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The King's Fund's Health priorities for an incoming government sets out the three areas that we believe the new government should focus on. These are: responding to the financial challenge facing the NHS, improving the quality of health care, and promoting well-being and independence.

For further information please read our introduction to the priorities or find out about them below.

The King's Fund's priorities for an incoming government

Respond to the financial challenge facing the NHS:

  • Drive productivity improvements relentlessly
  • Take a measured approach to structural reform
  • Foster a productive and engaged workforce

More on responding to the financial challenge >

Improve the quality of health care:

  • Strengthen the focus on patient experience
  • Intensify efforts to improve safety
  • Get smarter about measuring quality

More on improving the quality of health care >

Promote well-being and independence:

  • Promote healthy lifestyles and renew the drive to tackle health inequalities
  • Improve care for those with long-term conditions
  • Introduce comprehensive reform of social care
  • Increase the priority given to end-of-life care

More on promoting well-being and independence >

Download the full report

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Seven Priorities for a New Government to Tackle HIV in the UK

Election offers opportunity to get better on HIV in the UK

NAT is concerned that HIV in the UK has gone down the political agenda, despite prevalence significantly increasing. The General Election in 2010 provides an important opportunity for politicians to commit themselves to taking action on HIV in the UK.

There are now more people than ever before – an estimated 85,000 – living with HIV in the UK. More than a quarter of those are unaware of their infection because they have not been tested, having serious consequences for individual and public health.
 
NAT is calling on parliamentarians, policymakers and the new Government in 2010 to take forward seven specific actions that would support better HIV testing, prevention, treatment and care, and policy in the UK:
 
Better testing
 
A national screening programme for HIV
 
Nationwide reductions in the proportion of people with HIV who are diagnosed late
 
Better prevention
 
Increased expenditure on cost-effective HIV prevention at national and local levels, within ring-fenced public health budgets
 
Better treatment and care
 
HIV included in Department of Health long-term condition strategy, policies and programmes
 
The AIDS Support Grant retained, and maintained in line with the social care needs of people living with HIV
 
Better policy
 
A cross-departmental strategy for HIV post-2010 which includes a clear action plan to tackle HIV-related stigma and discrimination
 
The appointment of a high-level ‘HIV champion’ to advocate for the HIV strategy across Whitehall, the NHS and local government
 
http://www.nat.org.uk/News-and-Media/Press-Releases/2009/December/Election%20Asks.aspx

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25 things the Government can do by THT

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Planned A&E closures 'misguided'

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How many managers are there in the NHS?

The NHS employs 1.4 million staff and has a budget of around £100 billion, so it needs to be managed professionally.  There has been a lot of publicity about the rate at which the number of managers has grown (Daily Telegraph 2010,  Guardian 2010) and the amount that very senior managers are paid (BBC 2010Independent 2010). Here we set out some key facts about managers in the NHS.

Has the number of managers increased?

In 2009, the NHS employed the full-time equivalent of 1,177,056 staff (1,431,996 headcount), of whom 42,509 were managers or senior managers. While the total number of NHS staff increased by around 35 per cent between 1999 and 2009, the number of managers increased by 82 per cent over the same period, from 23,378 to 42,509 (Information Centre 2009) (see table 1). As a proportion of NHS staff, the number of managers rose from 2.7 per cent in 1999 to 3.6 per cent in 2009 (Information Centre 2009). Table 1 shows changes in the numbers and proportions of certain groups of NHS staff between 1999 and 2009.

Table 1 Changes in numbers of certain groups of NHS staff 1999–2009

Changes in numbers of certain groups of NHS staff 1999–2009.<br />
Source: Information Centre 2009. Total staff numbers do not add up to<br />
100 due to rounding.

The NHS Confederation, which represents NHS managers, argues that the proportion of NHS managers is relatively low given the size of the organisations that they run. They point out that it is lower than the proportion of managers in the whole of the workforce in the UK (NHS Confederation 2007), which in 2009 was 16 per cent (Office of National Statistics).

Why has the number of managers increased?

The NHS Careers website lists 78 categories of manager, including clinical management, human resources management, IT and financial management. There is no data available on which of these broad categories of management has seen the most growth. Recent reforms to the NHS, including delivering waiting times targets, changes to the hospital payment system (Payment by Results), the electronic booking system (Choose and Book) and other IT projects, are likely to have increased the need for managers in hospital trusts.

For primary care trusts (PCTs), the recent Health Select Committee Report into Commissioning identified a continuing rise in administration costs dating from the purchaser–provider split in 1991 and was critical of the government’s inability to supply 'clear and consistent data about transaction costs' relating to billing and commissioning.  

The regulatory framework for health care in England has also become more complicated. A report in 2009 by the Provider Advisory Group, made up of NHS and independent sector providers, concluded that there was unnecessary duplication in the information NHS providers in England are required to submit to the 35 key regulators, auditors, inspectorates and accreditation agencies. Supplying this information has led to an increase in the number of non-clinical staff employed by the NHS.

In 2007 the Department of Health set a target to reduce the number of ‘people years’ spent gathering data by 30 per cent.  In October 2007 a baseline of 498 years was set with the goal of a reduction to 348.6 by May 2010. This target is not on schedule to be met: in December 2009, this figure stood at 380 - a 23.6 per cent reduction.

There have been few systematic attempts to measure the quality of management in the NHS. A recent study published by the LSE found a relationship between the quality of management – as measured by surveys – and the quality of clinical services in hospitals, as measured by the Healthcare Commission. The Department of Health recently launched the National Leadership Council to improve the quality of senior management in the NHS, which has traditionally spent a very small proportion of its training budget on managers.  

How much are managers paid?

Pay for most NHS managers is determined by Agenda for Change, which is the nationally agreed pay framework for all NHS staff (other than doctors, dentists and very senior managers (VSMs)).  NHS managers below the level of VSMs can be paid anything between £25,472 and £97,548. Examples of pay in 2010 include a radiography team manager (£30,460 – £40,157), a head of procurement and supply (£38,851 – £55,935) and a chief finance manager (£45,254 –£80,810).

There are currently around 1,120 VSMs in England – chief executives, executive directors and others with board level responsibility. Their salaries, along with those of other senior public servants, are agreed by ministers on the advice of the Senior Salaries Review Body. In 2009 the average pay of a chief executive of a non-foundation NHS trust was £147,500, and the average pay of a chief executive of a Foundation trust was £157,500 (Senior Salaries Review Body 2010).

Following recommendations by the Senior Salaries Review Body, the government had previously announced that the pay of very senior NHS managers should increase by 2.2 per cent in 2008/9. (Hansard 17 June 2008). A report published in April this year by Incomes Data Services (PDF) showed that, in fact, chief executives had received an average pay increase of 6.9 per cent in 2008/9.

Pay increases for VSMs have been limited to 1.5 per cent for the financial year 2009/10 (Hansard 31 March 2009) and there will be no pay increases at all for the financial year 2010/11 (Hansard 10 March 2010). Other managers will receive a pay increase of 2.25 per cent for 2010/11 as part of a three-year pay deal set out by Agenda for Change, which the government has chosen not to review (Department of Health 2009).

Has the pay of managers risen more than the pay of other NHS staff?

Increases in the number of NHS staff and higher pay costs have absorbed more than half the increases in financial resources made available to the NHS since 2002 (Thorlby and Maybin eds 2010). Managers’ pay has risen slightly less since 1997/8 than that of other NHS staff groups and much less quickly than that of consultants (see figure 1). 

Figure 1 Changes in real average earnings per full time employee for selected NHS staff groups

Changes in real average earnings per full time employee for<br />
selected NHS staff groups. Source: The King’s Fund calculations based on<br />
 House of Commons Health Committee 2010

What are the political parties’ policies on NHS management costs?

All three major parties are committed to reducing management costs in the NHS. The Labour government promised to reduce management costs in PCTs and strategic health authorities by 30 per cent over the next four years. The Conservative party is committed to reducing costs by removing ‘expensive layers of bureaucracy’, which it says will reduce administration costs by a third and the Liberal Democrats say they would cut the Department of Health by half, abolish strategic health authorities and cap the remuneration of senior managers so that none is paid more than the Prime Minister.

http://www.kingsfund.org.uk/general_election_2010/key_election_questions/how_many_managers.html

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England 'lagging on lung cancer'

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UK 'has higher early death rate than many rich nations'

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Social care budgets should not be cut, says charity

Social care funding in the UK should not be reduced over the next few years, a charity group has insisted.

According to Age Concern and Help the Aged, factors such as the ageing population in Britain are leading to greater need for the provision of care and support.

Andrew Harrop, spokesman for the group, has therefore urged the government not to cut budgets and withdraw support from those who need it the most.

He warned that diverting funds away from social care at this time would be a "national disgrace".

Meanwhile, the Local Government Association has said the level of funding needs to be increased in line with the number of elderly people in the UK.

"Essentially, more people are needing more care on less money," a spokesman stated.

This comes shortly after Unison called for more permanent jobs in social care to be created to ease pressure on the sector.

By Steven Jones

http://www.hclplc.com/articles/Social-care-budgets-should-not-be-cut%2C-...

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Disabled voters unimpressed with politicians over social care

Disabled voters are unimpressed with the way all political parties have addressed their concerns over social care and other issues.

Almost nine in ten said they felt their views were not being heard by politicians, in a survey of 431 disabled voters by polling agency ComRes and disability charity Scope.

The poll showed social care was one of the top priorities for disabled voters with 35% including it among their biggest concerns. Respondents also rated benefits and the NHS as highly important.

Richard Hawkes, chief executive at Scope, said: "As disabled people are more reliant on public services than the rest of the population, it is hardly surprising that benefits, health and social care services are key issues for them. We know there are deep concerns among disabled people that the services they rely on most will be seen as easy targets for cuts."

All parties are committed to some reform of social care.

Both Labour and the Lib Dems would set up a commission in the next Parliament to examine how social care should be funded. Labour would also introduce free personal care for people at home with the highest needs and those who had already been in residential care for two years.

The Lib Dems would provide all full-time carers with a week's worth of breaks each year, while the Conservatives want to introduce a voluntary insurance system through which people could waive all residential care costs by paying £8,000 on retirement.

None of the parties has promised to protect adult social care from funding cuts, something the Tories and Labour have pledged to do for other service areas, notably the NHS.

Both Labour and Conservatives aim to move people off incapacity benefit on to jobseeker's allowance through the work capability assessment, but plan to review the working of the assessment itself.

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http://www.communitycare.co.uk/Articles/2010/05/04/114415/disabled-voter...

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Election triggers fears over adult social care reform

Social care has "lost the road map" for reforming adult social care funding following the election of a hung parliament with the Conservatives as the biggest party.

That was the message from Association of Directors of Adult Social Services president Richard Jones, following an election result that left no party with an overall majority but effectively gave the Conservatives the first opportunity to form a government.

The Conservatives did not sign up to Labour's adult care White Paper, published on the eve of the election. The paper outlined a plan to introduce a national care service, with services free at the point of need, but with a decision on how this should be funded referred to an independent commission.

Jones said: "What we have in the White Paper is a detailed road map [for reform]. There were three phases laid out there; if we don't have Labour in government you have to assume we lose the detailed map for how we do that."

Negotiations are under way as to who will form the next government, with the Conservatives offering the Liberal Democrats a deal that may lead to a coalition government.

While rejecting parts of the White Paper, the Lib Dems also backed forming a independent commissionon funding reform, but the idea is opposed by the Conservatives.

Jones said he suspected social care would be at the forefront of the negotiations and said a lot more work needed to be done to build a consensus on social care funding once a government was formed.

He added that the next government needed to be strong enough to take tough decisions over social care funding reform in a tough economic climate. He said it would not be advantageous for the sector to have care ministers who were anticipating another election soon.

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Social care White Paper heralds 'free' national care service

http://www.communitycare.co.uk/Articles/2010/05/07/114453/election-trigg...

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Public sector jobs may be safer under hung parliament

The severity of proposed cuts to the public sector could be reduced as a result of the hung parliament, according to a leading academic.

Ray Jones, professor of social work at Kingston University, said the results of last night's election might see some of the more radical changes proposed by the Conservatives watered down.

The Tories have won the most seats in the 2010 general election, but their failure to secure an overall majority has led to Britain's first hung Parliament since 1974.

This leaves key policy pledges in doubt, such as the Conservatives' commitment to deliver £12bn in public sector efficiency savings over the next year. Within this total, the Tories previously said that £1bn-£2bn of the savings planned for 2010-11 could be made by reducing the use of agency staff and not filling vacant posts, while £2bn to £4bn could come through cuts in IT spending.

The plans immediately came under fire from unions, who estimated the Tory plans could place between 20,000 and 40,000 public sector posts at risk.

"[The Conservatives] may choose not to move forward because they don't want the controversy of having those policies opposed," said Jones. "No one will be able to push through controversial policies at the pace they want to."

But Jones admitted that the "axe is about to fall", regardless of which party or parties come to power. "The question is how quickly and how ferociously."

A Tory minority government would push for a one-year pay freeze for public sector employees in 2011, excluding those earning less than £18,000.

If Labour forms a coalition government with the Liberal Democrats, pay increases for public sector employees would likely be capped. Labour proposed a 1% cap on increases for 2011-12 and 2012-13 and the Lib Dems proposed a £400 cap on increases initially for two years.

"My view is that there is enough of an affiliation between Labour and the Lib Dems for them to work together to produce a coherent government – that would be the ideal, as they tend to be more supportive of social care," said Jones.

A spokesperson for Unison, which represents 40,000 social workers across the UK, added: "A Tory minority government would still go ahead with plans to cut faster and deeper, hitting public spending and public services harder than the Lib-Lab alternative.”

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Hung parliament means uncertainty for social care

Hung parliament may further delay care funding reform

Unions slam Tory proposals to freeze social workers' pay

http://www.communitycare.co.uk/Articles/2010/05/07/114444/public-sector-...

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Rising to the challenge: health priorities for government & NHS

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Liberal Democrat influence good news for social care

An election pact with the Liberal Democrats could force the Conservatives to abandon policies that would have starved social care of money, experts say.

Tony Travers, director of the Greater London Group at the London School of Economics, said the Conservatives could be forced to revise their pledge to spare the NHS from budget cuts.

"Unlike the Tories and Labour, the Liberal Democrats never committed themselves to protecting certain funds," Travers said. "So a pact with the Liberal Democrats would make it easier for the Tories, for example, to spread the cuts more evenly across public services rather than concentrating those cuts in areas like social care to try to protect schools and the NHS."

However, Travers warned that major cuts were inevitable, even if they were postponed until the economy improved, as the Lib Dems have demanded.

Anna Turley, deputy director of the New Local Government Network think-tank, said any pact between the Tories and the Liberal Democrats nationally could also "tone down the thirst for deep cuts to social care and see a more progressive approach".

However, she said that, if a Conservative-dominated government made massive public sector cuts, the increased number of Labour-dominated councils since last week's local elections could spark more fights over funding.

She said that, although the Local Government Association - now under Conservative control - might decide to work with a Tory government to decide how cuts are implemented, councils could be take a harder line in their relationships with ministers.

"It may mean that some individual councils will end up being bolder than the LGA and more prepared to stand up to the government, as we saw happening in the 1980s," Turley said.

One leading social care source said he felt pitched battles over the sector were unlikely because there was consensus that its problems needed to be resolved. "The issues will focus more on short and long-term funding priorities," he said.

"Councils are going to have to take difficult financial decisions and the uncertainty around the national situation means they won't have a longer term context in which to place them. It will probably mean more councils raise their eligibility criteria in adult care, for example."

http://www.communitycare.co.uk/Articles/2010/05/11/114471/Liberal-Democr...

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Sector expects imminent shift on adult social care policy

Social care leaders have predicted a major statement on adult social care funding reform if a Conservative-led government is formed this week.

After the general election result, Association of Directors of Adult Social Services president Richard Jones said social care had "lost the road map" for reform because the result meant Labour could not implement its White Paper, published in March.

The Conservatives opposed the White Paper and the Liberal Democrats rejected parts of it.

Jones said: "What we have in the White Paper is a detailed road map [for reform]. There were three phases laid out there - if we don't have Labour in government you have to assume we lose the detailed map for how we do that."

But with a Lib Dem-backed Tory government now probable, Local Government Association adult social care lead Andrew Cozens said: "Because there wasn't a political consensus about [Labour's] White Paper, I'm anticipating that there will be a White Paper quickly setting out the new government's intentions."

Richard Kemp, the Local Government Association's Lib Dem group leader, said he expected social care reforms to proceed but they would take a different course from that proposed by Labour. However, he added: "I don't think having to start building a new way forward makes that much difference because there was a hell of a long way to go between the [Labour] White Paper and legislation."

If the Conservatives form the next government, their care White Paper would be likely to include plans to allow people to insure themselves against the costs of residential care by paying £8,000 on retirement.

However, Martin Green, chief executive of the English Community Care Association, warned that parties would have to revise their manifesto promises on social care, given that none had an overall majority. He described the whole reform process as being "all up for grabs".

Richard Humphries, senior fellow in social care at the King's Fund, said: "You could argue that if the Lib Dems and Tories can agree on the really big issue to form a government then they should be able to do so on social care."

http://www.communitycare.co.uk/Articles/2010/05/11/114470/sector-expects...

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Conservative and Liberal Democrat health policy Venn diagram

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Improve NHS productivity, but to do what?

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Disabled People’s Priorities for the New Parliament

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Have targets improved NHS performance?

Targets will be remembered as one of the defining features of Labour’s approach to health policy since 1997. However, Labour did not invent targets: the previous Conservative government had set targets in the 1990s – for example, guaranteeing a maximum two-year wait for non-emergency surgery and reducing rates of death from specific diseases. But what was different about Labour’s approach to targets in the NHS (and across the public sector more generally) was the volume of targets and the vigour with which they were performance-managed from the centre. 

There has been particular criticism of the targets for waiting times and the strong performance management that accompanied them – dubbed ‘targets and terror’ by some (Bevan and Hood 2006). However, the strength of the target regime in England is also credited with having driven faster reductions in waiting times than other UK countries between 1996 and 2006 (Connolly et al 2009).

Have the targets that were set for health been met?

The government’s targets were set out in policy documents  – such as the NHS Plan of 2000  – and through Public Service Agreements (PSAs), which set out priorities for the expenditure allocated by Treasury spending reviews. The Department of Health publishes a report every autumn that tracks achievement against PSA targets. Many of the targets have been met or seen considerable progress, with the exception of targets to reduce inequalities in health status. The main targets, with an indication of whether they have been met, are below. Click on the links for more information about each target.

So what’s wrong with targets?

Targets have been blamed for distorting clinical priorities. The Conservative party has claimed that the four-hour target for waiting times in accident and emergency (A&E ) has led to distortions such as holding emergency patients in trolley waiting areas. And media reports based on internal ambulance service documents suggest that some patients have been held in ambulances outside emergency departments to avoid ‘starting the clock’ (Guardian 2008, Telegraph 2009). 

Analysis published by the Information Centre in 2009 found that the number of patients leaving A&E reaches a peak as the four-hour deadline approaches: 66 per cent of patients are admitted to inpatient wards from A&E in the last ten minutes before the four-hour deadline, while the figure for all patients who pass through A&E is 21 per cent.

In relation to the inpatient waiting time target a survey of consultants in eight NHS trusts (The Kings Fund, 2005) found that a ‘significant minority’ of clinicians felt that ‘attempts to meet maximum waiting times targets can clash with their own clinical judgments concerning when to admit patients from waiting lists’. However, the same research concluded that ‘no evidence was found of substitution of lesser for more serious cases’ and that ‘serious and extensive clinical distortions are likely to have been fairly limited’. More recently, Dr Colin-Thomé’s report on failures in emergency services at Mid Staffordshire NHS Foundation Trust concluded that an over-reliance on process measures and targets had come at the expense of focusing on the quality of services provided to patients (Colin-Thomé 2009). But it is very difficult to establish how widespread such problems may be.

Another concern is that targets concentrate resources on one area at the expense of others. Infection control targets, for example, have been successfully met, but apply to a limited range of infections and at-risk populations (Millar M 2009). MRSA, for example, has been the focus of media attention and was the first healthcare-acquired infection for which a target was set, but it accounts for only 2 per cent  of healthcare-acquired infections in the NHS (Millar M 2009).

In summary, enforced targets do appear to have been successful in improving aspects of NHS performance, particularly in relation to waiting times, but there is some evidence of unintended consequences – for example, distortion of priorities or neglect of other non-targeted activities.  However, it is important to recognise that such unintended consequences may not be the inevitable result of targets in themselves, but rather of the particular way in which those targets were designed and enforced.  

Public Service Agreement targets

Life expectancy

Target: By 2010, to increase the average life expectancy at birth in England to 78.6 years for men and to 82.5 years for women.

Current status: Progress According to 2006–8 figures, life expectancy at birth in England continues to increase for both men – 77.7 years – and women – 81.9 years.

Health inequalities

Target: By 2010,to reduce health inequalities by 10 per cent as measured by life expectancy at birth.

Current status: Deterioration The relative gap in life expectancy was 7 per cent wider in 2006–8 than the baseline for men (compared with 4 per cent wider in 2005 –7) and was 14 per cent wider than the baseline for women (compared with 11 per cent wider in 2005–7).

Smoking

Target: By 2010,to reduce adult smoking rates to 21 per cent or less overall and to 26 per cent or less among routine and manual groups.

Current status: Met In 2007 the percentage of the overall population aged 16 or over who smoked was 21 per cent and in the routine and manual occupations it was 26 per cent.

Mortality rates from heart disease

Target: By 2010,to reduce rates of death from heart disease and stroke and related diseases by at least 40 per cent in people under 75.

Current status: Met For the period 2006­–8, rate of deaths from circulatory disease in England was 74.8 per 100,000 population, a decrease of 47.1 per cent. 

Inequalities gap in rates of death from heart disease

Target: By 2010,to reduce the inequalities gap in rates of death from heart disease between the fifth of areas with worst health and deprivation indicators (the spearhead group) and the population as a whole by 40 per cent.

Current status: Progress The baseline figures for 1995–7 showed the absolute gap (ie, difference) in deaths from heart disease between the spearhead group and the population of England as a whole was 36.7 deaths per 100,000 population.

For the period 2006­–8 the gap was 22.6 deaths per 100,000 population (a decrease of 38.4 per cent).

Mortality rates from cancer

Target: By 2010,to reduce rates of death from cancer in people under 75 by at least 20 per cent.

Current status: Progress For the period 2006–8, the rate in England was 114.0 deaths per 100,000 population, a decrease of 19.3 per cent.  

Inequalities gap in rates of death from cancer

Target: By 2010,to reduce the inequalities gap in rates of death from cancer between the fifth of areas with worst health and deprivation indicators (the spearhead group) and the population as a whole by 6 per cent.

Current status: Met The baseline figures for 1995–7 showed that the absolute gap (ie, difference) between the spearhead group and the population of England as a whole was 20.7 deaths per 100,000 population.

In 2005–7 the inequalities gap was 18.6 deaths per 100,000 population (an increase from 18.0 deaths per 100,000 in 2005–7, but a decrease of 10.5 per cent since the baseline).

Suicide

Target: By 2010,to reduce rates of death from suicide and injury of undetermined intent by at least 20 per cent.

Current status: Progress The baseline figure is a three-year average rate for the period 1995–7, which showed 9.2 deaths per 100,000 population.

In the period 2006–8, this reduced to 7.8 per 100,000 population (a reduction of 15.2 per cent).

Four-hour wait in A&E

Target: By 2004,to reduce to four hours the maximum wait from arrival in A&E to admission, transfer or discharge.  In 2003 this target was adjusted so that 98 per cent of patients in A&E be seen within four hours.

Current status: Met In the first quarter of 2005, 97 per cent of patients were seen within four hours; currently this figure is 97.8 per cent.

Access to GP services

Target: From 2004, patients should be able to see a primary care professional within 24 hours and a GP within 48 hours.

Current status: Progress In the GP patient survey of 2007/8 87 per cent of patients reported that they had seen their GP within 48 hours. (Information Centre 2009)

Under-18 conception rate

Target: By 2010,to reduce the rate of conception in under 18s by 50 per cent.

Current status: Limited progress In 1998, there were 46.6 conceptions per 1,000 females aged 15–17.

Between 1998 and 2007 England’s rate of conception for females aged 15–17 fell overall by 10.7 per cent.

18 weeks from referral to treatment

Target: By 2008,no one should wait more than 18 weeks from GP referral to hospital treatment: 90 per cent of patients admitted to hospital for treatment and 95 per cent of those not admitted should receive consultant-led care within 18 weeks unless it is clinically appropriate not to do so, or they choose to wait.

Current status: Met Latest data (2009) shows that 93 per cent of admitted patients and 98 per cent of non-admitted patients began treatment within 18 weeks. The median length of wait was 8 weeks for admitted patients and 5 weeks for non-admitted patients. 

Patient experience

Target: To secure sustained national improvements in patient experience as measured by independently validated surveys.

Current status: Limited progress Measurement of this target is through the National Patient Survey, which asks patients about their experience of care. For the 2009 Department of Health annual report, improvement was measured on two surveys:

  • the adult inpatient survey showed an increase on the baseline with a score of 76.0 against a baseline of 75.3 (2007/8)
  • the emergency department user survey score was 75.7, a slight decrease on the baseline score of 75.8 (2004/5)

Mental health services

Target: To improve life outcomes of adults and children with mental health problems through year-on-year improvements in access to crisis and child and adolescent mental health services (CAMHS).

Current status: Met The percentage of primary care trusts reporting that they provide: a full range of CAMHS; access for 16 to 17 year-olds; 24-hour cover and a full range of universal services by local authority/PCT rose from 13 per cent to 27 per cent from 2008/9 to 2009/10.

MRSA rates

Target: The total number of cases of MRSA in each of the years 2008/9, 2009/10 and 2010/11 should be below 3,850 (half the 2003/4 baseline) for each year.

Current status: Met In 2003/4 7,700 cases of MRSA were reported.  The total number of cases reported in 2008/9 was 2,935, which is 24 per cent below the 50 per cent baseline year reduction target.

Clostridium difficile rates

Target: In 2010/11 the number of cases ofC. difficile should be 30 per cent less than the figure for 2007/8.

Current status: Met In 2007/8 55,498 cases of C. difficile were reported.  The total number of cases reported in 2008/9 was 36,095 which is 7 per cent below the 30 per cent 2010/11 baseline year reduction target.

Sources:  Department of Health Autumn Report 2008 & 2009, PSAs 2002, 2004, 2007

http://www.kingsfund.org.uk/general_election_2010/key_election_questions...

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RCN welcomes focus on improving public health and reducing healt

RCN welcomes focus on improving public health and reducing health inequalities.

The Royal College of Nursing welcomes the focus on improving public health and reducing health inequalities in the Queen’s speech to Parliament today. However, the RCN is urging the government to engage in meaningful dialogue with nurses to see how this can be best achieved.

The RCN says that nursing staff are key to considering how best to improve care while achieving financial savings because they spend the majority of their time in contact with patients.

RCN Chief Executive & General Secretary Dr Peter Carter welcomes the focus on improving public health and reducing health inequalities as supporting patients to improve their own health is an integral part of nursing.

“The RCN has said that specific resources need to be targeted at reducing health inequalities by providing public health information, tackling the root causes of ill health and promoting healthy lifestyles,” says Dr Carter.

The RCN looks forward to working with the government on the details of these proposals.

http://www.rcn.org.uk/newsevents/news/article/uk/rcn_welcomes_focus_on_i...

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NHS London chairman quits over government policy change

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Freeing the NHS from politics
The proposal to set up an NHS independent board has long been a Conservative party ambition. It is likely that yesterday’s promised health bill will include provisions to establish an independent NHS board as part of the government’s aim to replace the ‘top down approach’ with devolution of power to doctors and patients, and to rid the NHS of political micro-management.

In 2007 the Conservative party published a document – NHS Autonomy and Accountability – which set out in more detail their ideas for an NHS board. Does this give clues as to how it might work in practice?

The board’s stated aim at that time was to ensure consistent standards and access to care across the country and to reduce political interference, which was seen to distort clinical priorities and reduce autonomy of NHS clinicians. Recent announcements have stated its two main functions will be to allocate resources and provide commissioning guidelines, suggesting that the proposals are broadly in line with earlier ideas.

But will an independent board deliver the promise of reduced politicisation of the NHS and increased autonomy?

Our earlier report, Governing the NHS, suggested that it would be challenging for an NHS board responsible for such a significant proportion of public expenditure to avoid coming under political pressure. The current economic context suggests this is likely to be more difficult, with Treasury colleagues no doubt keen to keep close tabs on public spending. It also argued that reduced micromanagement of NHS commissioning was desirable, with a greater focus on outcomes and population health, but that there was no guarantee that a board would resist intervening where local commissioners were failing. In the current context there are likely to be high profile instances where commissioners decide to disinvest in local services. It is difficult to see how a board would not come under some political (or public) pressure to intervene in these cases.

While the ambition to put patients and clinicians at the centre of the NHS and to reduce political interference is a noble one, only time will tell whether an independent board can be just that –independent.

http://www.kingsfund.org.uk/blog/freeing_the_nhs_from.html

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Coalition plans could test health and social care links

Moves to integrate health and social care in England may be put to the test under coalition government plans for primary care trusts and GPs, it has emerged.

Though the government has not explicitly promised this, the NHS Confederation is predicting the creation of fewer and larger PCTs that would cover a number of local authorities.

Shared boundaries between individual PCTs and councils - which apply in most cases - have historically been seen as important in driving integration.

The coalition's programme for government outlines plans to cut NHS administration costs by a third, which the confederation said implied reductions in PCT numbers.

The coalition also plans to shift a number of PCTs' existing commissioning functions to GPs or GP consortia, with PCTs commissioning "residual services" that are best undertaken at a wider level and taking greater responsibility for public health.

Jo Webber, deputy director of policy at the NHS Confederation, said this pointed to councils developing a closer relationship with GPs, saying there was a "strong likelihood" of more social workers being based in GP practices.

Steve Field, president of the Royal College of GPs, also predicted more social workers being based in GP surgeries. He added that it was sensible to allow GPs to commission care as they were at the "front end" of primary care.

Field said the college had been encouraging the concept of federations of practices for many years and added that it was time to see closer working between GPs and local authorities along the lines of councils' current links with PCTs.

However, he added that it was important to maintain the close links developed between PCTs and local authorities, with councils set to have an enhanced role within public health under the coalition's plans.

Andrew Cozens, the Local Government Association's strategic lead for adult social care, added it was unclear what the changes would mean for the relationship between local government and the NHS in children's services.

Other coalition plans include for PCTs to have board members who are directly elected and others appointed by local authorities. Currently all are appointed centrally.

Related stories

Personalisation grant saved from cuts, ministers confirm

Social workers in surgeries will not work

http://www.communitycare.co.uk/Articles/2010/05/28/114618/Coalition-plan...

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Harnessing the benefits of the independent sector:

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NHS cuts 'haphazard', doctors say/MPs express concerns over NHS

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NHS chiefs advertise for 'cost-cutting' adviser.. at £1000 a day

Hospital bosses are advertising for an adviser to help decide which jobs to axe to save money - and will pay £1,000 a day for their services. The so-called 'turnaround' director will earn twice as much as the Prime Minister to oversee 'efficiency and cost-saving measures'. Details of the lucrative salary came as the NHS is being forced to make spending cutbacks, with frontline staff at risk. Campaigners warn that hundreds of doctors and nurses already face redundancy despite Government pledges to protect the overall health budget from cuts. The advert for the £1,000-a-day post was placed by Mid Essex Hospital Services NHS trust and circulated among head-hunting agencies last week. It reads: 'In light of the pressures the NHS is facing, our client requires a turnaround director with a strong financial background to lead on a number of efficiency and costsaving measures.' The successful applicant will be based at the Broomfield Hospital, Chelmsford, and will work for at least six months earning the equivalent of £261,000 a year.

This compares to the £142,000 annual salary earned by David Cameron and the £259,999 paid to NHS chief executive Sir David Nicholson. Critics point out that if the hospital did not hire the consultant in the first place, bosses. ALL overseas doctors who want to work in the UK should be made to pass strict language and competence tests, a medical leader has said. The call follows a number of scandals involving foreign doctors that have resulted in the deaths of NHS patients. At present doctors from the EU are exempt from checks on their English and clinical skills, which are mandatory for medics from elsewhere in the world.

But Dr Hamish Meldrum, chairman of the British Medical Association council, called for tighter controls, saying patient safety was being jeopardised by EU rules designed to promote free movement of labour.
Dr Meldrum said the death of retired engineer David Gray, 70, after being given ten times the normal dose of diamorphine by German locum Dr Daniel Ubani had shocked British doctors. Dr Ubani, who had snatched just a few hours of sleep after flying in to work his first shift for a private probably would not need to make so many cuts. John Lister, from campaign group London Health Emergency, said: 'We've got to the point where we're spending more money sacking staff than we are caring for patients. 'There are enough managers employed by trusts as it is - they shouldn't need to take someone on to cut staff. 'For those who do lose their jobs it will rub salt in the wounds knowing that the person who helped get rid of them is earning £1,000 a day.' Matthew Elliott, chief executive of the TaxPayers' Alliance, said: 'If you want to employ someone to cut costs, they should simply be paid a percentage of the savings they achieve. 'This is yet more evidence that the NHS does have waste within it that can be cut out.' The Health Service has been ordered to cut £20billion from budgets by 2014, with frontline staff expected to bear the brunt.

Yesterday a report by the British Medical Association found some hospitals are axing up to 500 staff over the next year, including 170 nurses. Separate figures earlier this year found that up to 36,000 hospital jobs are under threat, including 2,000 nurses and 650 doctors. Campaigners also fear that patient care - and even lives - will be affected.  Some GPs have already been told to restrict treatment of varicose veins, hernias and skin lesions. However, many trusts are still recruiting for posts seen as 'non jobs', such as website editors and 'change facilitators'.  Luton and Dunstable NHS Trust is advertising for a £40,157-a-year sustainability officer to implement energy-saving initiatives. Oxford and Buckingham Mental Health Trust is recruiting a 'change facilitator' earning up to £34,189 a year.

Royal Brompton and Harefield NHS trust is looking for a website editor for £46,374. Lambeth Primary Care Trust is seeking two members of staff to help discourage people from smoking, earning up to £40,000 a year. 

A spokesman for Mid Essex Hospital said: 'We face significant financial challenges this year so decided to seek short-term, external support to help us deliver our efficiency and cost-savings plan. 'We are looking for a highly experienced individual with a proven track record of delivering results.'

http://www.taxpayersalliance.com/media/2010/06/daily-mail-nhs-chiefs-adv...

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Featherstone: Government 100% committed to completing the journe

Featherstone: Government 100% committed to completing the journey to LGB and T equality

Home Office Equalities Minister Lynne Featherstone today set out the Government’s ambitious plans to tackle homophobia and transphobia and promote equal rights for all.

Speaking to the Trade Unions Congress (TUC) LGB and T conference ahead of Pride London 2010, the Lynne Featherstone stressed that the battle for equality is far from over and promised that the Government would do everything in its power to protect LGB and T people from discrimination.
 
The Minister highlighted the Government’s plan of action for the LGB and T community - the first of its kind to be published by any British government - which includes commitments to support businesses in protecting LGB and T people from discrimination in the workplace and tackle homophobic and transphobic bullying in schools.
 
Lynne Featherstone will join fellow Home Office Minister Nick Herbert in the Pride London 2010 march on Saturday and both Ministers will address the Pride crowd at a rally in Trafalgar Square. Spectrum, the Home Office’s own LGB and T group, will have a float in the parade, celebrating the Home Office’s role as a diverse employer.
 

Minister for Equalities Lynne Featherstone said:
 
"The Government is 100% committed to completing the journey to full LGB and T equality. We have made clear our determination to tackle discrimination and make this country a more tolerant, equal and fair place for everybody.
 
"We are committed to taking action to support LGB and T people, including changing the law so that historical convictions for consensual gay sex with over 16s won’t be disclosed on a criminal record check, and using our international influence to speak out against human rights abuses and for unequivocal support for gay rights.
 
"Changing culture is never going to be an easy task but it must be our ultimate goal if we are to achieve full LGB and T equality. I promise you Government will do their bit."

http://nds.coi.gov.uk/content/detail.aspx?NewsAreaId=2&ReleaseID=414230&...

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Differences in the nation's health revealed

A snapshot of health for each local area comparing key statistics such as life expectancy, deprivation and early deaths from stroke and heart disease has been published today by the Department of Health.

The health profiles will help local authorities, GPs and health services to target their resources effectively to improve the overall health and wellbeing of those who need it most.

The collated summaries show that there are clear variations in health across the country.

Key findings include:

  • Life expectancy for men and women continues to increase.
  • Early deaths from heart disease, stroke and cancer continue to fall.
  • The highest rates of alcohol-related hospital admissions are found in urban areas of the North East and North West, including Liverpool, Newcastle and Middlesborough.
  • There are higher rates of malignant melanoma skin cancer in the South West and South East, including Plymouth, Weymouth and Portland, and Oxfordshire.

This vital information will support the Government’s focus on prioritising prevention in public health issues and empowering clinicians to make decisions at a local level. Patients will be at the heart of local services in order to improve their overall health outcomes and make the demands of the NHS more sustainable.

Public Health Minister Anne Milton said:

"These figures are an excellent way for people to find out more about the health of their local population. It is great to see that we are living longer and that early deaths from heart disease, strokes and cancer are decreasing.

“But the differences in health from area to area are still too varied. Everyone should have the same chance to have a healthy life no matter where they live. I hope that this information will help clinicians, local authorities and community groups to think about what needs to be done to help make that change happen."

The profiles reveal different health priorities for each area, demonstrated using a ‘spine chart’. The spine chart shows how one area compares to all other areas in England, through a set of 32 health measures. Each area profile also includes a text summary highlighting priorities for the area, and interactive maps and charts with information about local people’s health. 

South East Public Health Observatory director, Dr Alison Hill said:

“Health Profiles give a picture of local people’s health for every area in England.  They help to start community discussions about what services are needed and how they should be provided.  The profiles encourage people to engage with public health issues by providing complex health related data in a clear, accessible format.”

Now in their fifth year, Health Profiles will help highlight inequalities by identifying some of the key factors that cause them – for example, adults who smoke, GCSE achievement, and child obesity. Last year, Nottingham City Council used Health Profiles to alert councillors and MPs to the challenges within their area and adapt training programmes for their local partners.

Other examples of where these have been used across the country include highlighting the need for smoking cessation services; alcohol harm reduction; provision of parenting support; and prioritising issues for local councillors.

The profile reports are available online through the Health Profiles website at www.healthprofiles.info . The website also provides interactive maps and charts which allow users to create their own comparisons between indicators and between local authorities.  

ENDS

Notes to editors


  1. For further information please contact the Department of Health Newsdesk on 0207 210 5221
  2. The Health Profiles are produced by the Association of Public Health Observatories (APHO) for the Department of Health, using the most up to date data available.  They are designed to be clear and accessible for councillors and community organisers who may not be familiar with technical health data.
  3. There is a profile for each local authority in England: District Councils, County Councils, Unitary Authorities, Metropolitan Districts and London Boroughs.
  4. The local authority and county level profiles are part of a ‘family’ which includes information produced at regional and national level. The Regional Health Profiles are also produced by APHO and were last published in January 2010.
  5. The Health Profile of England is the national chapter of this family and was last published in March 2010 and can be found at the following web-link:  http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsStatistics/DH_114561.

Case studies

Nottingham City Council and Nottingham City NHS

"NHS Nottingham City and Nottingham City council used Health Profiles to alert elected members and MPs to the challenges within their area, and help them understand the interdependency of factors that affect health outcomes.  The profiles helped to initiate a full council debate on health, which resulted in cross party adoption of a number of key upstream actions that the council elected members would previously not have considered their areas of responsibility." 

"Profiles were also used as key material for Nottingham City's nationally recognised interagency health inequalities training (HSJ finalists) and also in local procurement and provision training for our third sector partners".   

Dr Chris Packham, Director of Public Health, Nottingham City NHS

http://nds.coi.gov.uk/clientmicrosite/Content/Detail.aspx?ClientId=46&Ne...

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GENERAL ELECTION 2010: Achieving a fair deal for mental health

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Health Secretary sets out future of public health

In his first speech on Public Health, Health Secretary Andrew Lansley today set out his vision for a new Public Health Service that will release all of society to work together to get healthy and live longer.

Speaking at the UK Faculty of Public Health’s annual conference, Mr Lansley explained the philosophy behind the new approach and outlined what the framework required to deliver more effective Public Health might look like.

The plans to create a healthy nation are centred on a whole new approach which focuses on behaviour change; and which goes beyond constraining the supply of illegal drugs, alcohol and tobacco, and begins to understand and influence the drivers of demand.

The framework of empowerment includes:

  • A new responsibility deal between Government and business built on shared social responsibility and not state regulation;
  • A new ring-fenced public health budget;
  • A new ‘Health Premium’ to target public health resources towards the areas with the poorest health;
  • Clear outcomes and measures to judge progress alongside NHS and social care outcomes;
  • An enhanced role for Public Health Directors so they have the resources and authority to improve the health of their communities; and
  •  A new Cabinet Sub-Committee on Public Health, chaired by the Health Secretary, to tackle the drivers of demand on the NHS.

A White Paper, to be published later this year, will set out in more detail how the Public Health Service will work.

In his speech, Mr Lansley said:

“For too long our approach to public health has been fragmented, overly complex and sadly ineffective. We want to free the system up – to create a framework which empowers people to make the changes that will really make a difference to the nation’s lives.

“Working with communities and schools to develop young people’s confidence and self-esteem. Seeing diet, exercise and education about drugs, alcohol and smoking not as an end in itself, but as a means to an end, to empower young people to take better decisions when young, so that they enjoy greater health and well-being though life.

“This is why we need genuinely local strategies, based in neighbourhoods and schools. This is why we need to throw off the old ways and start seeing people and families as a whole, using local voluntary and charitable organisations more, cutting across boundaries, encouraging innovation, utilising the power of technology, joining up professions and budgets and putting the people – not the system – at the heart of the strategy. Making us all accountable for results, not for processes.

“My vision is for a new Public Health Service which rebalances our approach to health, and draws together a national strategy and leadership, alongside local leadership and delivery and, above-all, a new sense of community and social responsibility.

“We will not be dictating the ‘how’ when it comes to achieving better public health outcomes. But we will be very clear about the ‘what’ – what we want to measure and achieve, such as: increases in life expectancy, decreases in infant mortality and health inequalities, improved immunisation rates, reduced childhood obesity, fewer alcohol related admissions to hospital, and more people taking part in physical activity.”

http://nds.coi.gov.uk/clientmicrosite/Content/Detail.aspx?ClientId=46&Ne...

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NHS London's Pacesetters Conference - Commissioning for Differen

NHS London's Pacesetters Conference - Commissioning for Difference -

This event was held on 31 March 2010 and was attended by over 150 NHS and Local Authority professionals working in healthcare commissioning, public health and equality and diversity roles. The day was an overwhelming success with delegates impressed by the structure and content of the various conference and workshop sessions, all of which dealt with the need to reduce health inequalities in London.

If you attended the conference and didn't have a chance to provide feedback, you can download the feedback form here. Please either email your feedback to Maria Kyriacou, Pacesetters Strategy Manager at NHS London - Maria.Kyriacou@london.nhs.uk - or post the form to Maria Kyriacou at NHS London, Southside, 105 Victoria Street, London SW1E 6QT.

If you need speakers' PowerPoint slides, you can download them from this page by clicking the session name below.

Notes from the main conference

Notes from the workshop sessions

The Pacesetters Programme is funded by the Department of Health and is an initiative to reduce discrimination on account of age, disability, ethnicity, gender, religion, sexual orientation and gender identity in NHS services.

http://www.london.nhs.uk/news-and-health-issues/news/latest-news/commiss...

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Review into Palliative care funding

A new review into the funding of palliative care was announced today by the Secretary of State for Health, Andrew Lansley, in a speech to the International Carers Conference in Leeds.

The review, chaired by Tom Hughes-Hallett, Chief Executive of Marie Curie Cancer Care, will look at how Government can make sure that the money intended to help look after people who are approaching the end of life is spent in the right way.

This will better enable patients to choose how and from whom they receive their end of life care. The review will make recommendations for a funding system that will cover care provided by the NHS, a hospice or any appropriate provider:

•         which encourages more community-based care, so a patient can remain in their own home; and

•         that will be fair and transparent to all organisations involved in palliative care.

The review will cover both adults’ and children’s services and will report back by summer 2011.

Secretary of State for Health Andrew Lansley said:

“Having a terminal illness is a very distressing time for individuals and their families. People should be able to choose where they are cared for - most would choose to be cared for at home, surrounded by their friends and family – and be certain that the care they receive will be of the highest quality.

“This review will look at how we better deploy the money we spend on palliative care – so those in need are better supported. We intend that whatever care patients choose will meet their needs and wishes.”

Care Services Minister Paul Burstow, who yesterday visited St Ann's Hospice in

Heald Green, said:

“Everyone who is seriously or terminally ill should be properly supported. I have been to the St Ann's Hospice in Heald Green to see for myself the work that is going on and to meet families that use the services.

“The Government is committed to more personalised care for people at the end of life. Just last month we made this clear through confirming that £40 million will be invested to help hospices improve the environments where they provide care and support for patients, their families and carers.

"I am delighted that we are today taking the first step to honouring our commitment to introducing a new per-patient funding system for all hospices and providers of palliative care.”

Tom Hughes-Hallett said:

"I am delighted to have been asked to lead this important review. Good quality palliative and end of life care is so vital for patients and families. We need a funding system which is fair and encourages the provision of the right services to patients and families where and when they want them. It must also be fair to the full range of providers. "

Notes to editors


Any recommendations will be considered in the context of the Spending Review.

Professor Sir Alan Craft has been asked to be part of the review to cover children's services.

As well as £40 million to help hospices improve the environments where they provide care and support for patients, their families and carers, £30 million has been made available for this year to help children's hospices, networks and other providers develop local children's palliative care projects.

About 500,000 people die each year in England.

At present, around 56.8% of deaths occur in hospital, around 19.5% at home, around 16.6% in care homes (which for many is their home) and around 5.2% in hospices.

Surveys of the public have shown that the first preference for most people (56-74%) would be able to die at home.

Progress since publication of the End of Life Care Strategy shows a slow decrease in the number of deaths in hospital and a slow increase in deaths at home and in care homes.

http://nds.coi.gov.uk/content/detail.aspx?NewsAreaId=2&ReleaseID=414349&...

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