The National Institute for Health and Care Excellence (NICE) will publish quality standards for public health, starting with smoking, alcohol use and obesity.

The Institute will work with experts from Public Health England to develop standards for prevention and treatment at the public health level, now the responsibility of local government.

It is anticipated that the implementation of these standards will help to reduce the burden of diseases related to tobacco, alcohol and obesity on the NHS.

They will be based on existing NICE public health guidance, but will be focused to drive and measure improvements in public health outcomes.

Smoking, excessive alcohol intake and obesity are linked to both acute and chronic ill-health, and medicines feature in the treatment of all three conditions – with Lundbeck’s drug to prevent alcohol abuse, Selincro, being a major new example.

Speaking at NICE’s annual conference, Under-Secretary for Quality Lord Howe said: “Public health quality standards alongside and integrated with those for health and social care will provide a key tool to support Public Health England, local authorities and the wider public health community in achieving excellence.

“Our vision is over the next five years there will be a growing portfolio of NICE quality standards covering all the domains in all three outcomes frameworks.”

Professor Gillian Leng, Deputy Chief Executive and Director of Health and Social Care at NICE, commented that the new public health quality standards “will be a valuable tool for local authorities as they take on their new public health functions, and for Public Health England.

“By bridging the interface across health, social care and public health, NICE public health quality standards will help support integration across the three sectors.”

NHS emergency services are facing a major breakdown this winter due to staffing and funding shortages.

Reviews by the College of Emergency Medicine and the Foundation Trust Network have warned that A&E demand is continuing to outstrip capacity.

Health Secretary Jeremy Hunt responded that better “joined-up thinking” between health and social care was necessary to reduce the demand.

A&E attendance figures have increased by 50% in the last 10 years, due to a number of factors: the ageing population, lack of out-of-hours GP services and, more recently, problems with the new 111 helpline.

The College of Emergency Medicine surveyed more than half of UK’s A&E units and concluded that a shortage of both middle-grade and senior doctors was weakening the service.

In addition, it said, as many as 30% of patients attending A&E could be treated in non-emergency settings, given better access and information.

The Foundation Trust Network (FTN) noted that some hospitals are losing millions of pounds each year due to current rules designed to reduce A&E admissions.

Where A&E admissions rise above the 2008–9 level, the hospital is only paid 30% of the normal fee for each admission.

Fining hospitals for having too many A&E patients was no way to improve services, the FTN said.

Its Chief Executive Chris Hopson argued: “Unless we can change the funding structure, the A&E system is going to fall over. We simply cannot carry on.” This winter was likely to see the collapse of the A&E system, he warned.

Health Secretary Jeremy Hunt commented that the underlying problem was “a lack of joined-up thinking between the health and social care systems which we’re sorting out”.

Delayed transfers of care from the NHS to social services are becoming more prevalent, according to Government figures highlighted by Age UK.

NHS and local government leaders have declared a ‘pledge’ to close the gap between the NHS and social care by 2018.

However, the ‘pioneer projects’ declared will take place against a background of ongoing cuts in the social care and NHS budgets.

The Department of Health, NHS England, the Local Government Association and the umbrella bodies for directors of social care have launched a joint programme to stop patients falling into the gap between NHS and social care.

From the end of this summer, a number of ‘pioneer projects’ will seek to address the problem – including ways to pool budgets, speed up discharge from hospital and streamline patient assessments.

Age UK has published Government figures showing that on average, patients in hospital are waiting 30 days for a care home place, while patients at home are waiting 27 days for a care package.

In both cases, these figures show a 13% increase relative to three years ago – a reflection of the deep cuts in social care budgets.

Social care commissioners have been warned of further cuts this year, while the ‘Nicholson challenge’ – an absolute cut of £5bn per year in the NHS budget – is now planned to continue indefinitely.

Michelle Mitchell of Age UK commented: “Waiting in hospital needlessly not only wastes NHS resources, but can also undermine an older person’s recovery and be profoundly upsetting for them and their families.”

The NHS has launched a plan to support its overloaded A&E services, with the formation of ‘urgent care boards’ able to invest in emergency care.

NHS England will work with the NHS Trust Development Authority and Monitor to address the problem of increasing A&E waiting times.

One priority is for hospitals to bring forward their planning for next winter to ensure that seasonal urgent care needs are under control.

The growing pressure on A&E services is due to increasing demand – four million more people in England are using these services than in 2004 – combined with the budget cuts of the ‘Nicholson challenge’.

Health Secretary Jeremy Hunt angered the BMA by blaming the increased A&E attendance figures on lack of GP access, but it is beyond doubt that many people use A&E to bypass primary care and referral barriers.

The NHS support plan therefore aims not only to help maintain A&E capacity, but to relieve the pressure on emergency care through GP and outpatient care.

At the same time, the increasing number of people attending A&E who require urgent hospital care points to a need to improve not just access to care, but the quality of care outside hospital.

While 90% of patients in A&E are seen within four hours, the average waiting time is increasing. The support plan notes: “Long waiting times in A&E not only deliver poor quality in terms of patient experience, they also compromise patient safety and reduce clinical effectiveness.”

The urgent care boards will bring together healthcare leaders from across the local NHS. By the end of May, these boards will ensure that local recovery and improvement plans are in place for each A&E department.

NHS England will ensure that extra money is made available: the urgent care boards will oversee the use of the fees paid for emergency admissions, and ensure that expenditure achieves specific improvements.

Professor Keith Willett, NHS England’s National Director for Acute Episodes of Care, commented: “When pressure builds across the health and social care system, the symptoms are usually found in the A&E department.”

The plan to introduce value-based pricing (VBP) for NHS drugs was “flawed from the start” and should be scrapped, according to a healthcare think tank.

A report from 2020health argues that VBP could reduce patient access to expensive drugs by replacing the existing patient access schemes.

It also argues that VBP will “politicise” drug pricing by exposing it to lobbyists and media campaigns.

Under the current Pharmaceutical Price Regulation Scheme (PPRS), companies’ total income from the NHS is restricted but individual drug prices are not.

VBP, currently being negotiated between the Government and the ABPI and due to be introduced in 2014, aims to relate drug pricing to value in a broad sense – i.e. to apply NICE’s current decision-making process to drug prices.

The report states: “Value-based pricing sounds like an excellent idea with a well-researched methodology. On further examination the cracks begin to appear... The real concerns of patients, doctors, and carers are only hidden from view.”

One problem, it says, is that the drug access schemes negotiated by the industry and the Department of Health will disappear, potentially reducing patient access to much-needed drugs at a time of NHS austerity.

Another is that “patients could become political pawns” if the availability of a particular drug is focused on by “the press, a political party or an MP”.

Julia Manning, Chief Executive of 2020health, said: “The Government’s new plans for pricing will politicise a formerly non-contentious issue. Despite the intensive negotiations and new promises to include patients further in deliberations, this is an idea it seems was flawed from the start.”

The report urges the Government to improve the existing drug pricing system by further encouragement of patient access schemes, and by tightening controls on any one company’s revenue from the NHS.

A pilot physiotherapy scheme by NHS Newcastle West CCG has helped saved thousands of pounds and reduced unnecessary hospital visits.

Commissioners introduced private appointments in GP surgeries for basic cases and established a call referral management centre to decide how patients are treated before being referred.

The two-year project allowed more serious cases to be transferred to secondary care physiotherapy services at Newcastle Hospitals NHS Foundation Trust whilst reducing demand.

The CCG established a partnership in 2010 with private therapy company Connect Physical Health to bring services closer to patients’ homes.

Patients who had minor requirements saw a physio or specialist at a primary care setting and were also given access to a one-to-one advice line to receive guidance at home.

Patient feedback from the pilot scheme revealed that 96% of patients said the standard of care they received was “excellent or very good” and 97% of doctors agreed the service was better than when it was first introduced in 2010.

Commissioners have estimated that if the scheme was introduced across CCGs in England it could make savings for each group of around £220,000.

The Government’s controversial shake up of the NHS resulted in more than 10,000 workers being made redundant, new official figures show.

Information in the DH’s people tracker report showed that 2,394 redundancies were made in 2012-13, 2,100 in the year before that and an estimated 5,600 throughout 2010-2011. An additional 3,841 left the NHS on their own accord.

Initial estimations by the DH in January 2011 expected around 16,000 redundancies and a further 3,600 staff to leave the health service during the reforms.

These figures have since been acknowledged by the DH as uncertain but the report hailed a “successful people transition process while minimising redundancies and maximising the retention of essential skills.”

The report adds there may be more redundancies to come from commissioning groups as a result of reorganisation.

However, further job losses were avoided as 34,204 jobs from organisations such as strategic health authorities and primary care trusts were moved to new bodies, such as NHS England.

The chair of the Royal College of General Practitioners (RCGP) has hit back at claims by Health Secretary Jeremy Hunt that doctors are to blame for the increased pressure put on A&E services.

Dr Clare Gerada (pictured) issued a statement claiming Mr Hunt was wrong to blame GPs for a lack of out-of-hours provision and said doctors were being used as a “scapegoat” by the Health Secretary.

She said it is “not acceptable” to point the finger of blame at GPs for rising levels of A&E use and there is “no evidence” to prove this increase is down to the 2004 GP contract – as some ministers have claimed.

Hunt first made the accusation in the House of Commons when he was discussing the 2004 GP contract introduced under the former Labour government. A DH spokesperson subsequently insisted the Health Secretary was “clearly not blaming GPs.”

However, Hunt reiterated that doctors were to blame during a speech at Age UK where he outlined plans to “rethink the role of primary care” and said that “inaccessible primary care” had resulted in increased pressure on A&E services.

Dr Gerard insists “it is not true that the rise in demand on A&E services is due to a reduction in out-of-hours provision by GPs” and that there are “numerous reasons why our colleagues working in A&E departments are under pressure.”

She highlighted a shortage of consultants and a lack of integration between community and social care which has caused a “myriad of problems, including unnecessary admissions.”

The chair added that assumptions that the NHS “starts and ends with hospitals” should be ended and called upon the Health Secretary to consider the wider picture before pointing the finger of blame. “We are one NHS with patients accessing different services at different times,” she said.

“These are tough times for us all and one of the issues Mr Hunt should be addressing is the shortage of 10,000+ GPs across all services, not just out-of-hours. As a national health service we should all be working together with Government to improve patient care, not blaming GPs for perceived ‘inadequacies’ in patient care.”

NICE has not recommended Novartis’ Jakavi (ruxolitinib) in final draft guidance for the treatment of disease-related splenomegaly or symptoms in adults with myelofibrosis.

An independent appraisal committee concluded the treatment is clinically effective but raised concerns around the manufacturer’s economic model and many of its assumptions.

Sir Andrew Dillon, NICE Chief Executive, said the regulator had to be sure treatments are clinically and cost effective otherwise “money has to be diverted from elsewhere” to fund such drugs in the NHS.

The guidance states that Jakavi is not recommended for the treatment of disease-related cases of an enlarged spleen or its symptoms in adults with primary myelofibrosis, post polycythaemia vera myelofibrosis or post essential thrombocythaemia myelofibrosis.

Myelofibrosis is a rare type of blood cancer in which the bone marrow produces too many cells too rapidly. This affects the bone marrow making it less able to create cells. Other organs, such as the liver and spleen, then compensate for this by producing additional cells. The spleen, as it begins to create cells, becomes enlarged.

NICE noted that Jakavi was clinically effective in reducing the size of the spleen in these cases and related symptoms. However, it could not be considered a cost-effective option of NHS resources when compared with existing treatments.

The committee found there were “fundamental issues” with the structure of the economic model supplied by Novartis. It concluded that the associated assumptions made increased the uncertainty of the cost-effectiveness ratio (ICER) for the treatment and that rectifying this would actually increase the ICER.

Final guidance is now expected in June 2013.

The Government has launched a ‘catch-up’ programme to give the MMR vaccine to a million children in England who lack full protection against measles.

The campaign, in which Public Health England and NHS England will work together, was provoked by the recent outbreak of measles in Swansea.

Most of the children targeted are aged 11–16, a group made vulnerable by a steep decline in uptake of the MMR vaccine following the publication of a medical paper in 1998 claiming it was linked to autism.

The paper has since been exposed as fraudulent, though its claims are still supported by some anti-NHS tabloids.

In the mid-1990s, measles had almost been eradicated in the UK. But by the year 2000, uptake of the MMR vaccine had dropped to 80%, allowing the virus to circulate widely.

In 2012, there were nearly 2,000 cases of measles in England – the highest level in two decades. This year, an outbreak in Wales has infected over 900 people.

The million children in England targeted by the new NHS campaign form three similar-sized groups: children aged 11–16 who have received no vaccine; children aged 11–16 who have received one vaccine dose without the ‘booster’ jab; and children in other age groups who lack protection.

Local area teams will use general practice case registers to identify children at risk and ensure their vaccination in schools and GP surgeries.

Mary Ramsay, Head of Immunisation at Public Health England, said that although take-up of the MMR vaccine had returned to a high level, there was a “legacy of under-vaccinated children” who needed protection.

MMR vaccines, which protect against measles, mumps and rubella, are available from GSK and Sanofi Pasteur MSD.