Should be modelled on successful screening programmes

Covid-19 outbreaks in care homes expose serious inadequacies in social care services across the UK. Data from across the world show that deaths from covid-19 mainly occur among older people, particularly those over 80. 1 By 12 April 10 612 deaths had been reported in the UK 2-40% of deaths have occurred in those aged 60-79 and 52% in those 80 years or over. 3 Close to 1.5 million vulnerable people are currently self-isolating indoors for 12 weeks. 4 These include many older people and people with disabilities and chronic illnesses. Many are essentially in solitary confinement. Many residents in care homes are trapped in their rooms, with no visits from relatives and minimal interactions with staff. The decision to exclude relatives means that care homes have become closed institutions, increasing the risk that people are inappropriately denied hospital admission as well as the risk of neglect and abuse. 5 6 Of equal concern are plans to transfer patients recovering from covid-19 from the NHS into empty nursing home beds. 7 Editorials EDITORIALS

Objective Multimorbidity (the coexistence of two or more long‐term conditions) is highly prevalent in people who have rheumatoid arthritis (RA). The present work systematically reviewed the literature to determine the effect of multimorbidity on all‐cause mortality, functional status, and quality of life in RA. Methods Six electronic databases were searched: CINAHL, The Cochrane Library, Embase, Medline, PsycINFO, and Scopus. Full‐text longitudinal observational studies in English were selected. Quality appraisal of studies was undertaken using the Cochrane‐developed QUIPS tool and a narrative synthesis of findings conducted. Results The search strategy identified 5,343 articles, with 19 studies meeting the inclusion criteria. Nine studies had mortality as an outcome, 9 reported functional status and/or quality of life, and 1 study reported both mortality and functional status. The number of participants ranged from 183 to 18,485, with studies conducted between 1985 and 2018. The mean age of participants ranged from 52.0 to 66.6 years, and 60.0–88.0% were female. Nine studies showed a significant association between multimorbidity and higher risk of mortality in people with RA. Ten studies reported significant associations between multimorbidity and reduced functional status in RA. Three studies also showed a further association with reduced quality of life. Only one study investigated the influence of mental health comorbidities on outcomes. Conclusion Our review findings indicate that multimorbidity is a significant predictor for higher mortality and poorer functional status/quality of life in people with RA and should be considered in clinical management plans.

No abstract

A proposed amendment to the law will give special administrators powers to reconfigure health services well beyond those provided by the trusts they are administering. Allyson Pollock and colleagues argue that this will undermine equal access to care in England