ASH Daily News for 2 December 2019


  • Relationships between public health directors and NHSE improve locally whilst weakening nationally
  • Health visitor numbers in England ‘fall by a third’


  • Thai court fines Philip Morris £30.7 million for tax evasion
  • US: Nicotine sickness – the latest vaping scare


Relationships between public health directors and NHSE improve locally whilst weakening nationally

An increasing proportion of directors of public health have reported a negative relationship with NHS England, with particular concern over access to NHS data. A survey of members by the Association of Directors of Public Health, found that relationships with clinical commissioning groups (CCGs) have improved, with 83% saying they are positive compared to 79% in 2017. However, relationships with NHSE continue to be weak. Just 27% said the relationship is positive, the same as 2017, and a greater proportion said it was negative this year (26%) compared to the last survey (15%).

Ongoing issues with access to NHS data, insufficient data sharing arrangements and delays in intelligence sharing were highlighted as particular barriers, with just only over half (55%) reporting they had sufficient access to data. Just 60% of directors of public health in areas with sustainability and transformation partnerships said they felt positive about the role of public health in the process, which has been led by the NHS.

In areas where STPs have developed into integrated care systems, the proportion feeling positive about the role of public health was slightly higher at 68%. There was a drop in positivity about relationships with the nine regional Public Health England centres. In 2017, 87% of respondents said they were positive about relationships compared to 76% this year.

The report added: “Relationships with centres are hugely variable and dependent on local relationships. Issues mentioned continue to be around duplication of work, an imbalance between local and national jurisdiction, and a lack of understanding from PHE centres of the local government context.”

However, the survey received positive feedback on the role of public health within councils. Despite 67% saying they report directly to the council chief executive, compared to 73% in 2015, those who said they had direct access to chief executives increased from 94% in 2017 to 97% this year. The survey, based on responses submitted throughout June and July, found the fall in direct reporting to chief executives “masks a web of complex arrangements where line management does not necessarily reflect access, influence or accountability” and survey results reflected “healthy and increasing levels of influence within local authorities”. A total of 99 responses to the survey were received from directors of public health across the UK, with 71 submitted by those based in England.

Source: Health Service Journal, 2 December 2019

See also: ADPH – ADPH System Survey 2019 Report

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Health visitor numbers in England ‘fall by a third’

The number of health visitors in England has fallen by about a third over the last four years, according to analysis of NHS data by the Labour Party. As of July this year, there were 6,931 full-time equivalent health visitors in England, says the Party, which is a drop of 3,378 since the peak of 10,309 in October 2015, at the end of the national health visitor programme set up by the coalition government in 2011 to boost numbers.

The coalition’s programme said health visitors were crucial to ensuring families got off to the best possible start, going into homes before and after births to help, reassure and pick up problems. Funding for health visitors was shifted to local authorities as part of an NHS reorganisation and became funded through public health budgets, which have been affected by significant cuts. In June, the Institute of Health Visiting published a position paper, voicing concern “about the quality and effectiveness of the service that families are now receiving”. More than a quarter of health visitors (27%) were each responsible for 500 or more children, it said.

Labour says its analysis of NHS England data shows that the number of women who did not get a visit at 28 weeks or later during pregnancy increased by more than 6,000 between 2017-18 and 2018-19. New birth visits were delayed – 11% nationally did not take place within the first 14 days. Across England, 15% of babies missed out on their six- to eight-week review last year, rising to 29% in London. More than 23% of children did not get their one-year review within the first 12 months of life, rising to 39% in London.

Source: The Guardian, 1 December 2019

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Thai court fines Philip Morris £30.7 million for tax evasion

A court in Thailand found the local unit of tobacco giant Philip Morris International guilty of evading taxes by under-declaring the value of cigarettes it imported from the Philippines on Friday 29th November. It ordered the company to pay a fine of 1.2 billion baht (around £30.7 million).

The case began in 2006, when Thailand’s Department of Special Investigation began an investigation after the state’s Excise Department filed a complaint. The case was dropped by Thai prosecutors in 2011 but launched again in 2013.

Thailand´s state prosecutor filed criminal charges in 2017 against the company, accusing it of evading more than 20 billion baht (£511.6 million) in taxes between 2003 and 2006. The case triggered an international trade dispute, with the Philippines charging that Thailand’s import tariffs were unfairly used to give an advantage to the state-controlled Thailand Tobacco Monopoly. The Philippines won a ruling from the World Trade Organization (WTO) that Thai customs authorities were unfair and had not acted according to WTO rules.

Source: Daily Mail, 29 November 2019

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US: Nicotine sickness – the latest vaping scare

In total, over the past year, Sharon Levy, director of the adolescent substance use and addiction programme at the children’s hospital in Boston, Massachusetts, and her team have dealt with 181 cases of teenagers with what’s medically termed “nicotine use disorder” (a tiny fraction of one percent of the teenage vaping population in the US), although she makes it clear that almost all of them have resulted from vaping. In what is becoming known as “nic-sick”, Levy has since seen the number of teenagers suffering from similar nicotine overdoses continue to rise. “Kids vomiting or experiencing headaches is common,” she says. “But it can get even more dramatic than that. I’ve had patients who get dizzy or lose their orientation. Sometimes I’ve even had kids tell me they’re disassociating while vaping, and they suddenly can’t remember where they are” Levy added.

The Food and Drug Administration’s (FDA) recently released National Youth Tobacco Survey found that more than five million American teenagers have used e-cigarette products in the past month, with nearly a million using them daily. The survey found that more than a third of high school students who use e-cigarettes are vaping at least 20 days per month, along with a fifth of middle school users.

Researchers believe that the main reason that teenage vaping is more prevalent in the US than in the UK or Europe is because of a lack of regulation around both the marketplace and advertising. E-cigarette manufacturers in the US have been able to conduct large-scale campaigns through TV, radio and billboards and target younger age groups through social media platforms and YouTube.

Source: The Observer, 30 November 2019

See also: FDA – Results from the National Youth Tobacco Survey

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