College of GPs, said that family doctors only prescribed medication after fully investigating a patient's circumstances and concluding that drugs were the best option.

"It's really important that increasing numbers of antidepressant prescriptions are not automatically seen as a bad thing, as research has shown they can be very effective drugs when used appropriately," she said.

Prof Stokes-Lampard said that part of the rise in prescriptions could be down to an increased awareness of mental health conditions in society, and more people feeling able to seek medical advice.

"No doctor wants their patients to be reliant on medication - and most patients don't want this, either - so, where possible, we will consider alternative treatments, such as CBT and talking therapies.

Full details:
https://www.bbc.co.uk/news/health-47740396

Nearly one in seven Britons could live alone by 2039, study shows

Another story which speaks to the challenge of rural isolation.

Nearly one in seven people in the UK could be living alone by 2039, according to government figures, which also reveal that those currently living alone are more likely to be renting and feel less financially secure than couples without children.

Analysis from the Office for National Statistics also shows the number of single-person households in the UK is rising sharply.

The number of those living on their own increased by 16% between 1997 and 2017, to 7.7 million, said the ONS, which predicted that 10.7 million people could be living alone in 20 years’ time.

And the costs are not just financial: when it comes to wellbeing, those living on their own report lower levels of happiness and higher levels of anxiety than those living with a partner and no children.

The Guardian recently reported that more than 1 million people aged over 65 without children were “dangerously unsupported” and at acute risk of isolation, loneliness, poor health, poverty and being unable to access formal care.

Full details:
https://www.theguardian.com/society/2019/apr/04/nearly-one-in-seven-britons-could-live-alone-2039-study-shows

Dementia patients should be offered music and dance therapy  

I am aware of a number of excellent examples of rural action to help ameliorate the impact of dementia – music and memories at UTASS (http://utass.org) comes to mind. This article demonstrates that Matt Hancock is a fan of such schemes!

More people with dementia should be given music or dance therapy in a bid to prevent them being "over-medicalised", the Health Secretary has said.

It follows research which found that giving people with dementia personal playlists resulted in a 60 per cent reduction in the need for mind-altering drugs.

Matt Hancock said that while guidance says local areas should consider music or dancing for people with dementia, such therapies have not been widely adopted across England.

He has previously called on GPs to prescribe “personal playlists” to reduce agitation in patients with dementia.

Speaking following a reception hosted by the Prince of Wales at Clarence House in support of "social prescription" therapies, Mr Hancock said doctors were “dishing out” too many pills, when other options should be offered.

Full details:
https://www.telegraph.co.uk/news/2019/04/05/dementia-patients-should-offered-music-dance-therapy/

Other Stuff

1.   Parliamentary Inquiry into Rural Health and Care - Session 3

At the beginning of April we held Session 3 of the Inquiry focusing on what things don’t work too well for patients. We had speakers from: The National Centre for Remote and Rural Medicine, World Organization of Family Doctors, Healthwatch England and Shropshire Council.  The outcomes of the session will be posted here 

2.   NHS Confederation Workforce Consultaion on the workforce powers, freedoms and responsibilities integrated care system (ICS) and sustainability and transformation partnership (STP) footprints are increasingly asking for

The NHS Confederation is organising two roundtables to explore the workforce powers, freedoms and responsibilities integrated care system (ICS) and sustainability and transformation partnership (STP) footprints are increasingly asking for and the local commitments and relationships necessary to deliver this change. 

with recommendations for the devolution of a range of decision-making powers in the areas of strategy and planning, supply and retention, and deployment. 

ICS leaders understand that with increased accountability comes responsibility, requiring widespread system commitments to greater local partnership working. 

There is a clear desire for ICSs to be determined as the default level for future workforce decision- making in health and care; with increased autonomy over the development of local system architecture, responsibility for managing strategic external relationships and critically, control of dedicated funding streams. 

To complement this more involved strategic role, ICSs should pilot and prioritise local approaches to supply and retention, such as ‘Grow Your Own’, and develop and deploy new measures to better understand and utilise their existing health and care workforce. 

While the role of the national arms-length bodies will remain important, there is a need for greater clarity about the roles and functions of the various national workforce organisations and how they encourage longer-term, more strategic local planning. 

This consultation also focuses on the role of the NHS in the wider local labour market. As the largest employer in any given area the NHS and local authorities could exercise significant power and influence on local skills development and employment, however there remains the question of how best to use it. 

The NHS Confederation is asking for comments on this consultation for workforce development, including responses to the listed consultation questions, by 30 April 2019. 

3.   National Centre for Rural and Remote Medicine Inaugural Conference

Remote healthcare is increasingly an issue across the UK and the rest of the world; large populations are being significantly disadvantaged by geographical location. The National Centre for Remote and Rural Medicine (NCRRM) inaugural conference in June aims to pull from global and regional experience and education, to better understand demand and how providers can address these needs with education, training and innovation in health technology. You can learn more about the conference here