News round-up (6 October 2023)

Several stories this week raise concerns about the NHS. A large-scale study shows that women and ethnic minorities are less likely to be offered life-saving heart valve surgery than white men, while NHS England admits that it lacks the staff to respond adequately to a pandemic surge. NHS leaders and government are in discussions about how to plug a funding gap of more than £1bn, and a submission to the Covid inquiry reveals that the NHS lacks the staff to respond adequately to a pandemic surge. More encouragingly, research suggests that screening at A&E could pick up undiagnosed cases of type 2 diabetes, leading to more lives being saved.

Report finds concerning inequalities in NHS heartvalve surgery

Patients who are female, black, Asian or less well-off are significantly less likely to be offered heart valve surgery on the NHS in England, according to a new report.

Researchers at the Liverpool Heart and Chest hospital NHS Foundation Trust analysed data from hospital episode statistics from April 2016 to the end of March 2019.

During this time, 183,591 adults with aortic stenosis were identified, 31,436 of whom underwent aortic valve replacement (AVR) surgery. Women with aortic stenosis were 30% less likely to undergo AVR than men, while black and south Asian people were, respectively, 26% and 22% less likely to do so than white people.

People develop aortic stenosis when their aortic valve narrows as a result of calcium buildup, impeding normal blood flow. This causes shortness of breath, light headedness and chest pain. AVR surgery relieves those symptoms and also increases life expectancy. Without AVR, up to one in four of those with severe or very severe aortic stenosis will die within five years.

BMA accused of holding back medical research

The British Medical Association (BMA) has been accused of undermining scientific research by refusing to endorse an appeal for GPs to release the medical records of patients who have given consent for their data to be shared.

More than half a million people have joined the UK Biobank, a world-leading study set up as a resource for scientists investigating the causes and potential cures for diseases such as diabetes, arthritis, dementia and asthma.

These patients have given written consent for all their medical records to be provided to the database for health-related research. The data protects the identity of the participants.

Only a fifth of GPs have agreed to hand over the information they hold, however. Professor Naomi Allen, the UK Biobank’s chief scientist, said that the study was being “severely hampered” by the lack of access to GP records.

Last week the UK Biobank, NHS England and the Royal College of GPs wrote to all family doctors in England urging them to approve the release of primary care data for the patients in the programme, but the BMA refused to sign the letter. It said it had “competing urgent priorities” and wanted a fuller consultation before joining the appeal.

NHS unable to prepare for pandemic surge because of lack of staff

The NHS has too few staff to prepare for a pandemic surge, NHS England has warned.

A new NHS England submission to the Covid-19 public inquiry says that funding pressure from 2010 has undermined the NHS’s “resilience” and that “resilience and capacity issues in social care are national issues which must be addressed from the centre”. It added that its ageing buildings would also undermine its pandemic response, saying that 12% of the estate pre-dates the founding of the NHS in 1948, while 17% is over 60 years old.

The information was contained in a document posted to the inquiry website last month. No current or former NHS England leaders have so far given evidence to the inquiry. Referring to the NHS’s ability to create “surge capacity [with] flexible staff and equipment which can be pivoted into different roles”, the document states: “It is only possible to train staff to work more flexibly into different roles/environments if they can be freed up to attend training and refreshers. This requires ‘surplus’ staff numbers on rotas, which is not currently possible in relation to many staffing groups across the NHS.”

PM proposes to raise legal smoking age every year

The age at which people can buy cigarettes England should rise by one year every year so that eventually no-one can buy them, Rishi Sunak has said.

Speaking at the Conservative party conference, the prime minister said he would give MPs a free vote on the issue. Under the plan, the age of sale would rise from 18 every year. This means that a child aged 14 today would never legally be allowed to buy cigarettes or tobacco. The plan was originally proposed by a government-commissioned review in 2022.

Sunak said he believed it was the right step to tackle the leading cause of preventable ill-health. “There is no safe level of smoking,” he said.

Although smoking rates have fallen in the past few decades, there are still more than six million smokers in the UK.

Government discusses urgent funding gap with NHS leaders

The government is in talks with national NHS leaders over how to fill an urgent funding gap of at least £1bn this financial year, HSJ has reported.

An analysis by HSJ found that all 42 local integrated care systems were behind their own plans less than halfway through 2023-24.

Common reasons included the expense of covering strikes, slow progress on delivering savings, drug price inflation, and escalating costs for NHS-provided social care packages.

Senior sources told the publication that NHS England is negotiating with the treasury over how to cover a total NHS revenue funding gap expected to be approximately £1bn for 2023-24. Both NHS England and the government are attributing most of the unplanned deficit to the cost of ongoing industrial action, which results in high staffing costs to cover for those on strike. They are still negotiating over whether the government will provide additional revenue to cover the gap, and if not, what drastic measures might be needed to bring spending down.

Screening at A&E could diagnose people with diabetes

Thousands of people who are unaware that they have type 2 diabetes could be diagnosed if screening was introduced in A&E departments, according to a new study.

The study, which took place in an NHS trust in England, suggests that 10% more cases could be picked up with the use of a simple blood test. Screening could also pick up 30% more cases of pre-diabetes, a condition in which blood sugar levels are higher than normal.

Researchers examined the data for 1,388 patients visiting the A&E department in Ashton-under-Lyne. None of the people had a diabetes diagnosis and they were all selected at random. All the patients were screened for type 2 diabetes using the glycated haemoglobin (HbA1c) test, which gives an indication of average blood sugar levels over the previous two to three months. People were also asked to complete a questionnaire about their background, ethnicity and risk factors for diabetes.

Of all the patients screened, 848 (61%) had normal blood glucose levels but 420 (30%) were found to have pre-diabetes and 120 (9%) were diagnosed with type 2 diabetes.

Based on these results, researchers said that thousands of new cases of pre-diabetes and diabetes could be diagnosed in A&E departments every year.