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** 16 September 2024
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** UK
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** NHS restricting access to obesity services across England, BMJ finds (#1)
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** Darzi: NHS ‘unlikely’ to meet performance targets in five years (#2)
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** Lib Dems raise £1mn from business attendees at annual conference (#3)
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** Scotland to review alcohol advertising after deaths rise (#4)
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** Parliamentary activity
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** Written questions (#5)
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** UK
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** NHS restricting access to obesity services across England, BMJ finds

The NHS is restricting access to obesity services across England, leading to patients in nearly half the country being unable to book appointments with specialist teams for support and treatments such as weight-loss jabs.

An investigation by the British Medical Journal found budget cuts to local services fell disproportionately on obesity care, with patients living with the condition often deemed less worthy of care than others.

The restrictions amounted to the NHS “rationing” obesity services, one expert said, leading to a “postcode lottery of care”.

Patients in one in six local healthcare areas could not access bariatric surgery, one of the most clinically effective treatments for obesity, according to the investigation, which analysed responses to freedom of information requests from all 42 of England’s integrated care boards (ICBs).

Dr Nicola Heslehurst, a professor of maternal and child nutrition at Newcastle University and chair of the UK Association for the Study of Obesity, told the BMJ that weight management services did not “in any way meet the need”, adding that “radical” action was needed to avoid rising obesity and care costs, worsening inequalities, and children “being set up for a life course of poor health”.

Obesity is estimated to cost the NHS in England £6.5bn a year and is the second biggest cause of cancer after smoking.

ICBs are funded by NHS England to provide healthcare services for their local population, but budget cuts have left many under huge financial pressure. When money is allocated, services seen as less important may not receive any funding, and obesity care is often the first to face the axe.

More than a third of ICBs reported restrictions on tier three obesity services, where patients are seen by multidisciplinary teams that can provide weight-loss drugs. Six said their services were closed to new patients, seven only covered part of their catchment area, and four did not have any tier three services.

Tier four services, including gastric bypass surgery and more intensive weight-management services, are restricted in many parts of England, the investigation found, with seven ICBs not providing any bariatric surgery.

John Wilding, a professor of medicine at the University of Liverpool, told the BMJ that obesity services were “not deemed a priority”. “I think there is an unconscious bias which says: ‘This is mostly their fault, so they should just get on with it, go on a diet and lose weight.’ But we know from genetics and other factors that it’s much more complicated than that,” Wilding said.

The BMJ’s findings echo those of a recent report by the Future Health research agency. It found that many of the NHS’s ICBs in England had not set out detailed plans to tackle obesity and treat those with it, despite it costing the UK an estimated £98bn a year in health costs, lost productivity and other costs.

Richard Sloggett, the author of that report, and a former special adviser in the Department of Health and Social Care, said the new disclosures showed the NHS was “rationing” obesity treatment. “These findings back up our Future Health research showing that many ICBs do not currently see obesity as a priority. In certain parts of the country there is no access to tier 3 and tier 4 services at all.

“This rationing is leading to a postcode lottery of care. Given the scale of the obesity challenge facing the country and the wider health and economic costs and impacts associated with it, there is an urgent need for government and the NHS to commit new action. This should start with a clear timeline for reviewing NHS obesity services and ensuring there is a minimum service specification agreed and in place in each ICB.”

Source: The Guardian, 11 September 2024

See also: BMJ - Obesity: Only half of England has access to comprehensive weight loss services ([link removed]) | Future Health - Building new health system action to reduce obesity: Audit findings of Integrated Care Board Forward Plans ([link removed])
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** Darzi: NHS ‘unlikely’ to meet performance targets in five years

Labour is “unlikely” to meet its flagship manifesto commitment to restore the NHS’s constitutional waiting times during this parliamentary term, Lord Darzi has warned.

The former Labour minister made his downbeat verdict on the party’s key manifesto pledge in his government-commissioned review of NHS performance, published [last week].

The wide-ranging 142-page report, an Independent investigation of the National Health Service in England, details a litany of problems, and places much of the blame for them on a lack of investment by the last government, particularly in capital and infrastructure.

On key areas covered by constitutional waiting time standards, the report sets out how cancer targets have not been met since 2015, long waits for elective care have been “normalised”, and A&E “is in an awful state”.

The review concludes: “I have no doubt that significant progress will be possible [on waiting times] but it is unlikely that waiting lists can be cleared and other performance standards restored in one parliamentary term. Just as we in the NHS have turned around performance before, we can do so again.”

This is in sharp contrast to comments before the election by Wes Streeting, now health and social care secretary, that Labour was committed to restoring all constitutional performance standards – covering elective, A&E, cancer and ambulance services – in a first term in office.

Mr Streeting said at the time: “We know that these are challenging [commitments]. If I think about the range of performance standards, we know that on UEC [urgent and emergency care], that’s a tougher challenge than on the elective backlog…

“That’s why we’ve been working with some of the best minds across the system to help us [on emergency care delivery]… and that’s what’s given us the confidence to make that commitment.”

Lord Darzi’s report does not appear to propose ditching any of the constitutional standards – despite NHS England spending several years trying unsuccessfully to do precisely this as part of its ‘clinical review of standards’ which was launched in 2019, with the four-hour A&E target their main priority for reform.

Source: HSJ, 11 September 2024

See also: Lord Darzi of Denham – Independent investigation of the NHS in England ([link removed])
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** Lib Dems raise £1mn from business attendees at annual conference

The Liberal Democrats’ annual conference has generated more than £1mn in revenue for the first time since it was last in government, after receiving a boost in business interest off the back of its record electoral performance.

The Lib Dems’ 72 MPs will descend on the coastal city still beaming from the general election in July, which delivered their highest ever total of seats and more than quadrupled their presence in the House of Commons.

The Lib Dems are seeking to forge a new path in 2024 by acting as a “constructive opposition” to Labour on a handful of key policy areas including health, care work and sewage, deputy leader of the party Daisy Cooper told the FT.

Cooper is set to meet health secretary Wes Streeting to discuss Lib Dem ideas for health policy reform, including the need to drastically increase investment in the health and care sectors in the short term and hire thousands more GPs.

“The choice isn’t as stark as [Labour] is saying — the choice isn’t just reforming the NHS or raising personal taxes,” she said, adding that Streeting should look at taxing “big banks” more and increasing capital gains tax paid by the top earners.

“If they decide there’s no extra investment, that’s a major problem,” she warned.

In a sign of the levers the party will seek to use to influence policy discussions, the Lib Dems this week secured chairs of select committees that will cover health and social care, and environment, food and rural affairs.

Source: The Financial Times, 14 September 2024
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** Scotland to review alcohol advertising after deaths rise

Neil Gray, the health minister, said he did not deny that the death toll from drugs and alcohol was ‘harrowing’.

Experts are being called in to review how the public’s exposure to alcohol advertising can be reduced after the “harrowing” rise in alcohol deaths, Neil Gray, Scotland’s health secretary, has said.

Last year, when he was first minister, Humza Yousaf shelved plans which could have involved alcohol bottles being obscured in shops, saying the government would be going “back to the drawing board”.

Shops and alcohol producers had objected to the proposals before they were halted.

On Thursday Gray updated MSPs on steps the government is taking in response to rising drug and alcohol deaths in Scotland. Deaths attributed to alcohol rose to 1,277 last year, an increase of one from 2022 and the most since 2008.

Gray said that new measures were needed to tackle alcohol harm and that he will commission Public Health Scotland to carry out a review of the evidence on the range of options available to reduce exposure to alcohol marketing.

In 2023 Humza Yousaf shelved proposals launched by Nicola Sturgeon to ban all alcohol advertising in Scotland.

Answering questions from MSPs, Gray said the government would consult on any recommendations from the review, ensuring action is “proportionate”.

Source: The Times, 13 September 2024
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** International
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** Written questions

Asked by Jim Shannon, Democratic Unionist Party, Strangford

To ask the Secretary of State for Health and Social Care, what assessment he has made of the implications for his policies of levels of vaping by young people.

Answered by Andrew Gwynne, Labour, Gorton and Denton

The Government is concerned about the worrying rise in vaping among children, as rates of youth vaping have tripled in the past four years, and 18% of children have tried a vape. All too often, vaping products are promoted in a way that appeals to children, despite the risks of nicotine addiction and the unknown harms. To address this, the Tobacco and Vapes Bill will reduce the appeal and availability of vapes to children. The bill will stop vapes from deliberately being branded and advertised to children, including regulations on flavours, packaging, and changing how and where they are displayed in shops. The bill will be introduced to Parliament soon.

We will publish an impact assessment for the bill shortly, and we will publish further impact assessments alongside our future vaping regulations. We will also undertake an implementation review after a set period to determine the effect of these policies on youth vaping rates.

Source: Hansard, 13 September 2024

Asked by Stuart Andrew, Conservative, Daventry

To ask the Secretary of State for Health and Social Care, what assessment his Department has made of the potential impact of banning smoking and vaping outside pubs, restaurants and nightclubs on the (a) night-time economy and (b) viability of local high streets.

To ask the Secretary of State for Health and Social Care, whether he plans to consult on banning smoking and vaping outside pubs, nightclubs and restaurants; and whether he has a planned timetable for the proposed ban.

To ask the Secretary of State for Health and Social Care, whether his Department has carried out an impact assessment of the Government's plans to ban (a) smoking and (b) vaping across university campuses.

To ask the Secretary of State for Health and Social Care, what assessment he has made of the potential impact of the Government's proposals to ban outdoor smoking and vaping in and by pubs on the number of pub closures.

To ask the Secretary of State for Health and Social Care, whether his Department has carried out impact assessments of the Government\'s plans to ban (a) smoking and (b) vaping (i) in pub gardens, (ii) at outdoor restaurant tables, (iii) at outdoor shisha bar seating and (iv) in outdoor nightclubs.

Answered by Andrew Gwynne, Labour, Gorton and Denton

The Government will soon introduce the Tobacco and Vapes Bill into Parliament, which stands to be the most significant public health intervention in a generation, and will put us on track to a smoke-free United Kingdom.

The Government supports measures that will create a smoke-free environment, helping to reduce 80,000 preventable deaths, reduce the burden on the National Health Service, and reduce the burden on the taxpayer. Any proposed extension of smoke-free legislation is subject to the approval of Parliament, as well as a full public consultation and further engagement with relevant organisations.

An impact assessment will be published on the new bill after it has been introduced, and further impact assessments will be published on new regulations when they are laid in Parliament. More details will be set out soon.

Source: Hansard, 13 September 2024

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ASH Daily News is a digest of published news on smoking-related topics. ASH is not responsible for the content of external websites. ASH does not necessarily endorse the material contained in this bulletin.

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