Casebook May 2019

Posted: May 23rd 2019


Casebook, May 2019 Edition

In Casebook this month, rural obesity, children and mental health, the loss of a huge cadre of mental health nurses, growing levels of opiod addiction and spiralling rural local authority adult social care costs. Read on for more information


Rural lifestyles drive the global obesity epidemic, report warns 

It is normally urban places grabbing the negative and sometimes positive attention around health indicators. Therefore this story gives us considerable pause for thought. It tells us:

Rural lifestyles are a major driver of the global obesity epidemic, contradicting the commonly held view that growing waist-lines are an urban problem, experts have warned.

Rates of obesity have nearly tripled since 1975, with urbanisation often attributed as the cause. 

But in a study of body-mass index (BMI) of more than 112 million adults published in Nature, researchers found that while obesity levels are creeping up everywhere, BMI has risen more rapidly in rural communities than among city dwellers.

“The results of this massive global study overturn commonly-held perceptions that more people living in cities is the main cause of the global rise in obesity,” said Majid Ezzati, senior author of the report and a professor at Imperial College's School of Public Health. 

“So this is entirely different to the current paradigm. This means that we need to rethink how we tackle this global health problem,” he added. 


Children being 'locked up' and 'sedated' in mental health hospitals

This is a shocking story and I suspect as a number of these hospitals are in rural settings something that resonates with a number of rural communities.

Hundreds of children with autism or a learning disability are admitted to mental health hospitals where they can suffer "nightmare" failures of care, the children’s commissioner for England has found.

Anne Longfield found many children are admitted unnecessarily and go on to spend years in institutions as part of a system that is letting them down.

Her report also found "shocking evidence of poor and restrictive practices", including sedation, segregation and the use of physical restraint.

Children's Commissioner Anne Longfield has filed a damning report on mental health care for children.

The report concludes: "This research has shown that too many children are admitted to hospital unnecessarily and spending months and years of their childhood in institutions when they do not need to be there."

Ms Longfield's report comes at the start of a week that will see a focus on the treatment of those with autism or learning disabilities.


Doctors used as 'guinea pigs' in opioid painkiller promotion

A shocking revelation here

Opioids can be effective for managing acute pain but long-term and high dose use can lead to addiction and increased risk of death.

Once a patient becomes dependent, withdrawal symptoms such as stomach cramps, diarrhoea or sweating, together with increased anxiety, can make it difficult to stop.

The "opioid epidemic" in the US is well documented. The numbers of deaths from opioid abuse have skyrocketed over the past 15 years, killing tens of thousands of Americans every year.

And pharmaceutical companies there are accused of using misleading claims and underplaying the risk of addiction to doctors and patients. 

The dependence on opioids in the UK is nowhere near on the same scale as in the US.

But new research carried out at the Centre for Evidence-Based Medicine at the University of Oxford has found that the extent of the problem is far greater than previously thought. 

Researchers looked at trends and variation in opioid prescribing across England between 1998 and 2016. 

When they counted the number of prescriptions, the increase was 34% - but when they accounted for the strength of the opioids prescribed, the increase was actually 127%. 

The 34% increase took the number of prescriptions above 760 per 1,000 patients. 

The 127% increase took the total oral morphine equivalency from 190,000mg to 431,000mg per 1,000 patients.

"Previous research had missed that spectacular increase because they didn't account for the fact that opioids that are being prescribed today, are much, much stronger," Dr Ben Goldacre told BBC News.


Tory council chief warns of social care funding shortfall

A pronouncement on the perilous position of local government, driven by spiralling adult social care costs, given by the leader of a large rural local authority. This story tells us:

England faces a growing social care funding crisis which, if not fixed, will potentially leave hundreds of thousands of vulnerable people and their families without the care they need, a senior Conservative council leader has warned.

Cllr David Fothergill, the leader of Somerset county council – which last year made big cuts to Sure Start centres and libraries to avoid bankruptcy – was speaking ahead of the transmission of a fly-on-the-wall Panorama documentary that shows the traumatic effects of cuts on families reliant on the county’s adult social care services.

Fothergill said: “There is a national crisis and we need to sort it because it is only going to get worse.”

He told the Guardian that failure to find funding to cover soaring demand for social care would lead to increasingly difficult decisions about who would be eligible for state help. “What will happen is that there will be less funding for complex cases, while those with lower needs will go unfunded.”

His comments came as a report predicted that English councils risk insolvency if government does not move rapidly to fill a £50bn funding black hole opening up in local authority budgets, in large part because of the spiralling cost of paying for services for vulnerable older adults and children.

The report published by the Conservative-dominated County Councils Network (CCN) ahead of the promised government public spending review says that without extra funding, rising demand for social care will see council finances “plunged into disarray” and services cut to legal minimum levels.


NHS England loses 6,000 mental health nurses in 10 years

The eminent MP Norman Lamb has previous spoken in detail about the challenges of supporting people with mental health difficulties in rural areas. This story speaks to the issue very powerfully. It tells us:

The number of mental health nurses in England has slumped by more than a tenth over the past decade, new figures have revealed. This is despite commitments from both Theresa May and her predecessor, David Cameron, to boost resources for mental health services, which many medical professionals say are now in crisis.

The total mental health nursing workforce has decreased by 10.6% since 2009, according to the Royal College of Nursing (RCN).

While numbers of mental health nurses have grown in some areas, such as community care, they have fallen elsewhere. Numbers are down by a quarter (25.9%) in acute care and inpatient care – where the number of mental health nurses has fallen by more than 6,000 over the decade.

Donna Kinnair, appointed as RCN chief executive and general secretary last month, will use a speech to the group’s annual congress on Monday to call on ministers to address England’s 40,000 nursing vacancies, and point out the new figures on the reduction in specialist mental health nurses.


Other Stuff

Rural Coalition

- The National Centre for Rural Health and Care has been welcomed into the family of the Rural Coalition a network of rural interest groups, which work together to lobby Government other members are: 


Action with Communities in Rural England

Arthur Rank Centre

Campaign to Protect Rural England

Country Land & Business Association

National Association of Local Councils

National Farmers Union

National Housing Federation

Plunkett Foundation

Royal Institution of Chartered Surveyors

Royal Town Planning Institute

Rural Services Network

Town and Country Planning Association

Parliamentary Inquiry for Rural Health and Care

– the next session on 6 June is about recruitment and retention and we have the Chief Nurse and a key BMA representative attending to give evidence. Once this session is completed we will be half way through the programme although we have added an extra session which will focus exclusively on the issues connected with coastal settlements.


Burgeoning Membership

– we have now tipped the scales at over 50 significant members within the National Centre and have a very wide ranging England wide constituency.