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** 30 June 2022
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** UK
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** NHS outsourcing to private providers is associated with rise in treatable deaths, study shows (#1)
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** Restrictions on knee replacement surgery in regions of England for overweight patients (#2)
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** Seven bowel cancer 'risks' after Deborah James passes away from the illness (#3)
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** Oldham shopkeeper fined thousands after more than 20,000 illegal cigarettes seized (#4)
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** International
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** EU: Flavoured vapes could be banned as part of plan to fight cancer (#5)
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** US: New Florida State smoking law Florida law to allow counties to restrict smoking on the beach (#6)
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** Parlimentiary Activity
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** Parliamentary questions (#7)
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** UK
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Increased outsourcing of NHS services to private providers between 2013 and 2020 was associated with reduced quality of patient care and increased rates of deaths from treatable causes, a study has found.

In the analysis, published by the Lancet Public Health, researchers looked at how much each regional health board spent on outsourcing over the seven year period and at local mortality data. They found that an annual rise in outsource spending of 1% was associated with a rise in treatable mortality (deaths that could be avoided through timely and effective healthcare interventions) of 0.38%.

The paper concluded that changes to for-profit outsourcing since 2014 were associated with an extra 557 treatable deaths across the 173 clinical commissioning groups (CCGs).

Benjamin Goodair, study author and doctoral student in social policy at the University of Oxford, said, “While some have argued the Health and Social Care Act [2012] would improve the performance of health services by increasing competition, our findings add merit to long standing concerns it could instead lead to cost cutting and poorer health outcomes.”

Outsourcing of NHS services in England to private companies increased steadily between 2013 and 2020, rising from less than 4% to over 6% of total expenditure for regional health boards. A total of £11.5bn was spent outsourcing health services to the private sector over the study period.

Source: The BMJ, 30 June 2022
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Some Clinical Commissioning Groups (CCGs) have told patients that they must attain a certain body mass index (BMI) before knee replacement surgery, or face being refused, researchers from the University of Bristol said.

Researchers analysed the rates of knee replacement surgery of 481,555 patients between January 2009 and December 2019 using data from the National Joint Registry and compared regions with and without a BMI/weight policy. The study found that more than two-thirds of CCGs in England had a BMI policy for knee replacement surgery, with 61% of these policies denying access to surgery or mandating extra waiting time. It said surgery was down by 14% overall on what would have been expected had no policies restricting access been introduced. They found significant regional differences, concluding that BMI policies worsen inequalities.

Health campaigners expressed alarm, claiming the policy was a “blunt tool” being used to replace conversations between doctors and patients and risked exacerbating health inequalities, when in fact surgical decision making should operate on an individual basis for each patient.

Professor John Skinner, a council member of the Royal College of Surgeons of England and consultant orthopaedic surgeon, said: “Restrictive referral policies, such as BMI thresholds, penalise patients who become more immobile and then they are likely to suffer further health problems. NICE [National Institute for Health and Care Excellence] guidelines clearly state that restricting access to joint replacement based on BMI, smoking or other characteristics should not happen.

An NHS spokesperson said: “Patients and clinicians work together prior to surgery to optimise the chance of getting the best outcome and in some cases losing weight prior to surgery reduces risk to patients and improves the chances of success for the procedure.”

Source: Guardian, 30 June 2022
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Dame Deborah James tragically passed away on Tuesday 28th June, aged 40 years old. She was diagnosed with bowel cancer in 2016 and since then the 40-year-old BBC podcaster campaigned to raise awareness of the condition, raising millions of pounds for charity. .

Her family expressed how proud they were of Deborah for campaigning to ‘break down barriers’ and ‘challenge taboos’ over the illness that is the fourth most common cancer in the UK and is the second biggest killer.

Promoting further awareness of bowel cancer, Cancer Research (CR) UK has listed a number of seven factors that potentially increase the risks of developing it. These are diet, obesity, exercise, alcohol use, age, family history and smoking tobacco.

CRUK points that seven out of 100 bowel cancer cases are linked to smoking - and the risk level increases if you smoke a significant number of cigarettes.

Source: Daily Record, 29 June 2022
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See also: The Guardian – Dame Deborah James obituary ([link removed])
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An Oldham shopkeeper has been fined and ordered to carry out unpaid work after illegal tobacco was found hidden on his premises.

Following complaints from members of the public that illicit or counterfeit tobacco was being sold officers from Oldham Trading Standards and a trained sniffer dog raided the premises. The shop was searched and a total of 22,557 mixed brand cigarettes and 100g of rolling tobacco were seized in September 2020.

Commending the seizure, Councillor Jean Stretton, Cabinet Member for Neighbourhoods, said: “Illegal tobacco makes it easier for children and young people to buy cigarettes and get hooked on smoking. The people making money out of this do not care who they sell to, and the illegal tobacco trade has strong links with organised crime [...] If you know where cheap tobacco is being sold, often as ‘duty-free’, please get in touch. We will take action if we find illegal tobacco for sale.”

To can report illegal tobacco anonymously to Crimestoppers call 0800 555 111 or online at keep-it-out.co.uk.

Source: Oldham Times, 29 June 2022
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** International
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The European Commission has proposed a ban on the sale of flavoured heated tobacco products as part of its plan to fight cancer.

The European Commission said its proposal came in response to a significant increase in products sold, finding a 10% increase in sales of heated tobacco products in more than five member nations, while heated tobacco products exceeded 2.5% of total sales of tobacco products overall across the region.

Stella Kyriakides, Commissioner for Health and Food Safety, said: “With nine out of 10 lung cancers caused by tobacco, we want to make smoking as unattractive as possible to protect the health of our citizens and save lives.”

The European Commission previously said it wanted to ensure that less than 5% of the population uses tobacco by 2040. The ban’s proposal now goes to member nations and European Parliament lawmakers for review.

Source: Time, 29 June 2022

See also: European Commission – News, Europe’s Beating Cancer Plan: Commission proposes to prohibit flavoured heated tobacco products ([link removed])

Editorial note: Media coverage claims the ban includes vaping items, however the ban strictly covers devices that deliver heated tobacco.
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On July 1, the Florida Clean Air Act will go into effect in efforts to curb secondhand smoke exposure. The regulation gives counties and municipalities more control over where people can smoke cigarettes in their public parks and public beach areas.

The City of Indian Harbour Beach, Florida, has led the way in introducing designated smoking areas. John Coffey, the city manager for Indian Harbour Beach, told reporters: “We can be a leader in showing other communities how easy and seamless it is to implement,” after a number of residents pleaded with them to do something about the second-hand smoke in the parks.

Source: Spectrum News, 28 June 2022
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** Parlimentiary Activity
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PQ1/2: Alternative Products

Asked by Adam Afriyie, Conservative, Windsor

To ask the Secretary of State for Health and Social Care, whether his Department has made an assessment of the potential merits of bringing forward further regulations on nicotine pouches to ensure that they do not reach unintended audiences in the context of their growing popularity.

Asked by Adam Afriyie, Conservative, Windsor

To ask the Secretary of State for Health and Social Care, whether his Department has made an assessment of the potential merits of allowing targeted messages to smokers on (a) e-cigarettes, (b) heat-not-burn products and (c) other reduced risk products through inserts in cigarette packs.

Answered by Maggie Throup, Minister for Vaccines and Public Health

The Department is currently considering the recommendations made in the ‘The Khan review: making smoking obsolete'. This includes proposals related to e-cigarettes, heated tobacco and nicotine pouches and proposals to assist smokers to quit, such as through the introduction of pack inserts.

Our response to the review will be included in the forthcoming white paper on health disparities, which we plan to publish in summer 2022 and the Tobacco Control Plan, due to be published later this year.

Source: Hansard, 29 June 2022
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PQ1 transcript ([link removed])
PQ2 transcript ([link removed])
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