Each year, the Government decides how much to raise benefits and tax allowances. The basis for these upratings is rarely debated, yet has major long-term consequences for the relative living standards of different groups and for public finances. The impact of benefit and tax uprating on incomes and poverty from the Joseph Rowntree Foundation considers the implications of present uprating policies, which mean that some parts of the tax and benefit system are uprated by earnings growth, other parts by prices and some not at all.

The impact of continuance of these polices over the newxt 20 years will be a doubling of the child poverty rate alongside a substantial gain to the public finances. Some of this budgetary gain may be needed to meet other demands – of an ageing population for example – but the cost falls disproportionately onto poorer groups and could be raised more fairly.

The Bercow Review of services for Children and Young People (0–19) with Speech, Language and Communication Needs - Interim Report ( Executive Summary) identifies 5 key themes:

• Communication is crucial – communication is at the core of all social interaction.  Communication is a key life skill. Communication is a fundamental human right. For some children and young people, acquiring the ability to communicate is a difficult and ongoing challenge. Just as the nature and severity of their needs will vary, so will the type and extent of the help required to address them.
• Early identification and intervention are essential in order to avoid poor outcomes for children and young people – in addressing delay and disorders, the most important facts we know are the value of early intervention and the danger of its absence. If a child receives the right help early on, he or she has a better chance of tackling problems, communicating adequately and making progress. If a child does not benefit from early intervention, there are multiple risks – of lower educational attainment, of behavioural problems, of emotional and psychological difficulties, of poorer employment prospects and, in some cases, of a descent into criminality.
• A continuum of services, designed around the family, is needed – universal, targeted and specialist services are required to meet the range of needs and, as the Government envisages in its recent Children’s Plan, children, young people and their families must be at their heart.
• Joint working is critical – in planning, commissioning and delivering universal, targeted and specialist provision, it is critical that health services and children’s services, including schools, work together in support of children and young people with SLCN. No single agency can deliver any one of the five Every Child Matters outcomes for children and young people by working in isolation. Separate silos produce misunderstandings, cause divisions and can be bewildering or infuriating to parents for whose children services are delayed or denied as a result.
• The current system is characterised by high variability and a lack of equity – the current system is routinely described by families as a “postcode lottery”, particularly in the context of their access to speech and language therapy (SLT).

Person or place-based policies to tackle disadvantage? Not knowing what works from the Joseph Rowntree Foundation looks at the effectiveness of policies introduced by the Labour government since 1997 to encourage employment, education and reducing income disadvantage, focusing on policies that explicitly take account of people and places.

It finds that person and place-based policies have mostly developed separately and often in isolation from each other. This separation does not reflect the relationships between places and the poverty and disadvantage of people who live in them.

Key findings

• Most policy interventions, whether person or place-targeted, had small, favourable impacts. In the rare cases where information on expenditure was available, costs were generally offset by savings to the Exchequer.
• Both forms of intervention had significant positive impacts on particular aspects of education results and employment. However, it was not possible to determine whether person or place-based policies were better, as they tended to have different objectives that prevented direct comparison.
• Some interventions had negative consequences for the average participant or detrimental effects on some groups of participants.
• It was rarely possible to explain properly how policy interventions worked or why they failed, because the way they were intended to work.
• Evaluators judged policies to have the greatest impact if they delivered individually tailored support to the most disadvantaged people with minimal complexity. The evaluators considered policies successful if they reflected local needs and priorities and were shaped by active engagement with stakeholders, including end users.

Tackling health inequalities: 2007 Status Report on the Programme for Action provides a review of developments against the data since the publication of the Programme for Action in 2003. It considers progress against the Public Service Agreement (PSA) target, the national headline indicators and against government commitments. The report shows:

• Further slight narrowing of the infant mortality gap, little change in the gap in male
  life expectancy and a widening of the gap in female life expectancy since 2003–05.

• An encouraging picture on the cross-government indicators, with long-term progress in reducing child poverty and narrowing inequalities in housing quality, educational
  attainment and uptake of flu vaccinations. Cancer and circulatory (heart) disease
  mortality, child road accident casualties and teenage conceptions show a narrowing of
  inequalities in absolute terms (but not in relative terms); other areas, for example
  smoking, show a general reduction in prevalence but no narrowing of the gap between social groups

• Most departmental commitments set out in the Programme for Action and due for
  delivery by the end of 2006 have been wholly or substantially achieved.

Top tips for health in Local Authorities commissioned by ChaMPs (Cheshire and Merseyside Public Health Network) and from the Liverpool Public Health Observatory offers practical tips on joint working between the NHS and Local Authorities in the areas of:

• Reducing health inequalities

• Tackling obesity: Creating opportunities for healthy eating

• Tackling obesity: Creating opportunities for physical activity

• Improving mental health and well-being

• Promoting sexual health

• Encourage the sensible drinking of alcohol

• Creating a smokefree environment

Hit or Miss - women’s rights report from ActionAid shows that promises made by the world’s governments to tackle poverty are failing to deliver because the basic rights of women in the developing world are being ignored.  The report finds that women and girls formed the majority of the poor and hungry, and, in south Asia, women are getting a shrinking share of income as the economy continues to grow. Ten million more girls than boys miss out on primary school, while African women accounted for 75% of all young people living with HIV/Aids.

Giving a comprehensive overview of the social care sector in England ‘The state of social care in England 2006-07 (Executive Summary)’ the Annual Report of the Commission for Social Care Inspection follows concerns raised by the Commission last year, and explores the experiences of people not deemed eligible for state-supported social care. It shows that many younger disabled people and frail older people are being ‘signposted’ to voluntary services. Many are forced to rely on help from family and informal arrangements which can break down at short notice. People unable to rely on families or friends and unable to pay for care services themselves are simply left to cope with everyday life, while some become virtually trapped in their own home.Local authorities are increasingly only helping those with ‘substantial’ or ‘critical’ needs. This despite the use of a national set of rules (called Fair Access to Care Services - FACS ) to decide who is eligible for support. However who does or doesn’t get help varies not only between but also within the same council. In practice the criteria can be interpreted in different ways by local staff.

The full report can be downloaded using the links below along with the evidence that informed it.

State of social care - foreword & overview

State of social care - context and focus

State of social care - part 1

State of social care - part 2

State of social care - appendices

Lost to the System? The Impact of Fair Access to Care

Self-funded social care for older people: an analysis of eligibility, variations and future projections

You can also download the mp3 audio summary Audio summary.

Lesbian, gay, bisexual and trans (LGBT) people experience a number of health inequalities which are often unrecognised in health and social care settings. These briefings are intended to show that LGBT people can be younger, older, bisexual, lesbians, gay men, trans, from black and minority ethnic (BME) communities and disabled, and to dispel assumptions that they form a homogeneous group.

The briefings provide easy-to-read guidance for health and social care commissioners, service planners and frontline staff. They aim to inform the delivery of appropriate services and to support health and social care professionals in their everyday work with LGBT people by providing fundamental awareness and evidence of LGBT needs in relation to health.

• Introduction
• Briefing 1: Working with lesbian, gay, bisexual and trans (LGBT) people
• Briefing 2: Improving access to health and social care for lesbian, gay, bisexual and trans (LGBT) people
• Briefing 3: Young lesbian, gay and bisexual (LGB) people
• Briefing 4: Older lesbian, gay and bisexual (LGB) people
• Briefing 5: Lesbian health
• Briefing 6: Gay men’s health
• Briefing 7: Bisexual people’s health
• Briefing 8: Healthy lifestyles for lesbian, gay, bisexual and trans (LGBT) people
• Briefing 9: Mental health issues within lesbian, gay and bisexual (LGB) communities
• Briefing 10: Sexual health
• Briefing 11: Trans people’s health
• Briefing 12: Lesbian, gay and bisexual (LGB) people from Black and minority ethnic communities
• Briefing 13: Disabled lesbian, gay and bisexual (LGB) people

A brief shout out to Sue over at Lancashire Care who noticed this.

Disability Poverty in the UK shows that disabled people are twice as likely to live in poverty as non-disabled people.  Disabled people are more likely to live in poverty than they were 10 years ago, with an estimated three million disabled people living in relative poverty in the UK .

The report shows

• Low levels of employment for disabled people mean that many are trapped in inescapable poverty. For people not expected to work, benefit levels frequently fail to cover basic costs of living, leaving them with no real route out of poverty.
• Half (49 per cent) of disabled people surveyed had no savings. The majority revealed this was because their incomes were way below the national average.
• Disabled people face discrimination in the education system. Disabled people are more than twice as likely to have no qualifications as non-disabled people.

The Leonard Cheshire Disability report makes a significant number of recommendations to help end disability poverty. This includes extending Winter Fuel Allowance to many disabled people who would also benefit from support with heating costs and reviewing how disability benefits support those disabled people who are not expected to work.

Excess cancer mortality and incidence by PCT in the North West, 2001-2005   a report from the  North West Cancer Itelligence Service states that over a thousand more people die from cancer every year in the North West – who wouldn’t have died if the region had the same rates death rates as the rest of the country. The great majority of these deaths are caused by lung cancer highlighting the links between cancer, smoking and deprivation.

There are 1334 excess deaths annually in the North West than would be expected if the cancer death rates were the same as the rest of the country. 60% of these are due to lung cancer with the rest being down to deaths from many different types of cancer. Cancer deaths in the North West are 8.5% higher for men and 6.7% higher for women than in England and Wales.

The comparison focuses on excess mortality for the most common cancers between 2001 and 2005. Excess mortality is the additional number of cancer deaths above what would be expected using England and Wales rates.

The Implementation plan for reducing health inequalities in infant mortality: a good practice guide is about delivering the recommendations and themes of the Health Inequalities Infant Mortality PSA Target Review (February 2007).  Building on the key interventions in the review, it shows how to narrow the health inequalities gap in infant mortality by looking at current examples of good practice. The actions in this plan will contribute to meeting the target, and improving infant and child health for all disadvantaged groups.

These reports summarise progress against Department of Health inequality targets for 2010.

Infant mortality report

The inequality gap in the infant mortality rate has reduced but not yet by a sufficient amount to meet the target, based on the trend since the current socio economic classifications were introduced in 2001.

Life Expectancy Report

Inequality gaps in male and female life expectancy at birth have both increased since the baseline. If current trends continue, the target would not be met.

Mortality Report

Cancer mortality

The inequality gap in cancer mortality has declined since the baseline and the minimum requirement for the 2010 target has already been met.

All circulatory diseases mortality

The inequality gap in circulatory disease mortality has declined, and is on track to meet the target.

The vital role of interagency working in childrens services is recognised and developed in a new document setting out the Government’s goals for 2020. it identifies a new leadership role for Children’s Trusts in every area, a new role for schools as the centre of their communities, and more effective links between schools, the NHS and other children’s services so that together they can engage parents and tackle all the barriers to the learning, health and happiness of every child are detailed in The Children’s Plan: building brighter futures (Executive Summary).

The plan will

• strengthen support for all families during the formative early years of their children’s lives
• take the next steps in achieving world class schools and an excellent education for every child
• involve parents fully in their children’s learning
• help to make sure that young people have interesting and exciting things to do outside of school
• and provide more places for children to play safely.

The Single Equality Scheme Delivery Plan that underpins the plan emphasises equality of opportunity regadless of disabilty, race and gender.

The NHS has improved dramatically over the last few years, but still cannot guarantee that basic minimum standards are being met for patients throughout England and Wales, according to State of Heatlhcare 2007: Improvements and challenges in services in England and Wales. More than a quarter of NHS hospitals failed to provide adequate emergency services for children and 48% could not provide children with a satisfactory service in outpatient clinics, the Healthcare Commission said in its annual report on the state of the nation’s healthcare.

Key findings are:

The health of the population is improving with significant increases in life expectancy, but there are major disparities around the country, particularly in poorer areas where there are often fewer GPs.

• Men are living over four years longer than they were 20 years ago, while women are living three years longer.
• Men from more deprived areas live for a decade less than those in wealthier areas. Looking at local authority areas, for example, Kensington and Chelsea has the highest life expectancy for both men and women, at 82.2 years and 86.2 years respectively. The lowest life expectancy for men is in Manchester at 72.5 years, and for women in Liverpool at 78.1 years.
• In poorer areas, where people tend to experience worse health, there are 18% fewer GPs than in the least deprived areas (54 per 100,000 people compared to 66).

Patients are positive about hospital services overall but some organisations perform poorly. Beneath the headline figures there are concerns about aspects of care such as dignity and privacy.

• National analysis of the Commission’s survey of 80,000 inpatients at acute hospital trusts shows that 89.2% (149) were ranked “satisfactory” on patient experience, 7.8% (13) were “below average” and 3% (5) were “poor”. Eleven of those in the latter two groups were rated as “below average” or “poor” for the second year running. The survey also shows concern about specific issues such as help with eating - one in five patients who wanted help eating did not get it.
• Almost a third of the complaints about hospitals referred to the Commission for independent review relate to dignity and respect, nutrition and other aspects of basic personal care. They included: patients left in soiled bedding and clothing; no regular baths or showers or oral hygiene; inappropriate or inadequate clothing.

There have been dramatic improvements in waiting times but there are hidden waits for some services, which are not measured and therefore difficult to address.

• Government standards say no patient should wait longer than 26 weeks for a hospital appointment. In 2006/07, 83% of trusts met this, leaving some 350 patients with longer to wait than 26 weeks. This is a vast improvement on figures for 2000 when 264,000 patients waited this long.
• Waiting time targets do not apply fully to some services, making it difficult for problems to be addressed and patients needs to be met. Evidence suggests that a two-year wait for those referred for psychological therapies is not uncommon. People in some areas are still waiting between 12 and 24 months to have hearing aids fitted.

NHS trusts are performing better overall on quality of services, but the performance of primary care trusts (PCTs) has declined, with many not getting to grips with the needs of their communities so as to provide services to match.

• Overall, the quality of NHS services is improving with 46% of trusts rated ‘excellent’ or ‘good’ in 2006/07, compared to 40% in 2005/6. But for PCTS, only 26% were ‘excellent’ or ‘good’ in 2006/7 compared to 33% in 2005/6. Many PCTs went through a reorganisation over the period but this does not provide a complete explanation for the underperformance.
• The Commission says PCTs form the bedrock of healthcare. They control more than three-quarters of the budget, purchasing services from other providers, including hospitals. They are directly responsible for providing services handling more than 80% of NHS contact with patients, including those carried out by GPs and dentists.
• The report says that many PCTs do not fully understand the health needs of their local people, making it difficult for them to buy targeted services. For instance, last year 2.3 million people did not have their BMI index recorded as planned, with GPs not recording the data, which provides vital statistics on levels of obesity. The number of people diagnosed with heart failure is also considerably less (140,000) than expected, indicating that GPs may not be picking up on signs of serious illness. There is also a poor understanding of the sexual health of local populations at a time when sexually transmitted infections are rising rapidly.
• Where there is a known need, PCTs are not always providing the services required. Some 60,000 people with serious long-term conditions did not get the care from community matrons that was originally planned. Forty-one per cent of PCTs failed to purchase sufficient crisis services for people who are seriously mentally ill, resulting in 5,000 fewer people receiving the service than planned. Some 85% of PCTs did not have arrangements for providing education programmes for patients with diabetes in their area. And 2,000 GP practices did not fulfil their PCT’s plans to establish registers for those people at risk of coronary heart disease, designed to help prevent these patients from becoming seriously ill.

There is progress towards a stronger culture of safety and grounds for cautious optimism in reducing healthcare-associated infection. But trust boards need to show stronger leadership.

• On safety more generally, there has been an encouraging increase in reporting of incidents. Reported figures show more than 229,000 known incidents causing low or moderate harm and more than 9,400 incidents causing severe harm or death.
• Only 58% of NHS trusts complied with all the government’s nine core standards on safety, with infection control, decontamination of medical devices and medicines management the biggest areas of concern.
• Infection control is arguably of greatest public concern; latest figures suggest grounds for cautious optimism. Cases of MRSA fell from 7,096 in 2005/2006 to 6,381 in 2006/2007. There are early signs that increases in cases of Clostridium difficile are slowing. Between 2005 and 2006 the number of cases increased 7% to 55,620, compared to a 16% rise from 2004 to 2005.
• By the end of October 2007 the Commission had visited 87 trusts to check their performance in meeting the requirements of the hygiene code. Only one trust needed to be issued with an improvement notice, suggesting that organisations are taking the issue seriously. But there was a need for stronger leadership from trusts’ boards to improve monitoring, isolation facilities, training, and compliance with policies and procedures.

New figures show that more independent healthcare providers meet core standards, mirroring a similar trend among NHS trusts. But there are concerns about compliance among independent providers of mental healthcare.

• The proportion of independent healthcare establishments that met the government’s national minimum standards - including those that were not inspected as they were considered not to be at risk - was 63% in 2006/07 compared to 50% the year before. Five per cent of independent establishments failed five or more of the standards.
• Although NHS trusts must meet a different set of standards, the broad picture is similar. The number of trusts that were “fully met” on government core standards rose from 49% in 2005/06 to 55% in 2006/07. Six per cent of trusts were judged “not met” on core standards overall.
• In the independent sector, non-compliance was greatest on national minimum standards covering: monitoring of quality of treatment (C4); ensuring patients get care from appropriately recruited, trained and qualified staff (C9); and taking account of patients’ views (C6).
• Independent mental health providers, which mostly look after NHS patients, performed worse than others in the sector. Non-compliance was greatest in relation to national minimum standards for: ensuring patients receive care from appropriately recruited, trained and qualified staff (C9); providing treatment in safe and appropriate premises (C17); and ensuring patients are resuscitated appropriately (C27).
  Independent providers of mental health services need to focus on ensuring patients are appropriately and safely restrained. In 2006/7, 17% of establishments failed a standard in this area compared with under 9% in 2005/2006.

The NHS often fails to meet the needs of children and young people and there are concerns about other groups requiring specialist care, such as people with mental health problems and with learning difficulties.

• Paediatric hospital services are generally good at looking after children, but other more general services are not. Some 70% of specialist inpatient services were rated “good” or “excellent” by the Commission, but 28% of emergency and day case services were “weak”. Transition from children to adult services is not managed well in services for people with mental health problems, diabetes and disabilities, and those requiring palliative care services. Vulnerable children such as those with disabilities, those in care and young offenders face particular problems in getting appropriate care. One in 20 NHS trusts are not yet compliant with child protection standards.
• On specialist wards for people with mental health problems and people with learning difficulties, more than half of the inpatients were found to be in mixed-sex accommodation.
  Levels of violence in mental health services remain high, although there are signs of it being dealt with better. The report includes new data from an audit into violence in the sector, which found that almost one in 20 patients reported being assaulted. Forty-six per cent of nurses reported being physically assaulted, and 72% said they had been threatened or made to feel unsafe. On older people’s mental health wards, almost two-thirds of nurses reported physical assault by patients.

There have been dramatic improvements in responding to the big killers - cancer, circulatory and respiratory disease - but five-year survival rates for cancer, and mortality rates for respiratory disease, are worse than in other comparable countries.

• The mortality rate for people under 75 diagnosed with cancer fell by almost 17% between 1996 and 2005, which suggests that some 60,000 fewer people died prematurely.
• Despite this improvement, the UK survival rates do not compare favourably with most of Europe. For instance, the survival rate for lung cancer in Holland and Spain is around double that in England, which stands at 6.5% for men and 7.6% of women.

Just into the library this special issue of Sociology of Health and Illness focus’ on Diversity, Inequalities and Ethnicity. You’ll need your NHS Athens password to access the full text articles. If you haven’t got one and you work for Liverpool PCT you can apply for one here.

Locating ethnicity and health: exploring concepts and contexts

Waqar I. U. Ahmad and Hannah Bradby

pages 795–810

• Abstract
• References

The Black diaspora and health inequalities in the US and England: does where you go and how you get there make a difference?

James Nazroo, James Jackson, Saffron Karlsen and Myriam Torres

pages 811–830

• Abstract
• References

Race and nutrition: an investigation of Black-White differences in health-related nutritional behaviours

Peter Riley Bahr

pages 831–856

• Abstract
• References

Describing depression: ethnicity and the use of somatic imagery in accounts of mental distress

Sara Mallinson and Jennie Popay

pages 857–871

• Abstract
• References

Hospice or home? Expectations of end-of-life care among white and Chinese older people in the UK

Jane Seymour, Sheila Payne, Alice Chapman and Margaret Holloway

pages 872–890

• Abstract
• References

Contextualising accounts of illness: notions of responsibility and blame in white and South Asian respondents’ accounts of diabetes causation

Julia Lawton, Naureen Ahmad, Elizabeth Peel and Nina Hallowell

pages 891–906

• Abstract
• References

Long-term health conditions and Disability Living Allowance: exploring ethnic differences and similarities in access

Sarah Salway, Lucinda Platt, Kaveri Harriss and Punita Chowbey

pages 907–930

• Abstract
• References

Interpreted consultations as ‘business as usual’? An analysis of organisational routines in general practices

Trisha Greenhalgh, Christopher Voisey and Nadia Robb

pages 931–954

• Abstract
• References

Retraction

Clive Seale

pages 955–955

• Summary

‘Racism, ethnicity, identity, and health: UK and US comparative perspectives’

Nancy Krieger

pages 956–956

• Summary

If you need some training to make the most of this or any other electronic resource available via the Fade Library and you work in Liverpool PCT, please contact us using the form below.

Opinion on a report about the effect of the NHS P4P programme on different ethnic groups.

This perspective describes a report about improving quality and reducing health disparities by implementing pay-for-performance initiatives.  The authors look at the impact of pay-for-performance, in the NHS, on different ethnic groups.

Citation:
Can pay-for-performance improve quality and reduce health disparities?
K Coleman, R Hamblin
PLoS Medicine, 2007, 4(6), e216
View print version

Ethnic disparities in diabetes management and pay-for-performance in the UK: the Wandsworth Prospective Diabetes Study
C Millett, J Gray, S Saxena, G Netuveli, K Khunti, A Majeed
PLoS Medicine, 2007, 4(6), e191
View print version

From the NLH Document of the Week.

New from the Office for National Statistics is the release of updated data on life expectancy from the ONS Longitudinal Study. Key findings are that while life expectancy has risen for all social classes over the last 30 ears, people in professional occupations (Social Class I) have the longest expectation of life, followed by managerial and technical occupations (Social Class II), and so on. People in unskilled manual occupations (Social Class V) have the shortest expectation of life.

• Males in the professional class had a life expectancy at birth of 80.0, compared with 72.7 years for those in the manual unskilled class

• Females in the professional class had a life expectancy at birth of 85.1 years compared with 78.1 years for the unskilled manual class

• Unskilled men (Social Class V) aged 65 could expect to live a further 14.1 years, fractionally above the expectation of life professional men would have had in 1972-76 (14.0 years)

• Unskilled women aged 65 had an expectation of life of 17.7 years, less than professional women in 1972-76 (19.1 years)

Details can be found in Variations persist in life expectancy by social class - 2002-2005 data.

If you want to see what the mass media said about it you can do so here.