The ‘metabolic’ health of younger adults is worse than that of previous generations, exposing them to greater risks of cardiovascular disease.

A large cohort study from the Netherlands found the incidence of obesity, high blood pressure and high cholesterol were much higher among adults in their twenties and thirties than formerly.

This increase in risk factors for diabetes, stroke and heart disease could offset the advantage of reduced incidence of lung cancer from the decline in smoking.

The researchers analysed data on more than 6,000 individuals in a cohort study that began in 1987, with follow-up examinations after six, 11 and 16 years, measuring body weight, blood pressure and total cholesterol level.

The subjects were divided into ten-year age groups to help determine whether there were ‘generation shifts’ in risk profile.

The results showed that while the prevalence of obesity and hypertension increased with age, the younger generations had a higher prevalence of these risk factors than those 10 years had shown at the same age. For example:

• incidence of overweight among men in their thirties had increased over 11 years from 40% to 52%

• incidence of hypertension had increased between generations in both sexes

• incidence of diabetes had increased between generations in men.

The investigators concluded that “the more recently born adult generations are doing worse than their predecessors”.

Lead study author Gerben Hulsegge commented that in terms of the prevalence of obesity, the younger generation was “15 years ahead” of the older.

He predicted: “We are likely to see a shift in non-communicable disease from smoking-related diseases such as lung cancer to obesity-related diseases such as diabetes.” As a result, he warned, increases in life expectancy could level off.

The UK medical professions have worked together to develop a strategy to address the national obesity crisis – the worst in Europe.

Two thirds of adults in the UK are now overweight and a quarter are clinically obese, the Academy of Medical Royal Colleges (AoMRC) has warned.

Professional training, weight management services, nutritional education and changes to the built environment are among the measures it recommends.

Obesity is a strong risk factor for diabetes, heart disease, musculoskeletal disorders and mental health problems.

The UK’s national health services should collectively invest £100m in weight management services modelled on the existing smoking cessation services, the AoMRC argues.

These should range from early intervention to bariatric surgery, with QOF incentives for GPs to refer patients to the relevant services.

Healthcare professionals should seek to “make every contact count” in influencing patient behaviour.

While most of the recommendations are related to patient lifestyles and the “obesogenic environment”, many medicines can impact on weight management – and vice versa.

While some measures, such as a ban on the advertising of junk food to children, are unlikely to be adopted by the Government, the prioritising of the obesity crisis within the NHS will influence many aspects of medical care.

Linda Hindle, Chairman of the Dietitians in Obesity Management group, said: “Obesity in the UK is an absolute epidemic, there is no question that the recommendations in this report are essential.”

The ABPI sets out to deliver tailored support and advice to healthcare providers on the medicines its member companies produce. Kevin Blakemore, NHS Partnerships Manager at the Association of the British Pharmaceutical Industry, discusses the advantage of partnerships in healthcare.

The pharmaceutical industry has experienced tremendous change and, as part of that evolution, forming successful partnerships in healthcare has become integral to our way of working. The NHS delivers outstanding care to patients – utilising the innovative medicines the pharmaceutical industry produces – so it makes perfect sense for us to work together, ensuring the best possible outcomes for patients. There are some points, however, to consider when embarking on ‘joint working’ ventures – these partnerships must be managed and guided to ensure that the process is efficient, seamless and offers patients maximum benefit.

Often these partnerships can result in patients spending less time in secondary care settings, and can deliver significant savings. Patients benefit most when those with a stake in their care work effectively, enthusiastically and efficiently together.

Joint working describes situations where, for the benefit of patients, NHS and industry, organisations pool skills, experiences and resources for the joint development and implementation of patient centred projects and a shared commitment to creating a streamlined, joined-up care pathway, where patients are kept at the heart.

Flexible joints
Joint working has already benefited thousands of patients across the UK and to help achieve greater outcomes, the Association of the British Pharmaceutical Industry (ABPI) has developed the ‘NHS Partnerships Team’. My dedicated team work with healthcare providers up and down the country, providing specialist advice and support, while facilitating successful working relationships.

The NHS Partnerships team is made up of eight individuals, each responsible for a different area of England. Their knowledge and expertise includes experience of working within the pharmaceutical industry and the NHS. They also bring their knowledge of innovative and effective medicines created by the industry, and this can be utilised for the benefit of patients. The central focus of the team is improving the healthcare environment in order to increase access to and uptake of innovative products. The team consists of Diana Vegh, Karen Thomas, Carol Blount, Harriet Lewis, Andy Riley, Mike Ringe, Angela Logun and myself.

Diana Vegh started her career in the pharmaceutical industry within regulatory affairs in AstraZeneca, working in scientific roles of increasing seniority. She then moved to the NHS where she held senior positions in the Strategic Health Authority, two PCTs and a Foundation Trust in the South West.
Diana returned to industry in a commercial capacity at UCB Pharma, working in market access for products. She has extensive networks across the industry and the NHS, and a wealth of practical, positive experience.

Veteran’s parade
Karen Thomas – a recent addition to the NHS Partnerships Team – has extensive experience of working in the pharmaceutical industry, and for the past 12 years Karen has worked for Bristol Myers Squibb, where her roles spanned finances, sales, commercial and market access, covering several therapeutic disease areas. Karen joined the ABPI in November 2012 as the Regional Partnership Manager for London.

Harriet Lewis has been a pharmacist for over 20 years. She has worked in a wide range of healthcare sectors including industry, community, hospital and primary care. Before joining the ABPI, Harriet’s most recent role was Associate Director for Medicines Advice with the National Institute for Health and Clinical Excellence (NICE). Harriet has led on a number of NHS support programmes, including local formularies, local decision making, controlled drugs, accountable officers and ‘specials’. She has authored several key documents for NPC and NICE. Harriet is the Regional Partnership Manager for the North.

Most recent additions to the team are Andy Riley and Mike Ringe. Andy joins us as the ABPI Regional NHS Partnership Manager for Midlands and East. He qualified as a pharmacist in 1987 and has held posts in hospitals, community pharmacies and health authorities in London, the North West and the West Midlands. Mike joins us as the ABPI Group Therapy Manager directly from the NHS, and previously held the position of Chief Operating Officer at Luton Clinical Commissioning Group.

My role is the NHS Partnerships Manager and I manage the team. Previously, I have worked in the pharmaceutical industry for over 25 years – at UCB and GlaxoSmithKline (GSK) – and I have been responsible for developing national level methodologies and frameworks to support patient and market access programmes.

Bonded by blood
The ABPI recently undertook a joint working project at a hospital trust in the North of England looking at epistaxis – one of the most common ENT emergencies in England, with over 27,000 patients presented to secondary care between 2008 and 2011. In 2009/10 the trust admitted 250 patients presenting the condition, with the average length of stay at over two days, costing a minimum of £400 per patient per day.

Like many other hospitals, the trust had limited specialist ENT experience in their emergency departments, and as a consequence nasal packing was frequently used as a first line treatment – even for small volume bleeding – when a more conservative or targeted approach would have been safe and effective. There was a clear opportunity here for the patient pathway to be revised and a different approach taken.

Through the ABPI, a joint working project was instigated between a local pharmaceutical company and the trust. They jointly agreed – through a joint working agreement – to truly address the challenges within the current treatment regime and completely redesign the service. Consequently, it addressed the training requirements within A&E and junior doctors.

The new treatment pathway encouraged clinicians to identify the bleeding point, if possible, and in cases of continued bleeding, to consider the use of a product manufactured by the local company – thereby avoiding unnecessary hospital admissions. The company and trust continued to work in partnership to develop training materials in order to develop the new treatment pathway and introduce the use of the medicine where possible.

This venture resulted in a number of positive outcomes, which included a reduction in hospital stays, improving productivity and cost savings. But most importantly, when compared with the three preceding years, the audit of the venture showed that the total number of bed days due to epistaxis, was reduced by 30 per cent and length of stay was reduced by 21 per cent. Additionally, staff were motivated to consider an alternative to immediate nasal packing/admission, which also resulted in a reduction in the length of stay.

QIPP while ahead
Working with the Department of Health and the NHS, we have developed a toolkit on successful joint working. Joint working is a relatively new concept for many, but has already shown tangible benefits to patients, the NHS and industry. For example:

East Lincolnshire Primary Care Trust (PCT) reduced hospital admissions for Chronic Obstructive Pulmonary Disease (COPD) by 23%, through working with three companies to target and screen patients, train clinicians and set up specific COPD clinics.

In Ashton Leigh and Wigan the PCT is tackling low life expectancy, high rates of heart disease and diabetes by working with industry on a ‘Find and Treat’ strategy.

The innovative approach to patient care adopted by that trust was aligned with the Quality, Innovation, Productivity and Prevention (QIPP) programme. QIPP is an NHS initiative to improve the quality of care it delivers, while at the same time making savings that can be reinvested into the service. It engages with staff from across the NHS, at local and regional level, and is supported by QIPP plans and work streams that provide guidance and tools.

The NHS also works with a range of partners to deliver QIPP, one of which is the pharmaceutical industry. Apart from supplying medicines that improve the quality of patients’ lives and outcomes, the industry can contribute business skills and expertise, as well as extensive knowledge of the therapy areas relevant to its medicines.

Joint working is the foundation for creating, developing and implementing innovative healthcare solutions which can lead to better health outcomes. We believe this is the way forward in healthcare and both the NHS and industry must seek out more opportunities to work together.

A pill that inhibits binge drinking has gained approval from the European Medicines Agency (EMA) for marketing in the EU.

Selincro (nalmefine) from Lundbeck blocks pleasure centres in the brain, and has reduced regular alcohol intake by 79% in a year-long clinical trial.

This is the first drug to reduce alcohol intake without abstinence: social drinking remains possible without ill effects.

Lundbeck plans to target Europe with the drug – starting with Russia in the first half of 2013.

The EMA has approved Selincro as a treatment for men who drink more than 60g (12 units), and women who drink more than 40g (eight units) of alcohol a day – eight units is one bottle of wine.

The drug is taken an hour before drinking commences. It attaches to opiate receptors in the brain, blocking pleasure signals and undermining the mechanism of alcohol dependency.

According to the EMA, it should be used together with “support that focuses on treatment adherence and reducing alcohol consumption”.

In a phase 3 clinical trial, alcohol consumption in alcoholic patients fell from 75g per day (average) to 16g per day after a year of treatment, while the side effects (insomnia and nausea) decreased with time.

Alcohol consumption in Europe is 40% higher than in the US and twice the global average. If the drug is successful in Europe, Lundbeck will seek approval for it in the US and elsewhere.

An analyst at Jefferies International in London predicted that peak sales of Selincro could pass €200 million.

Alcohol abuse is a major risk factor for mental illness, liver disease, heart disease and cancer.

The focus of global healthcare is shifting from preventing early death to helping people live with chronic illness, according to the Global Burden of Disease Study 2010.

The five-year study noted a decline in child mortality and deaths from infectious diseases worldwide, but a major increase in cancer, diabetes and heart disease.

Major factors driving the fall in deaths from infectious diseases include the widespread use of drugs to treat diarrhoea, TB and measles.

Lead study author Professor Christopher Murray of the University of Washington commented: “There’s been a progressive shift from early death to chronic disability. What ails you isn’t necessarily what kills you.”

The report concluded that medical and demographic changes had caused a broad shift from acute and communicable diseases to chronic and non-communicable ones.

Between 1990 and 2010, deaths from non-communicable diseases increased by nearly 8 million: they now account for two in three deaths.

Cancer deaths rose by 38% to 8 million people in 2010, while diabetes-related deaths rose by 100% to 1.3 million.

Life expectancy for both men and women has risen by more than 10 years since 1990, but far more people are now living with a serious illness.

The highest risk factors for ill-health worldwide are now high blood pressure and smoking, whereas in 1990 the leading risk factor was malnutrition.

Diabetes and lung cancer have become more prevalent, while TB and diarrhoea have become less so.

However, sub-Saharan Africa continues to have very high rates of premature death, and the gap in life expectancy between the countries with the highest and lowest figures remains the same.

The clinical networks set up to improve cancer care have seen their budget cut by 25% in three years, with a severe impact on their performance.

Projects such as accelerating cancer diagnosis – the kind of efficiencies praised by Sir David Nicholson in his NHS review – may not be possible in future.

Clinical networks to improve stroke and heart disease treatment have also been cut back, though less dramatically.

The 28 cancer networks and 28 cardiovascular networks will be amalgamated into 24 larger networks (12 of each type) after April 2013, with the cardiovascular networks also covering diabetes.

Funding for the cancer networks has been cut by 25%, with loss of 73 staff. The heart and stroke networks have lost 12% of their funding and 38 staff.

Shadow Care Minister Liz Kendall said the feedback from clinical networks revealed them to be “in chaos”.

She noted: “Ministers have repeatedly promised to protect the funding for clinical networks.”

The clinical networks guide and support service redesign to increase clinical effectiveness and efficiency – which, NHS Confederation leader Mike Farrar argued this year, is a principle to which the NHS only pays lip service.

The clinical networks reported the cancellation of programmes that have successfully supported doctors and nurses in the past, providing specialist input into challenging areas of NHS care.

A cancer specialist from Yorkshire commented that the new Yorkshire and Humber cancer network “will be too big to be able to reflect local capabilities and needs, yet too small to have the authority of national guidelines”.

Professor Sir Mike Richards, the National Director for Cancer, said the next few weeks would be unsettling and difficult for the cancer networks as services were cancelled and staff made redundant.

Health Secretary Jeremy Hunt has said it’s “not possible to make a prediction” on whether the NHS budget will remain protected.

In his first interview in his new role, Hunt said that whether Lansley’s promise to ‘ring-fence’ the NHS budget could be honoured would depend on “the eurozone”.

Hunt also said the Government was trying to decide whether there was “any way at all” of following the Dilnot recommendations on social care reform, including cheaper variations on it.

Speaking to The Spectator, a strongly Conservative journal, he said his aim as Health Secretary was to “safeguard Andrew Lansley’s legacy”.

The shift in leadership at the DH was due to a need for it to communicate how the reforms will “make a difference to patients”, he said – confirming speculation that Hunt’s more ‘personal’ presentation style was a key factor.

While he said his “instinct” was to protect the NHS budget, Hunt insisted that it could no longer be a commitment due to economic “uncertainty”.

Asked whether the Dilnot proposals might be realised from the NHS budget (as the Treasury is said to favour), he said that would be “extremely difficult”. However, he said, “other versions” of the Dilnot plan with a lower cost would be considered.

In clinical terms, Hunt stated his priorities to be: care for the elderly and those with long-term conditions, dementia care and achieving “the best cancer, heart and stroke survival rates in Europe”.

Finally, he expressed the aspiration of delivering a “measurably better” NHS that patients would recognise as such.

A new £12m health centre has opened in north Brixton to provide general practice, community health and social care services under one roof.

The state-of-the-art Akerman Health Centre brings together a range of services to provide convenience and access to support for local residents.

Services will be provided by Guy’s and St. Thomas’ NHS Foundation Trust Community Health Services, King’s College Hospital NHS Foundation Trust and South London and Maudsley NHS Foundation Trust.

Angela Dawe, Director of Operations at Guy’s and St. Thomas’ NHS Foundation Trust, said the centre would become the “health hub for local people”.

The centre will house three separate GP practices. In addition it will provide care for long-term conditions, such as diabetes and heart disease, access to mental health services and dentistry. It will also be used as the main base for district nursing and specialised maternity services in Brixton.

Dr Adrian McLaughlin, Chair of NHS Lambeth Clinical Commissioning Group, said the “great strength” of the facility will be its integration of healthcare and social care services.

“We hope that the centre will also bring shorter waiting times and better access to services for patients,” he said. “For us as clinical commissioners, reducing inequalities and improving healthcare for local people is a priority, and the Akerman Health Centre will go some way to achieving this.”

One in five PCTs will miss the mandatory ‘MOT’ health check target in 2012–13.

GPs are required to give the MOT check, which provides early warning of cardiovascular problems, to all patients aged 40–74.

However, according to data obtained by GP magazine, up to nine million eligible patients will not be given the relevant checks and questions.

A PCT that has not even started giving the MOT checks blamed “other pressures” for the omission.

The health MOT records age, height, weight, blood pressure and blood cholesterol (plus blood glucose in certain cases), as well as responses to enquiries about current medication, smoking and family history.

This can provide early warning of heart and circulatory disease and diabetes.

In the year 2011–12, before the MOT became compulsory, the NHS set a target of 20% of eligible patients receiving the checks. However, only 14% did so.

In that year, four PCTs gave no or very few MOTs, and two-thirds of PCTs did not meet the interim target.

A spokeswoman for NHS Cornwall and Isles of Scilly said the programme could not be delivered “owing to other pressures”.

Dr Richard Vautrey, Deputy Chairman of the BMA’s GP Committee, commented that giving the scheme “greater national standards” and “national rates of payment” would have led to “better cost and clinical effectiveness”.

From April 2013, offering five-yearly MOT checks will be among the public health responsibilities of local government.

NHS Wales has launched a consultation document for a programme of service improvements to reduce the incidence of, and death rate from, heart disease.

The Cardiac Delivery Plan for 2013–16 focuses on prevention, early diagnosis and treatment, care plans and reducing hospital admissions.

The three-month consultation is in line with NHS Wales’ ‘Together For Health’ strategy to promote personalised and integrated healthcare.

Coronary heart disease affects 9% of adults in Wales (and 33% of adults aged over 65), causing 4,700 deaths per year.

The document points to causal factors such as smoking and obesity, but also notes the need for more timely and well-integrated cardiac care.

A major aspect of the proposed strategy is that Local Health Boards will work with social services to develop “a care plan for those with long-term cardiac conditions” to ensure that “care is co-ordinated between community and hospital”, meeting each patient’s “individual treatment and support needs”.

The care plan will be shared with the patient and reviewed on an ongoing basis, with the aim of ensuring that care services “are compliant with national standards and guidelines” and are “safe, sustainable and available as locally as possible”.

The document also states that cardiac services should be provided “increasingly” within primary care.

Three performance measures are proposed: the percentage of patients treated in line with the cardiac disease waiting time target; the number of emergency admissions, readmissions and bed days; and the percentage of patients who have a care plan.

The consultation will close on 26 October 2012.