Casebook - October 2019

October 2019 Edition

In Casebook this month, the restorative qualities of the seaside, the heart attack gender divide, Brexit and medicine shortages and the benefit of user service re-design. Lots of interesting things going on in Other Stuff.


People who live by the sea less likely to experience anxiety and depression, study suggests

This is an interesting article. It provides some small cheer for those beleaguered trusts with a coastal context who find more often than not that it is very difficult to recruit staff.

Living next to the sea is good for your mental health, a new study has found.
Researchers from Exeter University found that those living around half a mile from the coast are less likely to experience mental health problems such as anxiety and depression.

The team say the results suggest the coast may act as a “protective zone” for psychological wellbeing and also highlight the importance of so-called “Blue Health” – the link between health and the natural environment.

For the study, researchers analysed data on more than 26,000 Brits taken from the Health Survey for England.

The physical and mental wellbeing of the participants was then compared to their proximity to the coast.

After adjusting for external factors, the scientists found people who live less than a kilometre from the coast are around 22 per cent less likely to have symptoms of a mental health disorder, compared to those who live 50km or more away.
For those from low income households who live less than a kilometre from the coast, the impact is even greater with people around 40 per cent less likely to have symptoms, than those earning the same amount living more than 50km away.

Published in the journal Health and Place, the findings suggest access to the coast could help to reduce these health inequalities in towns and cities.

Full details:

‘Heart attack gender gap’ causing needless deaths of women, charity warns

With a far higher proportion of older women in rural areas there is no doubt that this is a serious issue to address in rural settings. This story tells us:

A “heart attack gender gap” is resulting in needless deaths of women because they do not receive the same treatment as men, a charity has warned.

The British Heart Foundation (BHF) has released a new briefing titled “Bias and Biology: How the gender gap in heart disease is costing women’s lives”.

A study funded by the charity and conducted by researchers at the University of Leeds found that, over a 10-year period, more than 8,200 heart attack deaths among women in England and Wales could have been prevented if they had received equal treatment to men, equating to two deaths a day.

The research also showed that women are 50 per cent more likely than men to initially receive an incorrect diagnosis when they are experiencing a heart attack.
The BHF warned that while heart attacks are widely perceived as a “man’s disease”, twice as many women die from coronary heart disease than from breast cancer.

Full details:

Medicine shortages force government to limit HRT drug exports

As Brexit starts to loom again, I fear an increasing range of poorly planned for risks will begin to emerge. This story tells us:

The government will restrict exports of key drugs, including those used for hormone replacement therapy (HRT), after manufacturing problems caused medicine shortages in the UK.

HRT stocks will remain in the country until the manufacturing issues are resolved.

The Department of Health and Social Care (DHSC) has also permitted pharmacists to provide different strengths of fluoxetine, an antidepressant, after most strengths of the drug went out of stock.

“I know how distressing medicine shortages can be for those who rely on drugs like HRT and it’s absolutely crucial patients can always access safe and effective treatments through the NHS,” said Matt Hancock, the Health Secretary.
“Helping the NHS is a priority for this Government, and people should be fully reassured that we will always act to ensure that there is an adequate supply of the medicine you need.”
Full details:

Brexit may have 'gravest of consequences' for health: UK lawmaker

An interesting view of Brexit and health issues from Canada – this story tells us:

Britain's looming exit from the EU carries real risks that medicines and healthcare supplies will be delayed, the UK's public spending watchdog said on Friday, and an influential lawmaker said a no-deal Brexit may have the "gravest of consequences".

While Prime Minister Boris Johnson's government has taken some steps to manage the risks, the National Audit Office (NAO) said in a report, there is still significant work to be done.

Lawmaker Meg Hillier, who chairs parliament's public accounts committee, said the report was "deeply concerning".

The health ministry "still doesn't know whether all stockpiles are in place", she said, has no idea whether social care providers such as nursing homes for the sick and elderly are ready, and is not sure whether freight capacity needed for medical imports will be in place on time.

"If (the) government gets this wrong, it could have the gravest of consequences," Hillier said in a statement about the NAO report. She added that as head of the committee, she had already seen "countless examples of deadlines missed and government failing".

Johnson has vowed to take Britain out of the EU with or without a deal by Oct. 31 - increasing the chance of a sudden departure that will bring trade tariffs and customs checks with the continent for the first time in decades.

The risk is acute for health and social care services, as well as for the pharmaceutical industry, with 37 million packs of medicines imported into Britain from Europe every month.

Full details:

A chance to have my own voice': the care users redesigning support

In a slight change of theme I offer you this article, inspired by my recent trip to 65 High St Nailsea where community and service user planning, in a small hub town are key activities. This write up relates to Essex but the same is true of an increasing number of places where harnessing the user voice is driving out efficiencies. This happens where organisations are brave enough to listen to what people want rather than making choices for them. It tells us:

During the collaborative project between April and July, Sayer helped Essex county council create a health and care “one-stop shop” at a community venue in her Saffron Walden neighbourhood. This encourages learning disabled or autistic people to get help and information without visiting council offices. At a single session, 20 people got advice from professionals including social workers, voluntary sector care providers and employment advisers. The sessions now run monthly.

Sayer also helped launch an “easy read” (accessible) magazine featuring local events. “It’s a great way for people with autism and learning disabilities to find out about local news, events and jobs and services that might help them,” she says. The magazine was designed and printed by learning disabled people and there are plans for a regular publication produced by a permanent editorial team. These projects aim to boost support, opportunities and community connections.

The project in Essex was part of the 100 day challenge, a programme run by innovation charity Nesta that looks for alternatives to traditional top-down health and care support. Launched five years ago, the challenge encourages frontline health and care professionals to imagine new ideas, influenced by people who use services. Essex county council is the latest to follow the method and features in a new Nesta report.

The work involved communities in Saffron Walden, Canvey Island and Colchester. Among the new projects influenced by learning disabled people in Colchester, nine young people with learning disabilities ran book club sessions that are now being rolled out to three schools and a leisure centre. The launch of an inclusive cricket match in Canvey Island – an idea from a learning disabled sports fan – sparked weekly events at a leisure centre and plans for inclusive matches at a cricket club.

Full details:

Other Stuff


In collaboration with the Rural Services Partnership we are holding an AGM on 3 December in London. This will be an opportunity to hear more about our work in detail and to network with some of the 70 RHCA members who all share our collective vision. We will also have a keynote speaker on the challenges of rural service delivery in health and care. The event, which is scheduled for lunchtime, is free to attend. If you would like to join us please email:

Rural Proofing Toolkit

In partnership with Rural England the National Centre is just beginning to plan the development of a Rural Proofing Health Toolkit. The team also includes a representative from Nuffield Trust.  We are interested in opportunities to test and work up case studies around this initiative. If you would like to get involved from either of these perspectives please contact:

RHCW Conference 2019 – Rural Resilience in Health and Care, communities and individuals

The third annual RHCW Conference is taking place on the 5th and 6th November 2019 at the Royal Welsh showground, Builth Wells, Powys, with over 25 presentations on a broad range of topics, from training and recruiting health and care staff in rural areas to practical examples of innovative projects and research taking place across Wales, the UK and as far afield as the USA and Australia.

An Agenda for the Conference is attached, with on-line booking available here:

Parliamentary Inquiry – Session 5

This was held on 9 September on the theme of Education and Training and featured a number of inspiring presentations including from Sir Tom Hughes-Hallett on the work of Helpforce ( ).
You can view the notes here:

The next session on 9 November at the House of Commons is on systems based approaches and if you would like to attend as part of the audience (with an opportunity to contribute views) please contact:


Our latest free seminar on place based approaches to rural health and care was a big hit. We held it in Nailsea and you can access the presentations here:

The next seminar on delivering services differently is already fully booked (in Preston on 7 October) but I will make you aware in the next copy of Casebook so that you can access the slides.

We have upcoming seminars in Lincoln on Technology on 12 November and at Hambleton District Council on connectivity on rural transport on 9 December.  If you would like to book please contact:


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