October 22, 2014

Employers welcome King’s Fund report about more consultant doctors in the community

NHS Employers has welcomed the King’s Fund report ‘Specialists in out-of-hospital settings: findings from six case studies’, published today

Gill Bellord, director of employment relations and reward at the NHS Employers organisation, said:

“This is a useful report and we agree that consultant doctors have the potential to provide more care in a community setting, where it is best for the patient. Employers and consultants have shown their support for innovation – and the job planning process, both at team and individual level, is a good way of discussing and agreeing new ways of delivering services to meet ever-changing patient needs.

“This is early days and the NHS will want to explore relevant demand from commissioners and how training would be re-shaped to make this happen. However, the systems behind how they work needs to be modernised and quality care delivered in a cost-efficient way. So more work will be needed to take this forward in a sustainable way.”

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October 21, 2014

Smoking rates continue to fall in the UK

The Office for National Statistics latest survey, the Integrated Household Survey, shows that the prevalence of smoking in the UK fell from 19.8% in 2012 to 18.7% in 2013.

The study which surveyed over 260,000 adults found that 16.5% of women smoked compared to 21.1% of men. Men were more likely to be current smokers than women across every age group. Smoking decreased in England, Scotland and Wales but remained the same in Northern Ireland. Scotland reported the highest overall smoking rate of 21.1% , and England the lowest of 18.4%.

Looking at the different regions of England the survey data showed a north-south divide with smoking prevalence in London, the South East and the South West being significantly lower than in the North East, the North West and Yorkshire and the Humber.

George Butterworth, tobacco policy manager at Cancer Research UK, welcomed the news of the falling rates but warned that smoking rates will not continue to fall unless the government safeguards NHS smoking cessation services, and protects children from tobacco industry marketing by introducing plain, standardised packaging of tobacco products without delay.

The ONS survey also collected information on perceived general health and found that across the UK, 75.9% of adults said that they were in good general health in 2013, a similar level to that in 2012. Current smokers were less likely to report good general health than those who had never smoked. Among adults aged 50-64 years who were current smokers, 56.7% considered themselves to be in good health compared to 75.9% if adults who had never smoked.

BMJ 2014; 349:g6113

Editorial comment. It will be interesting to see in future surveys the impact of electronic smoking on the prevalence rates. And how much further can smoking prevalence fall before reaching an irreducible minimum?  Paul Walker.

 

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October 13, 2014

Malnutrition: the quiet epidemic that’s sweeping the nation

We are constantly confronted with media reports focusing on the current ‘obesity epidemic’, and the dangers of consuming too much sugar, salt and fat are widely broadcast. However, this focus on the need to tackle obesity has overshadowed a hidden crisis that affects millions nationwide: malnutrition.

 Dangers of malnutrition

 Over three million people in the UK are malnourished or at risk of malnutrition, and our elderly population is particularly at risk – over one million of those affected are aged over 65. The danger of this can’t be overstated, because malnutrition has serious implications for the health issues older people often face: it has the power to exacerbate on-going health issues such as frail bones and muscles, wound healing or a weak immune system, and can lead to problems absorbing medication.

 Malnourished people typically visit their GP twice as often as those who are getting a healthy, well-balanced diet. Malnutrition also contributes to a ‘revolving-door’ phenomenon amongst some hospital patients, who are discharged but subsequently become ill again as a poor diet inhibits their recovery at home – and are ultimately re-admitted to hospital.

 Why are our elderly malnourished?

 An elderly person might be under-nourished for various reasons: some older people living alone might not like to cook for just one person, or those who are frail might not feel confident going out of the house to the shops. However, one driving factor is the way we talk about diet and health, both in the media and in the health advice given by public bodies and the government.

 With the current focus on tackling obesity, there is a tendency to apply a very prescriptive, ‘one size fits all’ perspective to our diets, but this risks confusing older people, who often need very different dietary advice from the rest of the adult population: for example, older people may need to eat more fat and sugar to maintain a healthy weight.

 To tackle the problem of malnutrition amongst older people, The Malnutrition Task Force (MTF) was established in 2012. MTF aims to actively influence behaviours across the NHS, residential care and in the community to prevent and reduce malnutrition in older people. apetito, the parent company of Wiltshire Farm Foods, is one of the five founding partners of the MTF and has made a substantial financial contribution to its funding (along with Age UK, WRVS, BAPEN and Nutricia). Paul Freeston, apetito’s chief executive is also a member of MTF’s Steering Group.

 What’s to be done?

 There is a long way to go in fighting malnutrition in the elderly, but there are some tips those working with the elderly can bear in mind:

    • Spotting the signs: There are warning signs that might indicate an older person is malnourished. It can be difficult to gauge someone’s weight without forcing them onto a set of scales, but looking out for clues such as wedding bands that have become loose, or a noticeable decrease in upper arm circumference can give you an idea if the person has lost weight. You may also notice that an elderly person may seem more frail – when someone is malnourished they are likely to have deficiencies in several vitamins, such as zinc or vitamin D, that have knock-on effects for the rest of their health.

    • Debunk the myths: Healthcare professionals should work to combat false perceived norms, which are commonly held by older people: for example, that fat and sugar is bad for you and should be cut out of a diet where possible. It’s also worth emphasising that getting vitamins and minerals can come from a really wide range of sources, to suit all budgets: for example, frozen vegetables are just as full of nutrients as fresh (and sometimes more so), but many older people may think that only ‘fresh’ food is nutritious and therefore overlook alternatives. 

  • Offer flexible advice: A personalised approach should be taken when delivering dietary plans or advice, which takes into account varying medical needs of older people. It’s important to consider the person’s ability to swallow and digest food when creating a dining plan for them; texture-modified foods may make eating much easier for someone suffering from a condition like dysphagia.

Tasty, tempting and varied food is also essential to engage older people in eating well. At Wiltshire Farm Foods, we have a number of processes in place to make sure that the dishes we develop meet the tastes and preferences of our customers: perhaps most importantly, we have customer panels, where we invite feedback and ask our customers what they’d like to see. One example is our ‘Extra Tender’ range, which we developed in response to feedback from customers about what they found most comfortable to cut up and eat.

Education, care and nutritious food are the tools we have to tackle malnutrition amongst our elderly population. Reducing and, ultimately, preventing malnutrition is an enormous challenge, but with the work of the Malnutrition Task Force, government support and the enthusiasm of those working in health and care, we believe that we can make a real difference to the quality of life of so many older people.

By Helen Willis BSc RD, apetito and Wiltshire Farm Foods Dietitian; member of the British Dietetic Association and the National Association of Care Catering

 

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October 09, 2014

NHS Confederation responds to King’s Fund report on NHS finances

The NHS Confederation has said the King’s Fund report published today (9 October), ‘Financial failure in the NHS: What causes it and how best to manage it’, is a great contribution to the debate defined in the 2015 Challenge Manifesto.

Rob Webster, chief executive of the NHS Confederation, said:

“Unfortunately, evidence of hospitals in financial deficit is a sign of our times with the NHS facing unprecedented financial pressures. These financial challenges require a sustained approach in the medium term. The King’s Fund report is a great contribution to the debate around the future of health and care as defined in the 2015 Challenge Manifesto.

“On the specifics, we have called for more to be done to support organisations in distress, so failure is only seen as a last resort. We believe that short-term solutions to long-term financial problems are not sustainable and we maintain that the only way to turn around a failing organisation is to look at the challenges being faced across the whole system, rather than trying to solve them in isolation within one trust.

“The rules of engagement around crisis-driven change needed to be clearer and we were pleased to have secured reforms in the Care Act to strengthen the involvement of patients and staff in the Trust Special Administration (TSA) process. As we continue to work on a cross-party committee advising on the new guidance to TSAs, we will be adamant that the rules for TSAs need to be as clear, realistic and meaningful as possible.”

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October 07, 2014

Suffering in silence: New statistics prove that gout is no laughing matter

Quarter of gout patients say doctors do not consider gout to be an important health problem

 Today, Arthritis Care launched a new report which showed that the health service is failing to address the seriousness of gout. Gout Nation 2014 reveals that 83% of people with gout struggle with daily activities when their disease is at its worst, like walking and even putting on their shoes. The report also highlights that the pain associated with the condition can be so excruciating that 9% have reported often taking time off work and 4% under the age of 65 give up work altogether. One-third of people also reported feeling depressed during an attack of gout. Despite the effect that gout is having on people across the UK, Gout Nation 2014 shows that almost a quarter of sufferers believe that their healthcare professional does not consider gout to be an important health problem and half of sufferers who have discussed their gout with their family or friends have had unhelpful reactions from them, including that they find their gout condition humorous.

 With one in 40 people now suffering from gout, the report urges the public to change their perceptions of gout, and for those suffering in silence, to seek the help they need. At present, 10% of gout sufferers are diagnosing their condition online and 21% feel that they do not receive enough information from their GP about the long-term drug therapy treatments available to them.

“It is important to understand that gout can affect anyone, regardless of their age, sex or risk factors  and, if left untreated, can lead to serious health problems such as permanent joint damage, kidney disease and cardiovascular disease.”, said Michael Doherty, Professor of Rheumatology at University of Nottingham. “Gout is attributed to an interaction between a number of factors including genetics, the environment and personal circumstances, and it is important that people are aware of the factors which increase the risk of developing the condition. These include having a close family member with gout, certain medications, a diet rich in protein or purines, drinking excessive beer and spirits and being overweight.”

“The number of people living with gout and being diagnosed every year is continuing to increase, yet we as a nation are still not taking this condition seriously.” Said Judi Rhys, Chief Executive ofArthritis Care. We need new quality standards on the treatment of gout and we are calling on The National Institute for Clinical Excellence to take this forward.”

Gout Nation 2014 included results from a survey amongst 1,259 people with gout conducted by YouGov.  Access the full report via: www.arthritiscare.org.uk/LivingwithArthritis/gout-nation-2014/

7th October 2014

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