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** 8 July 2022
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** UK
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** 6,000-plus jobs to be cut at ‘new NHS England’ (#1)
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** BMJ Opinion: Will new health secretary Steve Barclay get the chance to leave his mark? (#2)
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** Greg Clark appointed levelling up secretary (#5)
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** Fresh concerns over alcohol labelling after new report (#6)
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** International
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** Greece Study: During pandemic times, harms of smoking amplified (#7)
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** Parliamentary Activity
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** Parliamentary questions (#8)
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** Link of the week
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** Webinar: NHS Community Pharmacy Smoking Cessation Service (#9)
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** UK
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** Thousands of jobs – amounting to around 30-40% of posts across NHS England (NHSE), Health Education England (HEE) and NHS Digital (NHSD) – will be cut over the next year as the organisations are merged, it was announced yesterday. Based on 20,000 current roles, this will mean a reduction of 6,000-8,000 posts.

The merger of all three arm’s-length bodies into NHSE will take place by April 2024, although NHSE, HEE and NHSD are due to merge legally in April next year. NHSE has not specified whether any compulsory redundancies are expected or planned.

In a note to staff, NHSE chief Amanda Pritchard said they had “told me that you are often frustrated by the complexity and bureaucracy that characterise some parts and activities of our organisation, concerns consistently raised by our colleagues delivering frontline care. Creating the new NHS England will mean a smaller, combined organisation. This means we can build a high performing organisation that addresses these frustrations and focuses on where we do, uniquely, add value”.

She continued: “We need to reduce the size of our organisation, so that we are focused on enabling and supporting change and empowering systems to lead locally. We need to simplify how we work across the new organisation and how we work with the wider NHS.

The move follows increasing scrutiny of the size of the centre of the NHS and the Department of Health and Social Care, as well as other parts of government. In May, the Telegraph reported on what it called an “‘astonishing’ explosion in central bureaucracy”, based on a report by the Policy Exchange think tank, which found the “number of officials working in the Department of Health and NHSE has more than doubled in two years, with even sharper rises seen at the most senior levels”.

Source: HSJ, 7 July 2022

See also: Telegraph - Report on NHS reveals ‘astonishing’ explosion in central bureaucracy ([link removed])
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** BMJ editor Adele Waters, reporting on England’s new health and social care secretary Steve Barclay’s previous political appointments, explores what the NHS and wider healthcare sector might expect from his tenure. Given the mounting resignations, Waters writes: “The question for the NHS is: what will he bring if he does survive long enough to achieve anything meaningful?”

Described as “hawkish” by political commentators when it comes to spending public money, particularly on health, the outlook isn’t promising, says Waters. At the Treasury, he is said to have pushed back on signing off the cheque for the covid vaccine programme on the basis of “value for money” and of course, by the time official approval had been gained, almost a million people had been vaccinated.

Barclays’s voting record shows he is a resolute loyalist — consistently voting with the government since becoming an MP. He has voted in support of government reforms to the NHS and against restricting the amount of income that trusts can earn from private patient care. On a crucial vote to improve workforce planning in the NHS (amendment 29 to the Health and Social Care Bill) he did not vote.

Waters makes reference to his “hostility” towards the NHS during the 11 months he was a junior health minister between January and November 2018. He writes that whilst Barclay was “responsible for NHS workforce, finance, efficiency but, interestingly, had little to do with the BMA [British Medical Association], despite workforce being a consistent policy priority”.

Looking to sector needs, Waters speaks to new BMA chair of council, Philip Banfield. Banfield emphasises Barclay’s most immediate priority should be working with the Treasury to secure proper funding of the health service, social care, and public health services, warning that “if the government chooses another sub-inflationary outcome with no plan to address the long term decline in doctors’ pay, it will set them on a collision course with the profession.”

King’s Fund chief executive Richard Murray stresses that Barclay’s success will rest on his ability and willingness to convince a sceptical Treasury that a serious workforce plan is better value for money than the current drift into a deeper crisis.

Source: BMJ, 7 July 2022

See also: Chemist and Druggist - Steve Barclay: What is the new health secretary's history with pharmacy ([link removed])
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Read Article ([link removed])


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Greg Clark has been appointed secretary of state at the Department for Levelling Up, Housing & Communities, replacing Michael Gove.

Until yesterday he was chair of the Commons' science and technology committee. Between 2015-2016 Mr Clark was secretary of state when the department was known as the Department for Communities and Local Government and was part of Theresa May’s cabinet. He held the role of business secretary between 2016-2019 and was universities minister between 2014-2015.

On Thursday he tweeted: "We have a duty to ensure that the country has a functioning government in the weeks ahead,” assuring he will “provide stability, good governance and accountability to Parliament at this important time."

Source: Local Government Chronicle, 7 July 2022
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Campaigners are warning that consumers are being failed by alcohol labelling and are now calling for the Government to make it a legal requirement for alcohol companies to display nutritional information and health warnings on their products.

In a new report, the Alcohol Health Alliance UK (AHA) examined 369 alcohol products at locations across the UK, including in the North East, to find out what information is available to consumers on alcohol labels. The report found just 20% of the products provided the full list of ingredients and 41% provided calorie content, whilst only 3% included a general health warning.

In the UK, alcoholic drinks are only required to display the volume and strength (in ABV) and common allergens on labels. Information on nutritional values (including calories and sugar content), ingredients, or health warnings is not required. In contrast, a survey by Balance, the North East of England’s alcohol programme, has found that 72% of North East adults would support a general health warning on alcohol and 66% support listing ingredients.

Ailsa Rutter, director of Balance said: “People have a right to know what their drinks contain and the risks of drinking, even if this is just to make informed decisions, and so we are urging the Government to intervene.”

Source: Northumberland Gazette, 7 July 2022
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** International
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** Smoking cigarettes while wearing a surgical mask results in a two-fold rise in exhaled carbon monoxide and impaired blood vessel function compared to non-mask periods, researchers from National and Kapodistrian University of Athens have found in their study published today in the European Journal of Preventive Cardiology.

The researchers measured exhaled carbon monoxide levels after a deep breath and markers of vascular function while wearing a mask during working hours and compared it to carbon monoxide levels during days off without a mask. In conventional cigarette smokers, exhaled carbon monoxide increased from 8.00 parts per million (ppm) at baseline to 12.15 ppm with no mask and 17.45 ppm with a mask. Individuals with known cardiovascular disease, hypertension, diabetes, dyslipidaemia, chronic kidney disease or atrial fibrillation were excluded as these conditions may affect vascular function.

In smokers, all vascular markers were higher while wearing a mask compared to no mask. This includes both combustible and non-combustible cigarette usage. In non-smokers, there were no differences in vascular markers between the three periods.

Source: ScienMag, 8 July 2022
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Read Article ([link removed])


** Parliamentary Activity
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PQ1: Oral tobacco

Asked by Alexander Stafford, Conservative, Rother Valley

To ask the Secretary of State for Health and Social Care, whether he plans to include a commitment to regulate oral nicotine pouches in either the (a) health disparities white paper or (b) updated Tobacco Control Plan for England.

Answered by Maggie Throup, Public Health Minister

Nicotine pouches are regulated under The General Product Safety Regulations 2005. During the Post Implementation Review of The Tobacco and Related Products Regulations 2016, we received submissions to further regulate these products under this framework. We will keep this under review in the development of the forthcoming health disparities white paper and Tobacco Control Plan.

Source: Hansard, 6 July 2022 ([link removed] )

PQ2: Disposable e-cigarettes

Asked by Alexander Stafford, Conservative, Rother Valley

To ask the Secretary of State for Health and Social Care, what assessment he has made about the potential negative health effects of smoking disposable e-cigarettes.

Answered by Maggie Throup, Public Health Minister
Although not risk free, e-cigarettes or vapes, including disposables, are less harmful than smoked tobacco. A Cochrane Review, ‘Electronic cigarettes for smoking cessation’, found that the rate of adverse events reported for vapes is similar to that of nicotine replacement therapy. This Review is available at the following link:

[link removed]

Through the current Tobacco Control Plan for England, the former Public Health England commissioned annual independent reports on vaping in England. The final report in this series will be published by the Office of Health Improvement and Disparities shortly. The report will include systematic reviews of the respiratory, cardiovascular and cancer risks from vaping, in addition to reports on the risks from fires, explosions and poisonings.

Any suspected adverse drug reaction (ADR) occurring after using a vaping product is reported to the Medicines and Healthcare products Regulatory Agency (MHRA). From 22 September 2020 to 22 September 2021, the MHRA received 50 suspected ADR reports associated with vaping use, with one report concerning an individual under the age of 18 years old. There have been seven reports concerning those aged under 18 years old in the last four years.

Source: Hansard, 4 July 2022 ([link removed])

PQ3: Regional health inequalities

Asked by Sir George Howarth, Labour, Knowsley

To ask the Secretary of State for Health and Social Care, whether the white paper on health disparities will include policy proposals to help tackle regional disparities in (a) obesity, (b) smoking and (c) alcohol consumption.

Answered by Maggie Throup, Conservative

The health disparities white paper will review the factors which influence people’s health, including preventable risks and among population groups and localities which experience poorer health outcomes. The specific policy content of the white paper will be available in due course.

Source: Hansard, 5 July 2022 ([link removed] )

PQ4: Heated tobacco products

Asked by Ben Bradley, Conservative, Mansfield

To ask the Secretary of State for Health and Social Care, with reference to the Answer of 3 August 2020 to Question 72841 on Tobacco: Marketing and the US Food and Drug Administration's Modified Risk Granted Order reference MR0000192, published on 11 March 2022, if he will (a) make it his policy to commission independent research into heated tobacco products as recommended in the Khan review: making smoking obsolete, published on 9 June 2022 and (b) introduce a new regulatory framework for those products.

Answered by Maggie Throup, Conservative

The next Vaping in England report, commissioned by the former Public Health England and produced by Kings College London, includes a chapter on heated tobacco products. This will be published in summer 2020.
Plans for future research will be set out in the forthcoming white paper on health disparities and the Tobacco Control Plan, which will be published later this year. There are no current plans to introduce new regulatory framework for these products.

Source: Hansard, 5 July 2022 ([link removed] )

PQ5 & Q6: E-cigarette recycling

Asked by Alexander Stafford, Conservative, Rother Valley

To ask the Secretary of State for Environment, Food and Rural Affairs, if he will make an estimate of the proportion of disposable electronic cigarettes that are properly recycled in the latest period for which data is available.

Answered by Jo Churchill, Conservative

Neither Defra nor the Environment Agency collect data on the proportion of disposable electronic cigarettes that are recycled.

Source: Hansard, 5 July 2022 ([link removed] )

Asked by Alexander Stafford, Conservative, Rother Valley

To ask the Secretary of State for Environment, Food and Rural Affairs, what estimate he has made of the number of facilities in the UK that safely recycle disposable electronic cigarettes.

Answered by Jo Churchill, Conservative

77 Approved Authorised Treatment Facilities (AATFs) are approved under the Waste Electrical and Electronic Equipment Regulations for the treatment of Small Mixed WEEE which would include electronic cigarettes. It is a matter for the operator to decide what specific categories of equipment they choose to treat under the terms of their approval.

Source: Hansard, 5 July 2022 ([link removed])
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** Link of the week
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** NHS England and NHS Improvement is hosting a one hour webinar about the NHS Community Pharmacy Smoking Cessation Service for community pharmacists and their teams, NHS trusts tobacco dependence leads and regional leads, on Tuesday 12th July 2022 at 7pm.

The community pharmacy service launched in March 2022 to provide ongoing support to patients with their stop smoking journey when they are referred to community pharmacy after discharge from hospital. As hospitals set up their in-house smoking cessation service, pharmacies can mobilise to be able to receive referrals. It complements existing local authority commissioned smoking cessation services, creating capacity in the system.

Speakers include Anne Joshua, Head of Pharmacy Integration, Professor Sanjay Agrawal, National Speciality Advisor for Tobacco Dependency, Gemma Ramsay and Claire Hobbs, Community Pharmacy Digital Strategy and Rob Hebdon, Pharmacy Integration Lead North West.

The session will provide more details about the service, support with implementation for acute trusts and top tips and lessons learned from those already offering the service.
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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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