A look to die for? How Liverpool council is fighting sunbed obsession

There is strong evidence linking sunbed use to skin cancer, and tanning machines are particularly damaging to people under the age of 35. Photograph: Frank Augstein/AP

A stroll down County Road in Liverpool reveals why the city is often referred to as the sunbed capital of the UK. Shops offering tans sit beside cafes and clothes stores. Now nail salons and hairdressers, even gyms, frequently offer sunbed facilities alongside other services. We estimate there are at least 200 sunbed businesses in the city, but there could be more as these outlets don't have to be licensed.

In Liverpool young people in particular regularly use sunbeds. In 2009 Cancer Research UK revealed half of 15- to 17-year-old girls in the city had used a sunbed, compared to 11% nationally.

One of the key priorities identified by our health and wellbeing board, in its new role, is skin cancer prevention. Skin cancer is the fastest growing cancer among 18- to 35-year-olds and is largely preventable. There is strong evidence that links sunbed use to skin cancer and these tanning machines are particularly damaging to people under the age of 35.

This is why last week we launched a campaign that educates young people in our city about the dangers of sunbeds. The campaign is also asking the government to grant local authorities the power to license sunbed businesses, so we can keep track of where they are and how they are operating.

Our campaign is not just about advertising our message and hoping people will listen, we are looking at the motivations of sunbed users and leveraging the truly collaborative approach to tackling behaviour change that the local authority's new public health role brings.

We involved young girls in the campaign development to get an understanding of why they use sunbeds and to ensure the campaign spoke to them. These girls say they feel better about themselves with a tan. Responding to this insight, we have a fake tan brand supporting the campaign by teaching girls how to use fake tan, to get the tanned look, without the health risks.

We also spoke to mums and discovered many are unaware of the risks themselves and don't speak to their daughters about sunbeds in the same way they would about drinking, smoking or unprotected sex. We'll be educating both teenagers and engaging with their parents via our schools, so they feel confident having these conversations.

It was only recently that councils became responsible for public health, as part of the health and social care bill, but it's already evident the transfer brings advantages. We're able to use the wide range of functions local authorities discharge to change behaviour in our city.

This isn't the first time we've taken a collaborative approach of combining the efforts of the NHS and the local authority in Liverpool.

In 2006 we played a pivotal role in influencing parliamentary vote in favour of legislation on smoking. Now, with public health being the responsibility of the council, there is an even greater opportunity to influence health through almost every area of policy, from planning and licensing to education, housing and economic growth.

We are asking the government to grant all local authorities (not just Liverpool), the power to license sunbed businesses and tighten regulations. We want to work with the sunbed industry to ensure a number of minimum standards are met – such as provision of goggles, skin assessments and approved educative materials about the risks.

We want to protect young people, who are most vulnerable, from the dangers of sunbeds and to ensure the rest of the population can make an informed choice about using them.

We hope that by asking for these powers across England and by sharing our learning we can encourage other authorities to take a similar approach to tackling this problem.

Paula Grey is joint director of public health at Liverpool city council.

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A look to die for? How Liverpool council is fighting sunbed obsession

There is strong evidence linking sunbed use to skin cancer, and tanning machines are particularly damaging to people under the age of 35. Photograph: Frank Augstein/AP

A stroll down County Road in Liverpool reveals why the city is often referred to as the sunbed capital of the UK. Shops offering tans sit beside cafes and clothes stores. Now nail salons and hairdressers, even gyms, frequently offer sunbed facilities alongside other services. We estimate there are at least 200 sunbed businesses in the city, but there could be more as these outlets don't have to be licensed.

In Liverpool young people in particular regularly use sunbeds. In 2009 Cancer Research UK revealed half of 15- to 17-year-old girls in the city had used a sunbed, compared to 11% nationally.

One of the key priorities identified by our health and wellbeing board, in its new role, is skin cancer prevention. Skin cancer is the fastest growing cancer among 18- to 35-year-olds and is largely preventable. There is strong evidence that links sunbed use to skin cancer and these tanning machines are particularly damaging to people under the age of 35.

This is why last week we launched a campaign that educates young people in our city about the dangers of sunbeds. The campaign is also asking the government to grant local authorities the power to license sunbed businesses, so we can keep track of where they are and how they are operating.

Our campaign is not just about advertising our message and hoping people will listen, we are looking at the motivations of sunbed users and leveraging the truly collaborative approach to tackling behaviour change that the local authority's new public health role brings.

We involved young girls in the campaign development to get an understanding of why they use sunbeds and to ensure the campaign spoke to them. These girls say they feel better about themselves with a tan. Responding to this insight, we have a fake tan brand supporting the campaign by teaching girls how to use fake tan, to get the tanned look, without the health risks.

We also spoke to mums and discovered many are unaware of the risks themselves and don't speak to their daughters about sunbeds in the same way they would about drinking, smoking or unprotected sex. We'll be educating both teenagers and engaging with their parents via our schools, so they feel confident having these conversations.

It was only recently that councils became responsible for public health, as part of the health and social care bill, but it's already evident the transfer brings advantages. We're able to use the wide range of functions local authorities discharge to change behaviour in our city.

This isn't the first time we've taken a collaborative approach of combining the efforts of the NHS and the local authority in Liverpool.

In 2006 we played a pivotal role in influencing parliamentary vote in favour of legislation on smoking. Now, with public health being the responsibility of the council, there is an even greater opportunity to influence health through almost every area of policy, from planning and licensing to education, housing and economic growth.

We are asking the government to grant all local authorities (not just Liverpool), the power to license sunbed businesses and tighten regulations. We want to work with the sunbed industry to ensure a number of minimum standards are met – such as provision of goggles, skin assessments and approved educative materials about the risks.

We want to protect young people, who are most vulnerable, from the dangers of sunbeds and to ensure the rest of the population can make an informed choice about using them.

We hope that by asking for these powers across England and by sharing our learning we can encourage other authorities to take a similar approach to tackling this problem.

Paula Grey is joint director of public health at Liverpool city council.

• What do you think? Email sarah.marsh@theguardian.com if you want to contribute an article to this debate.

Not already a member? Join us now for more comment, analysis and the latest job opportunities in local government.

View the original article here

A look to die for? How Liverpool council is fighting sunbed obsession

There is strong evidence linking sunbed use to skin cancer, and tanning machines are particularly damaging to people under the age of 35. Photograph: Frank Augstein/AP

A stroll down County Road in Liverpool reveals why the city is often referred to as the sunbed capital of the UK. Shops offering tans sit beside cafes and clothes stores. Now nail salons and hairdressers, even gyms, frequently offer sunbed facilities alongside other services. We estimate there are at least 200 sunbed businesses in the city, but there could be more as these outlets don't have to be licensed.

In Liverpool young people in particular regularly use sunbeds. In 2009 Cancer Research UK revealed half of 15- to 17-year-old girls in the city had used a sunbed, compared to 11% nationally.

One of the key priorities identified by our health and wellbeing board, in its new role, is skin cancer prevention. Skin cancer is the fastest growing cancer among 18- to 35-year-olds and is largely preventable. There is strong evidence that links sunbed use to skin cancer and these tanning machines are particularly damaging to people under the age of 35.

This is why last week we launched a campaign that educates young people in our city about the dangers of sunbeds. The campaign is also asking the government to grant local authorities the power to license sunbed businesses, so we can keep track of where they are and how they are operating.

Our campaign is not just about advertising our message and hoping people will listen, we are looking at the motivations of sunbed users and leveraging the truly collaborative approach to tackling behaviour change that the local authority's new public health role brings.

We involved young girls in the campaign development to get an understanding of why they use sunbeds and to ensure the campaign spoke to them. These girls say they feel better about themselves with a tan. Responding to this insight, we have a fake tan brand supporting the campaign by teaching girls how to use fake tan, to get the tanned look, without the health risks.

We also spoke to mums and discovered many are unaware of the risks themselves and don't speak to their daughters about sunbeds in the same way they would about drinking, smoking or unprotected sex. We'll be educating both teenagers and engaging with their parents via our schools, so they feel confident having these conversations.

It was only recently that councils became responsible for public health, as part of the health and social care bill, but it's already evident the transfer brings advantages. We're able to use the wide range of functions local authorities discharge to change behaviour in our city.

This isn't the first time we've taken a collaborative approach of combining the efforts of the NHS and the local authority in Liverpool.

In 2006 we played a pivotal role in influencing parliamentary vote in favour of legislation on smoking. Now, with public health being the responsibility of the council, there is an even greater opportunity to influence health through almost every area of policy, from planning and licensing to education, housing and economic growth.

We are asking the government to grant all local authorities (not just Liverpool), the power to license sunbed businesses and tighten regulations. We want to work with the sunbed industry to ensure a number of minimum standards are met – such as provision of goggles, skin assessments and approved educative materials about the risks.

We want to protect young people, who are most vulnerable, from the dangers of sunbeds and to ensure the rest of the population can make an informed choice about using them.

We hope that by asking for these powers across England and by sharing our learning we can encourage other authorities to take a similar approach to tackling this problem.

Paula Grey is joint director of public health at Liverpool city council.

• What do you think? Email sarah.marsh@theguardian.com if you want to contribute an article to this debate.

Not already a member? Join us now for more comment, analysis and the latest job opportunities in local government.

View the original article here

Liverpool care pathway review shows challenges in palliative care

The Liverpool care pathway has been encouraged to avoid unnecessary interventions in the care of people who are dying. Photograph: Voisin/Phanie/Rex Features

The law of unintended consequences can be insidious. The Liverpool care pathway (LCP) has been encouraged over the last decade with the express objective of avoiding unnecessary interventions in the care of people who are clearly dying, and ensuring they achieve a good death. However, it should now be phased out and replaced by an individual end-of-life care plan, according to the findings of the independent review led by Lady Julia Neuberger.

Almost a decade ago, the House of Commons health select committee conducted an inquiry into palliative care and while it supported the take up of tools such as the Gold Standards Framework and the LCP, the committee cautioned "that there are significant challenges in raising the skills and awareness of all healthcare staff in palliative care." The findings of the independent review provide testimony to the continued failures of training around the LCP, with the result that far from providing a model of good practice in palliative care, the LCP too often leads to poor practice – "uncaring, rushed and ignorant".

This is a shocking indictment of the care of people in their final days of life, often very elderly people whose relatives were left with the impression that their life was no longer valued. Withholding food and drink has caused the greatest concern and distress with staff apparently on occasion refusing to allow liquids for people who were thirsty and dehydrated. The review is in no doubt that the failure to provide oral hydration and nutrition "when still possible and desired should be regarded as professional misconduct."

Poor communication with patients and relatives is at the root of many of the failures and criticisms of the LCP, and evidence to the review found significant numbers did not feel involved in discussions about the care plan, or were not given the chance to be involved. People are sometimes not told that a loved one is dying or what they can expect to happen.

Inappropriate use of opiate pain killers and tranquillisers was also the focus of criticism, particularly when this led to a patient becoming drowsy, and relatives left wondering if the use of drugs had hastened death.

The review has recommended that the LCP should be phased out, and this has been accepted by health minister Norman Lamb. However, it is vital not to abandon the core principles which underpin the model. The failure of the LCP has been in its application and poor support; the review found that when used appropriately "patients die a peaceful and dignified death", but that implementation is sometimes associated with poor care.

The clear thinking and pithy recommendations of this review will be welcomed, so too will the speed of response from government. It is clear that when the LCP is operated "by well trained, well-resourced and sensitive clinical teams, it works well." The reverse is also true and the need for new guidance and training for all staff is evident. Nonetheless, existing guidance is not being adequately followed or understood and major cultural change is needed at all levels of health and care to prioritise good quality end-of-life care. The review identifies the need for a strategic approach from NHS England down to clinical commissioning groups, and with the Care Quality Commission taking a lead in reviewing how well dying patients are treated.

It is distressing that what began as a model to raise the quality of care for the dying has too often been reduced to a tick box procedure which takes insufficient account of individual needs or wishes, and where vital care and compassion are absent. It is a tragedy however for families and carers who have lost relatives who have been cared for under the LCP, and for whom there will remain considerable distress and unanswered questions. Did their relative die a hastened death? Did they suffer unnecessarily because of the interpretation of the LCP? And would they actually have been able to live longer and die better without the involvement of the LCP?

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