The healthmatters blog; commentary, observation and review
Commuting to work is bad for health
Long commutes are causing poor health and productivity outcomes for the nation’s employees, according to research from Britain’s Healthiest Workplace. The study of more than 34,000 workers across all UK industries, which has been developed by VitalityHealth and is delivered in partnership with the University of Cambridge, RAND Europe and Mercer, examined the impact of commuting as well as flexible and home working on employee health and productivity.
Longer commutes appear to have a significant impact on mental wellbeing, with longer-commuting workers 33% more likely to suffer from depression, 37% more likely to have financial concerns and 12% more likely to report multiple dimensions of work-related stress. These workers were also 46% more likely to get less than the recommended seven hours of sleep each night and 21% more likely to be obese.
Many employers aim to mitigate the impact of a long or stressful commute by offering flexible or home working arrangements to employees. The study showed that flexible working has a positive impact on both employees’ physical and mental health and their productivity. Employees who are able to work flexibly were less likely to be stressed or depressed, and were also less likely to smoke, be obese or get insufficient sleep. These employees also had an additional five productive days each year compared to those with no flexible working arrangements.
However, the study’s results suggest that working from home does not bring the same benefits. Employees who were able to work from home but did not have flexible working arrangements were in fact the least productive, losing 29 working days each year – even more than those with no home working or flexible working arrangements.
- 34% fear the dentist, 17% fear the optician
- 65% fear discovering a previously unknown health problem
- 22% have had a previous bad experience
- 79% hesitate to seek medical advice as a result
ALMOST a quarter of Brits fear the doctor’s waiting room, according to new research.
1 in 3 (34%) British adults confessed to a fear of the dentist chair, while 1 in 5 (17%) of those surveyed admitted that visiting the opticians made them nervous.
79% of those who admit to these fears hesitate to seek medical advice from doctors, dentists, and opticians regularly as a result.
A fear of the unknown or finding a previously unknown health problem (69%) was the number one reason for these kinds of fears.
A phobia of medical equipment, such as needles, the dentist’s drill and eye examination equipment, was the source of worry for 52%.
A bad experience during childhood (45%) was the third most popular reason for disliking the doctors, while a more recent bad experience was the source of anxiety for more than a fifth (22%).
Having a potentially painful experience during an appointment was a worry for 1 in 6 (14%).
Ed Fletcher, CEO of Fletchers Solicitors, said: “It’s interesting to see just how many Britons fear seeking face-to-face medical advice – many really do have a fear of the doctor’s waiting room or dentist’s chair, which for many continue throughout adulthood. It is important that everyone is at ease when they have a medical problem or question so that they speak to a medical professional when they need to. Putting off appointments is something many are guilty of but this can be dangerous.”
76% of those who feared a medical waiting room said their fear had originated during childhood and continued in adulthood.
Those aged 55-64 were most likely to have a fear of the waiting room, followed by those aged 65+.
Further statistics and information from the ‘Waiting Room Woes’ report can be found here: www.fletcherssolicitors.co.uk/
For more information, please visit: www.fletcherssolicitors.co.uk
Top Reasons for Apprehension of Medical Appointments
1. Finding a previously unknown health problem – 69%
2. Phobia of medical equipment – 52%
3. Bad childhood memory – 45%
4. Previous bad experience – 22%
5. Potential pain – 14%
Only 1 in 4 (26.2%) people with a mental illness or phobia lasting for 12 months or more are in work, according to a report published by the TUC to coincide with its Disabled Workers’ Conference on May 18th.
The report, Mental health and employment, contains new analysis of official employment statistics, which finds that while 4 in 5 (80.4%) non-disabled people are in work, people with mental illness, anxiety or depression have substantially lower employment rates:
Only 1 in 4 (26.2%) people with a mental illness lasting (or expected to last) more than a year are in work.
Less than half (45.5%) of people with depression or anxiety lasting more than 12 months are in work.
The TUC is concerned that this suggests employers are failing to make adequate changes in the workplace to enable people with mental illnesses, anxiety or depression to get a job, or stay in work. Mental health problems can often be ‘invisible’ to others, so a lack of mental health awareness amongst managers and employers is also likely to be a factor.
The employment rate for disabled people is increasing, but too slowly for the government to reach its target of halving the disability employment gap by 2020. The TUC estimates it will take until 2025 for those classified in official figures as having long-term depression and anxiety, and until 2029 for people classified as having long-term mental illness.
The TUC is calling on the government and employers to take the following action to help eliminate the disability employment gap:
Employers have a legal obligation to put in place reasonable adjustments for disabled workers. For people experiencing mental health problems, this could include time off for counselling or other medical appointments, changes to their role, moving their workplace or allowing for homeworking.
An employer may adjust the sickness absence policy for disabled staff where time off is related to a disability. This is in recognition that some disabled people may have different and higher forms of sickness absence and the policy needs to be adjusted accordingly.
As stigma remains a huge barrier, it may be useful to consider suitable awareness-raising exercises which could include working with trade unions, disabled staff and mental health charities on awareness-raising sessions at lunchtime.
Employers should create a workplace wellbeing policy which looks at the issue of mental health holistically. This can include information on regular breaks, reducing workplace stress, the importance of physical activity, and signposting to relevant agencies.
On mental health, like other disability issues, efforts should be made to consult with staff who have experienced mental ill-health. This is in keeping with the notion that disabled people themselves should be able to determine the solutions to the issues they face.
Employers should include reference to mental health in the sickness absence policy.
Ensuring senior managers champion awareness of mental health and fight to remove the stigma around mental health in the workplace.
Engage with the recognised trade union so they can input into all policies related to mental health to ensure collective equality rights for disabled workers.
Government policies to support people with mental health conditions at work
The government should abolish tribunal fees to make it easier for those people with mental ill-health who have experienced discrimination in the workplace to access justice.
The government can make more effort to widely promote Access to Work for people with mental health problems if government funding is required for the adjustments. Access to Work is a government scheme which helps employers access funding to make adjustments to the workplace to enable disabled people to work.
The government should stop cuts to disabled people’s financial support which make it harder for disabled people to survive and even harder to access work. This includes cuts to Employment and Support Allowance which supports people out of work, and to the Personal Independence Payment, which can support people both in and out of the workplace
The TUC report Mental health and employment is available at www.tuc.org.uk/sites/default/files/Mental_Health_and_Employment.pdf
“A core part of Google” has been told it has no lawful basis to process 5 years’ of patient data from the Royal Free Hospital in London.  With no legal basis, the data must be deleted.
In May 2016, the New Scientist reported that Google DeepMind had access to a huge haul of patient data, seemingly without appropriate approvals. In July 2016, the MHRA confirmed that DeepMind had not received any approvals for a trial involving patients, using patient data. In November 2016, DeepMind signed a replacement contract covering exactly the same data.
The National Data Guardian has provided a view on this matter (all emphasis added): 
The Royal Free “…confirmed to us [NDG] that 1.6 million identifiable patient records were transferred to Google DeepMind and that implied consent for direct care was the legal basis for the data processing.”
“…Streams was going through testing and therefore could not be relied upon for patient care, any role the application might have played in supporting the provision of direct care would have been limited and secondary to the purpose of the data transfer. My considered opinion therefore remains that it would not have been within the reasonable expectation of patients that their records would have been shared for this purpose.”
It is unclear whether Google DeepMind has complied with the finding that it had no legal basis for processing this data; nor is it clear what it was that first attracted DeepMind executives to unlawfully copy 1.6 million people’s medical records, repeatedly insisting on direct care as the sole legal basis.
medConfidential agrees with the Information Commissioner, when she said in a speech to technology companies: “I do not believe data protection law is standing in the way of your success.” She reminded her audience: “It’s not privacy or innovation – it’s privacy and innovation.” In this case, this DeepMind project turned out to be neither of those things.
The National Data Guardian’s investigation has made clear that DeepMind had no legal basis for their actions in this project. For further information or for immediate or future interview, please contact Phil Booth, coordinator of medConfidential at email@example.com
“The NDG has provided a view on this matter to assist the ICO’s investigation” was the National Data Guardian’s comment on the publication of the University of Cambridge paper, ‘Google DeepMind and healthcare in an age of algorithms’: https://link.springer.com/
article/10.1007%2Fs12553-017-0179-1 and http://www.cam.ac.uk/research/news/
The British Medical Association has warned that that the UK is facing a ticking time bomb in public health, with a lack of leadership on improving the nation’s health risking the future sustainability of the NHS, and public health budgets facing a cut of £400million from 2015/16 to 2020/21.
This comes as obesity rates remain stubbornly high across the UK, nearly one in six adults still smoke, and 7.8 million adults binge drink. Childhood obesity is a major public health threat across the UK, with between a quarter and a third of children either overweight or obese. This increases the risk of developing a range of long-term conditions and has a significant cost to healthcare services. It has been estimated that the NHS in England spent £5.1 billion on overweight and obesity-related ill-health in 2014/15.
Smoking is the single greatest cause of preventable premature death in the UK and places a significant financial burden on the NHS. Nearly one in six adults still smoke. Smoking has been reported to account for approximately 100,000 deaths a year in the UK, and is estimated to cost the NHS in England between £2 billion and £5.2 billion a year. Alcohol causes significant harm, there were 8,758 alcohol-related deaths in the UK in 2015 and there are more than a million hospital admissions related to alcohol consumption in the UK every year.
Politicians have been too slow and weak in tackling these challenges – from a watered-down childhood obesity strategy and failure to publish a new tobacco control plan, to the lack of recognition of the need for a new alcohol strategy. In its manifesto, A Vote for Health, the BMA is calling for urgent action to improve the health of the population and reverse cuts to public health. It is calling on all political parties to work with health professionals to deliver a public health strategy focused on tackling the causes of ill-health over a generation, and prioritise measures to tackle the impact of unhealthy food and drink, tobacco and alcohol on the public’s health through:
a 20 per cent tax on sugar sweetened drinks;
a mandatory traffic light approach to displaying nutritional information for all pre-packaged food and drink products, alongside new rules for advertising junk food to children;
working towards the new targets for sugar reduction, and widen this to include fat, salt and overall calories;
introducing a ‘polluter pays’ annual levy on tobacco companies to help fund stop smoking services;
the introduction of a minimum unit price for alcohol set at no less than 50p per unit.
A series of papers on public health published today by the BMA find that:
Commitments to prioritise prevention and public health are not matched by funding. In England, public health expenditure accounts for approximately 5 per cent of total health spending, mainly provided through the public health grant. Following an in-year cut of £200 million in 2015, there will be a further cut of £400 million between 2015/16 and 2020/21 (with real terms cash allocations decreasing from £3.47 billion to £3.07 billion).
Cuts to public health budgets are a false economy, undermining a prevention based approach and costing the NHS more in the long term. For example, many cases of type 2 diabetes are entirely preventable through public health approaches, yet, its prevalence is increasing year on year in the UK. In 2010/11, the cost across the UK was estimated at £8.8 billion, and is predicted to rise to almost double, £15.1 billion by 2035/2036 .
Cuts are impacting on patient care in accessing vital services. One in four local authorities reduced spending on sexual health services by more than 20 per cent between 2013/14 and 2015/16. Nearly 60 per cent of local authorities in England cut smoking cessation budgets last year, despite smoking being the biggest cause of preventable death in every part of England.
Cuts are occurring despite the fact that investing in public health and prevention activities is cost-effective. It is estimated that, on average, £14.30 is saved for every £1 invested in local and national public health interventions.
Efforts to improve the nation’s health are being undermined by an inconsistent approach to using effective, evidence-based measures. While these have been successfully used to reduce smoking rates, there has been a failure to introduce key measures to reduce alcohol harm, such as minimum unit pricing, and inaction on the widespread marketing and promotion of unhealthy food and drinks.
Dr Mark Porter, BMA council chair, said:“When it comes to public health, the UK is going backwards. Prevention is better than cure and cuts to public health have a damaging impact on individuals’ health and wellbeing, and end up costing the NHS more in the long term.
“In England, successive governments have failed to deliver a long-term plan to improve public health, and too often evidence-based public health measures have been kicked into the long grass. We need tighter regulation of the food and soft drinks industry, a minimum unit price on alcohol and support for people to quit smoking.
“Whoever is in government next, must make tackling the crisis in public health a priority. With the NHS at breaking point, and demand on services only set to rise we are facing a ticking time bomb.”
One in eight consumers in England (13 percent) have had their personal medical information stolen from technology systems, according to results of a new survey from Accenture (www.accenture.com.).
The survey of 1,000 people in England revealed that the vast majority (78 percent) believe healthcare providers have a great deal of responsibility for keeping digital healthcare data secure, compared to only 40 percent who believe it is their personal responsibility. Despite this, the findings show that more than half (56 percent) of those who experienced a breach were victims of medical identity theft and more than three-quarters of those victims (77 percent) had to pay approximately £172 in out-of-pocket costs per incident, on average.
In addition, the survey found that the breaches in England were most likely to occur in pharmacies — the location cited by more than one-third (35 percent) of consumers who experienced a breach — followed by hospitals (29 percent), urgent care clinics (21 percent), general practices (19 percent) and retail clinics (14 percent). More than one-third (36 percent) of English consumers who experienced a breach found out about it themselves or learned about it passively through noting an error on their health records or credit card statement. Only one-fifth (20 percent) were alerted to the breach by the organization where it occurred, and even fewer consumers (14 percent) were alerted by a government agency.
Among those who experienced a breach, the majority (70 percent) were victims of medical information theft with more than a third (39 percent) having personal information stolen. Most often, the stolen identity was used for fraudulent activities (cited by 82 percent of data-breached respondents) including fraudulently filling prescriptions (42 percent) or fraudulently receiving medical care (35 percent). And, a quarter of consumers in England (25 percent) had their health insurance ID number or biometric identifiers (18 percent) compromised. Unlike credit-card identity theft, where the card provider generally has a legal responsibility for significant account holder losses, victims of medical identity theft often have no automatic right to recover their losses.
Despite the myriad breaches occurring, consumers still trust their healthcare providers (84 percent), labs (80 percent) and hospitals (79 percent) to keep their healthcare data secure more than they trust the government (59 percent) or health technology companies (42 percent) to do so. About two-thirds of consumers in England (65 percent) either maintained or gained trust in the organization from which their data was stolen, following a breach. And, more than half (68 percent) of English consumers said they want to have at least some involvement in keeping their healthcare data secured, whereas only a quarter (28 percent) said that they have such involvement today.
In response to the breach, nearly all (95 percent) of the consumers who were data-breach victims reported that the company holding their data took some type of action. Some organizations explained how they fixed the problem causing the breach (cited by 29 percent), explained how they would prevent future breaches (23 percent) or explained the consequences of the breach (22 percent). Of those that experienced a breach, over half (53 percent) of respondents felt the breach was handled somewhat well while only 15 percent of respondents felt the breach was handled very well, indicating there is potential room to improve.
The findings in this news release relate only to the England portion of Accenture’s seven-country survey. The full research, “Accenture’s 2017 Healthcare Cybersecurity and Digital Trust Research,” represents a seven-country survey of 7,580 consumers ages 18+ to assess their attitudes toward healthcare data, digital trust, roles and responsibilities, data sharing and breaches. The online survey included consumers across seven countries: Australia (1,000), Brazil (1,000), England (1,000), Norway (800), Saudi Arabia (850), Singapore (930) and the United States (2,000). The survey was conducted by Nielsen on behalf of Accenture between November 2016 and January 2017. The analysis provided comparisons by country, sector, age and use. Visit www.accenture.com.for more details
For Infographic see infogdata
Niall Dickson, chief executive of the NHS Confederation, which represents health service organisations in England, Wales and Northern Ireland, said:
“We welcome the attention which all parties are giving to the issue of health and care funding. The current system is under immense pressure and is struggling to cope financially and clinically – significant extra money will be needed over the next Parliamentary session if we are to avoid a major crisis.
“It is vital that the next government commits to an objective assessment looking at which services are needed and the funding required to pay for them. We need an Office for Budget Responsibility for Health to undertake this and make sure that future funding is underpinned by a strong evidence base.
“And critically, we need a visible and objective measure of funding as we have seen for overseas aid and the armed forces – the next administration needs to commit to a minimum funding level for health and care linked to GDP. As the economy grows, so should health and care spending.”
Alzheimer’s Research UK, the UK’s leading dementia research charity, has welcomed a commitment in the Conservatives’ election manifesto, released today, to invest in dementia research. The charity is calling on other political parties to make similar commitments to ensure efforts to defeat dementia remain a priority in the next parliament.
Dr Matthew Norton, Director of Policy and Strategy at Alzheimer’s Research UK, said:
“It’s encouraging to see a commitment to dementia research investment in today’s manifesto, and we would urge all parties to make a similar pledge to ensure action against our greatest medical challenge. We also welcome recognition of the importance of the life sciences sector to the UK economy and commitment to take forward recommendations from the Accelerated Access Review. This will be vital for ensuring that people with dementia can benefit from future dementia treatments as soon as possible.
“It will be essential to see the detail of this commitment: with the government’s plan of action on dementia due for review next year, there is a real opportunity to scale up our ambition for research. Dementia is already the leading cause of death in England and Wales, and research suggests deaths from the condition will quadruple by 2040 if urgent action is not taken. With no treatments currently able to stop or slow the diseases that cause dementia, it’s vital that future investment in research matches the scale of this immense challenge.”
A massive cyber attack on the NHS began on Friday May 12th. The NHS has been warned about the hacking threat. In 2016, NHS Digital chair Kingsley Manning said cyberattacks were “a fundamental threat to the operations of hospitals” and chastised the health service for not taking digital security seriously enough. In recent years funding for IT services has been raided to fund other aspects of care.
In January 2017 the Health Service Journal reported a significant failure in cyber security, saying that a “major leak of patient data or a cyberattack that means health services across an entire region are flying blind for many days is overdue and yet completely absent from the risk registers of most NHS organisations”.
The attack begins
On May 12th, the “overdue” attack arrived and spread across the NHS, with trusts being targeted by a major ransomware campaign. There was a large outbreak of ransomware that spread at a rapid rate globally and also seemed able to spread internally within a network once the first host is compromised. At least 50 hospitals and community services have been affected, while CCGs and GP practices in some areas have also stopped using their computers. The attack has almost certainly had an impact on patients: some hospitals have diverted emergency ambulances, asked patients to go elsewhere, and cancelled elective care. Services affected include X-ray images, pathology test results, phone and bleep systems, and patient admin systems.
NHS Digital believes the malware used is Wanna Decryptor, (aka WCry, WannaCry, and WannaCryptor). Microsoft released a patch earlier this year to address the vulnerability that Wanna Decryptor exploits, but it appears that a number of hospitals and other users have not applied the patch. Dan Sloshberg of cybersecurity firm Mimecast, argues that: “Patient safety is at risk today because of archaic security across much of the nation’s critical IT systems. Studies consistently show that email is the number one attack method used to spread malware that holds critical services to ransom. A cyber resilient nation requires defence in depth security and continuity plans to keep critical services running every time they are attacked.”
There have been ransomware attacks on trusts before – such as Northern Lincolnshire and Goole in 2016 and Barts Health in January 2017 – but nothing on the scale of this attack. The attacks that have taken place do not appear to be targeted attacks; instead they appear to be part of a phishing campaign, though that has not been fully confirmed, according to Allan Liska, Senior Solutions Architect at Recorded Future.
Recovery from the attack
David Kennerley, Director of Threat Research at Webroot, said: It goes without saying that organisations should test their disaster recovery plan (DRP) regularly. This will help them understand the time it will take to restore systems to a useable state and what data is likely to be lost due to back up schedules. If this disruption is due to ransomware it will be interesting to hear what option the Trusts intend to take. Let’s hope they are all prepared, with the required backups readily available. The danger with paying the ransom is there’s no guarantee they’ll recover their encrypted data and this only makes ransomware more successful in the long run for hackers.
Israel Barak, CISO at Cybereason, described how these attacks are planned and carried out: “We know that ransomware purveyors are often savvy e-marketers that know their targets, and it is not uncommon for a ransomware gang to run multiple campaigns at the same time, with tiered pricing based on a variety of parameters such as vertical industry, region, age, etc. However, the attacks on the NHS Trusts across the UK seem to show particularly ruthless calculation even by criminal standards, banking on the Trusts having weak defences and being especially desperate to restore access to their systems due to health and even lives being at stake.
While ransoms have surpassed the hundreds of thousands mark, the goal is to set a price that makes it either cheaper or easier for the victims to pay the ransom then to recreate or restore the compromised systems, especially when the victim has a sense of urgency. Today’s ransoms show that this can still be very costly, especially when it comes to lost operational time and data. We’ve seen many examples where companies didn’t have the proper backups in place and decided to pay the ransom so that they could resume normal business operations, and that will obviously be a pressing concern for the affected Trusts.”
John Madelin, CEO at Reliance acsn, adds: Hospitals can make particularly soft targets for hackers due to the need to focus on putting tight budgets into patient care. As with other organisations, there is also a tendency to use an array of cyber-defence systems which inevitably work in silos and this very patchwork of ‘protection’ lulls institutions into a false sense of security when in reality they’re incredibly exposed. “Security strategies in the healthcare sector need a holistic treatment, with a more integrated, better executed, end-to-end approach – rather than multiple stand-alone security solutions working in siloes. The healthcare sector can engineer a culture-shift that will make it more resilient to cyberattack, allowing it to provide better care and prevent the need to cancel operations and treatments because of their networks being targeted by hackers.
There could be consequences beyond the disruption of medical services. Creighton Magid, a partner at the international law firm Dorsey & Whitney, commented “Although much of the focus in cybersecurity is in preventing data breaches, this attack points to the potential for an entirely different type of damage: shutting down entire businesses, hospital systems, banks, and critical infrastructure. Let’s hope that the attack on the National Health Service in Britain is simply a matter of inconvenience, and that nobody is denied essential care. But what happens if someone is, and is harmed as a result? What if a US hospital were attacked similarly, and someone’s health were to be seriously impacted? Beyond the human tragedy, it would suggest possible new liability targets, starting with the hospital that failed to ensure that it had updated all of its patches.”
Law firm Kemp Little’s head of data protection and privacy, Nicola Fulford, underlined this by saying: this is a stark reminder that everything is potentially vulnerable – and every business has a responsibility at some level under the law to protect against it even if absolute prevention is impossible.”
When the government announced unfavourable changes in taxes for self-employed staff a lot of IT technicians sub-contracted to NHS Trusts stepped away from their roles, leaving the NHS vulnerable to assaults like the present one. And some IT experts argue that the root cause of this attack was the use of non-standards- compliant internet browser technology used by Microsoft in the widely used Windows XP software. There is better, safer software that should be used. The Secretary of State for Health has told NHS Trusts to strengthen their IT defences (a pretty obvious response), whilst not conceding that his government’s budget squeeze has increased rather than decreased vulnerability to cyber attack.
THE FITTEST CITIES IN THE UK. Liverpool named the fittest city in the UK – Sheffield named as the least fit
LIVERPOOL has been named the fittest city in the UK following new research into fitness levels across the country.
A survey of 2,000 UK adults carried out by training and course provider Beabetteryou.com, found that scousers workout more than those in any other city in the UK with as 71% of locals claiming to exercise at least once per week.
Manchester and London followed in second and third place with 66% and 65% of each cities residents hitting the gym at least once a week.
Oxford came in fourth place, with 62% of locals exercising at least once per week, while 59% of those in Leeds do the same, completing the top five.
The research found that Sheffield was the least active city in the UK, with just 19% of residents sporting their trainers and exercising at least once per week.
Plymouth and Birmingham followed closely behind Sheffield, with just 22% and 24% of locals working out weekly.
As well as activity levels, the survey also quizzed respondents on their consciousness about what they eat.
While 77% of Liverpool residents claim to be careful when it comes to their diet, it is in fact Manchester which leads the way in the nutrition stakes as 85% of locals said they are careful about what they eat.
Simon Bubb, managing director at Be a Better You commented: “What I find interesting from the research is how we’re seeing such big variations from city to city.
“I am partly putting the fact that bigger cities such as Manchester, London and Liverpool boast higher fitness levels down to accessibility. For example, the main UK cities are home to more gyms, personal trainers, classes, and boot camps etc. so it’s likely this will impact on peoples’ motivation to get fit.”
The UK’s Fittest Cities
The UK’s Least Active Cities
Be a Better You is the UK’s number one personal trainer course provider, and offers REPs accredited personal trainer courses and fitness instructor courses around the country, as well as online at www.beabetteryou.com.