Casebook May 2023

Casebook May 2023

Posted: May 15th 2023


In this edition of casebook: school nurses, a very insightful report on covid failings from our friends at Nuffield, more flexibility to access pharmacies directly, the challenge and opportunity around clinical trials, the impact of “place” in terms of long covid and some interesting updates (we hope) in “Other Stuff.”

‘It all hinges on wellbeing’: UK school nurses’ crucial, underfunded role

This article highlights the value of the school nurse service and makes me reflect on its utility in rural communities where access to many statutory services is restricted. It tells us:

For O’Neill, this demonstrates the value of school nurses: they are trusted adults who are independent from the school, meaning students feel more comfortable sharing confidences with them. They can signpost services, and prevent today’s stress from becoming tomorrow’s mental health crisis.

School nurses are having to do this more often. Mental health problems among children were on the rise prior to the Covid pandemic, and lockdowns have resulted in more behavioural problems, while teacher-graded GCSEs mean year 13s have never experienced exam stress.

O’Neill used to work as a school nurse employed by the local authority, but five years ago she went independent after she became exasperated with only having time for child protection cases, and not preventive health and wellbeing work.

She is employed by the Unity Schools Partnership and spends one day in each of its 33 schools every term. Nearly two-thirds of those schools appreciate her work so much that they claw shreds of funding from their pupil premium, PSHE and CPD budgets to pay for additional sessions.

Ministers missed chances to prepare social care for a pandemic, review finds

A shocking and not surprising expose of the failure of a major plank of policy during covid. This report tells us:

A review of events in spring 2020, when almost 20,000 care home residents died with Covid in England and Wales, found it was the result of “letting one of our most important public services languish in constant crisis for years”.

A two-year study by the Nuffield Trust health thinktank and the London School of Economics found successive governments failed to respond to risks already exposed by cross-government pandemic planning exercises, didn’t have enough civil servants working on social care, and failed to appreciate the sector’s fragility when sending patients into ill-prepared care homes.

The study found:

  • The government excluded social care from pandemic-planning exercises such as Exercise Alice and after problems were identified by Exercise Cygnus, which did include the sector, action was not taken.
  • Social care leaders felt invisible at the start of the pandemic because there had been no dedicated director general for social care in government since 2016.
  • No adult social care representatives sat on the Scientific Advisory Group for Emergencies (Sage) and people leading the UK pandemic response lacked “deep understanding” of social care.
Seven conditions English pharmacies could prescribe for from winter

Good idea methinks….

Patients will be able to get prescription medicines for seven common health conditions directly from pharmacies in England under a blueprint designed to ease the pressure on GPs’ appointments.

For the first time, pharmacists will be able to write their own prescriptions for the conditions, under health changes ministers and NHS England chiefs hope will be introduced from this winter after a consultation with the industry.

Here are the seven conditions and their typical treatments:


Uncomplicated urinary tract infection in women

Sore throat




Infected insect bites

Plunge in clinical drug trials makes Britain an urgent case for treatment

I think rural settings have real potential to operate as clinical trial centres. I have previously shared our plans to make Mablethorpe in Lincolnshire an improbable but potent base for clinical trials. This article reveals the nature and also the dynamics of the challenge.

The number of trials initiated in the UK fell by 41% between 2017 and 2021, with a similar drop in cancer trials, according to the Association of the British Pharmaceutical Industry (ABPI), which represents about 70 drugmakers. The decline has been made worse by the Covid-19 pandemic as NHS hospitals, which conduct much of each study, have been overwhelmed by frontline work; more than 7 million people are on waiting lists for surgery or specialist treatment, a new record.

“Delays in set-up and approval of clinical trials and the fact that research isn’t fully embedded in the NHS were already challenges prior to the pandemic, but they have been exacerbated with the added pressure of the pandemic and resulting backlog,” says Jennifer Harris, the ABPI’s director of research policy.

The decline in clinical trials raises questions about Britain’s ability to drive innovation, and about benefits to patients, the NHS and the economy. Last week, a report by the Academy of Medical Sciences warned the future of the UK’s health research was at risk, and suggested that the hospitals that did such studies “have better patient outcomes overall”.

Access to new treatments through clinical research is particularly important for the 3.5 million people with rare diseases in the UK. Declining trials also mean less revenue for the NHS, as drugmakers pay on average £9,000 per patient recruited on to one. That brought in £355m to the health service in 2018-19.

Where you live makes you more susceptible to long covid

I wonder what impact rural areas might have on the likelihood of developing long covid? This article tells us:

The risk of developing long Covid is higher for people who live in poorer areas, new research has found.

Researchers found the chance of having long Covid is 46 per cent higher for those living in the most deprived areas compared to those living in the least deprived areas, a paper published in the Royal Society of Medicine found.

Analysing data from the Office for National Statistics (ONS), the study examined more than 200,000 working-age adults and is the first to establish a link between long Covid and socioeconomic status across a range of job sectors.

Other Stuff

In other stuff a heads up that we are planning a major – new think – about the shape and focus of the National Centre for Rural Health and Care. Your contributions would be welcome.

The rural proofing toolkit trials are now up and running and spanning locations from Rathlin Island to West Devon.

We have recently given evidence to the Hewitt Review and House of Lords Select Committee on the roll out of ICBs.

We are working actively with the Rural Coalition to ensure their new manifesto has a strong health and care component.

We have been supporting the development and roll out of the Centre for Future Living, see the article on clinical trials above. This has also involved liaison with the new Centre for Research Equity at the University of Oxford.