The healthmatters blog; commentary, observation and review

The Opportunities and Obstacles Facing the UK’s Burgeoning HealthTech Sector

Posted by on Jan 22, 2018 in Blog, NHS | 0 comments

In recent years, there has been an increasing use of the ‘tech’ suffix in all manner of industries. Even the passing observer will probably have noted that in the worlds of finance, marketing, property and health, tech start-ups are launching in their droves to help remould the way each sector operates.

Financial technology – FinTech – undoubtedly paved the way; in the aftermath of the 2008 global economic crisis, new online platforms and apps emerged at pace to challenge traditional practices, not to mention the incumbent banks that held a monopoly over the sector. Today, ten years on, consumers and businesses alike use all manner of new digital solutions to complete important transactions and manage their finances.

The same trend has since spread across many other industries. And promisingly, the healthcare sector has started to follow suit. In fact, as we enter 2018 it appears that HealthTech is finally in a position where it can begin having a significant, meaningful impact on people’s day-to-day lives.

On the one hand, new tools are empowering the individual to take better care of their own health. On the other, technological innovations are also enabling healthcare providers – both in the public and private sectors – to offer better, cheaper, efficient and personalised services.

From fitness apps and wearable devices through to online marketplaces and medical diagnosis tools, HealthTech covers a broad range of digital solutions and there are too many examples of brilliant new pieces of technology to name. But importantly, these solutions are not just ways of ridding us of cumbersome, out-dated processes and lengthy paper trails; they also deliver products and services that hitherto have simply not been possible or financially viable. The result is that in the home, on the go or in a hospital, we now have access to superior tools for improving our mental and physical health.

Separating new tech from hot air

However, as with any new technological trend, there are bumps in the road that must be navigated. One such issue is the habit of businesses jumping on the tech bandwagon; out of their desire to be seen as cutting edge and ‘on trend’, some companies will adopt the tech suffix even though, when you review the way they actually manage and deliver their services or products, there is little evidence of any proprietary technology involved.

While not a fatal concern, falsely labelling businesses as being a FinTech, PropTech or HealthTech firm threatens to undermine the truly innovative start-ups operating in these respective industries. It also has the potential to confuse consumers and deter investors, who may develop an erroneous impression of what these terms really mean, in turn prohibiting mass uptake on the new solutions.

As the HealthTech market matures, people will naturally cultivate a greater understanding of the term and what it encompasses. What’s more, over time the companies not offering a unique or well-built tech proposition will likely fade away, leaving a more concentrated collection of talented businesses that will be charged with driving the industry forward.

Start-ups seeking support

Another obstacle standing before the UK’s HealthTech sector is its need for support from multiple external bodies. In order for the current crop of HealthTech start-ups to transition into high-growth SMEs and potentially become multi-national enterprises in the years ahead, they will require help – help from the Government and help from investors.

Positively, amidst tightening budgets for the UK’s public healthcare services, the Government has placed an increasing emphasis on the adoption of new digital solutions. For one, it has already implemented its Five Year Forward View, which makes an explicit commitment to creating the conditions necessary for proven innovations to be adopted faster and more systematically through the NHS.

This intent is already having an impact; the Clinical Entrepreneurs Programme run by NHS England recently selected 138 entrepreneurs to design and deliver new technological solutions and innovations. Furthermore, with the Conservative Party looking for ways to lessen the burden on the NHS by providing better preventative and out-of-hospital care, this same willingness to embrace new tech could extend beyond hospitals’ walls and into the broader healthcare and wellbeing space.

The Government does not have to look far. High-growth start-ups are driving innovation across the industry. For example, to improve the accessibility and management of healthcare services, new platforms in the HealthTech space are now offering an online marketplace for people to source healthcare solutions, supported by integrated payment systems to take the pain out of previously disjointed processes. It’s simple and cost-efficient solutions such as these that will drastically improve the UK’s existing healthcare services.

Indeed, alongside the support from Westminster, the HealthTech industry also has reason for optimism as a result of the backing it has, and continues to receive, from investors. As seen with FinTech and, more recently, PropTech, investors are hungry to identify and put money behind promising, innovative new start-ups.  Consequently, the UK’s digital health market is expected to grow by nearly £1 billion in 2018 to reach a total of £2.9 billion.

Healthcare prepares to jump into the digital age

There are evidently many reasons for optimism in the HealthTech space. With public and private sector support and a plethora of stimulating talent emerging all the time, 2018 stands to be a breakthrough year as businesses and the wider public begin to embrace new technologies that will make their lives easier and, of course, healthier.

The market still has some distance to travel until it reaches maturity, but the trail blazed by FinTech pioneers over the last decade has already helped to alter people’s mind-sets by opening them up to using tech-based platforms for vital tasks. In the next 12 months and beyond, it will be exciting to see how readily people shift from traditional practices to instead using newer methods for bettering their health or those of others. Yet even if the process takes time, there is no longer any question that the healthcare sector is on the cusp of an irreversible move into the digital age.

Rohit Patni, CEO and co-founder, WeMa


MDR compliance – delaying could cost medtech firms dearly

Posted by on Jan 22, 2018 in Blog, NHS | 0 comments

Manufacturing in the medical devices sector is attracting close scrutiny by regulators as they seek to tighten up oversight to ensure the highest standards of public safety and to promote fair market access for all companies. Fundamental changes are being introduced under the new EU Medical Device Regulation (MDR) which will involve medtech firms adhering to stringent new standards across many critical processes. These include the reclassification of devices including legacy products, the reprocessing of single use devices, clinical evaluation and evidence standards, mandatory product liability insurance, labelling and the supply chain, and technical documentation.

At Maetrics we firmly believe that manufacturers who achieve MDR compliance as quickly as possible – rather than waiting until the 2020 deadline draws closer – will reap substantial commercial advantages over their less proactive competitors.

Why is this? Firstly, the requirements encompass the most wide-ranging set of changes to the regulatory landscape since CE Marking was introduced in 1993. Preparatory work, such as obtaining buy-in from the various stakeholders within the organisation and adapting the necessary business processes, will be an in-depth and lengthy process and can not possibly be achieved properly in a last-minute compliance rush. Secondly, the industry is already questioning whether there is sufficient capacity in terms of suitably qualified in-house consultants to guide compliance preparations, and likewise, enough Notified Bodies (NBs) to conduct the audits and certifications within the required timeframes. It has been reported recently that NBs have begun turning down new clients for CE Marking, which indicates the pressure they are already under even before the MDR floodgates are fully open.

In part, outsource providers can plug the in-house gap by providing expert support but it should be emphasised that this resource is also limited and is likely to be seized upon by the compliance first-movers. Even if they have the time to wait for in-house professionals or outsource providers to finish contracts and become available, medtech firms that delay their compliance plans will still find themselves at a severe disadvantage – not least because over-demand tends to push up costs. At the time of writing it is difficult to imagine how the dual challenge of the in-house skills shortage and regulatory under-capacity can be solved in time for the entire medtech industry to achieve compliance by the deadline, even if it is two and a half years away.

Our best estimates put MDR compliance under-capacity in the region of 20% of total market value.  The consequences of this are significant. Non-compliant manufacturers whose products are uncertified will simply be unable to service the market and their compliant competitors will step in to pick up the business. It has been acknowledged by large operators in Europe that this loss of market share may never be recovered.

We have formulated a financial model to put figures on the scale of this opportunity – the MDR Market Opportunity Value model (MOV) – and it reveals that $16.5 billion in potential revenues is the prize on offer to fully MDR-compliant manufacturers. If we look at this from the non-compliance perspective, it is also the value of the possible revenue penalty for those that find themselves excluded from the market.

It is clear that medtech firms need to take action sooner rather than later to reap full advantage of the MDR compliance opportunity. What measures can be taken in-house? First and foremost, they must book their certification work in with NBs (as soon as the NBs become MDR-compliant themselves). They should create a comprehensive, practical MDR compliance strategy which involves appointing team members from across the business to take ownership of assessing each necessary process. We would recommend that firms scan their product portfolios for any unnecessary products that could be eliminated before the auditing begins.

In many cases, medtech firms will choose to partner with compliance outsourcing specialists who can provide expert guidance throughout this process, from planning through to implementation and certification. This is especially likely to be the case given the unprecedented extent and complexity of the changes set out by the MDR and the scale of the Market Opportunity Value achievable by compliance pioneers.  

By Peter Rose, Managing Director Europe, Maetrics

See full details of Maetrics’ Market Opportunity Value model here

Healthcare email security on the critical list

Posted by on Jan 22, 2018 in Blog, NHS | 0 comments

The healthcare sector has long been one of the favourite targets for cyber criminals thanks to the large amounts of private data held by organisations. Patient records are a useful source of personally identifiable information (PII), such as names, addresses and birth dates, which can be used to launch more effective targeted cyber-attacks on individuals.

Deceptive emails are the weapon of choice for criminals angling for this data, with attackers most often impersonating a trusted contact to trick the victim into sharing confidential information. The most recent example of this highly successful tactic came in early January, when a healthcare organisation in Florida had more than 30,000 patient records stolen when a fraudster tricked an employee out of their database password. Our research has found that the healthcare sector is targeted by more deceptive email than any other sector, with 92 percent of all email domains used by healthcare organisations carrying fraudulent emails.

Why deceptive emails slip past defences

While the deceptive email strategy has been around for years, the threat has become more visible in recent months as attackers have both refined their targeting and increased the number of attempts. One of the reasons these deceptive emails have continued to be so effective is that they are designed to evade the email security systems most organisations have in place, and few of these solutions have adapted to catch them.

Traditional email solutions work by signature-based detection, looking for malicious attachments or blacklisted keywords that indicate a suspicious email. This does not work for these attacks, nor does the traditional anti-spam approach of looking for anomalous spikes in volume from a given sender, or spikes of a particular email subject line. A well-crafted deceptive email will contain nothing to alert a standard email scan, and will be effectively indistinguishable from a legitimate message. After fooling the machine, fraudsters have a number of tricks for deceiving the human eye as well, such as setting the display name to match that of a trusted contact.

While tricking a healthcare organisation into giving access to its database may be the ultimate win for a fraudster, many also attack individual patients by impersonating the organisation itself using the same tactics. Of the 875m emails appearing to come from monitored healthcare organisations over the last six months, we found 56 per cent were actually malicious emails spoofing the domain. Criminals generally use this approach to trick targets into giving up personal information which can be used to fuel more targeted social engineering attacks, or simply sold on to other criminal groups.

The difficulty in distinguishing a well-made fake from the real thing, combined with the steady number of deceptive emails reaching the inboxes of employees and patients alike, means that it is impossible to rely on individuals to successfully spot the difference. In other words, technology must address this threat.

Keeping patient data safe

Healthcare organisations need to work to prevent malicious emails from reaching their employees’ inboxes in the first place. One of the most effective ways of preventing email spoofing is the free-to-use Domain-based Message Authentication, Report & Conformance (DMARC) email authentication standard.

DMARC uses two email authentication techniques, Domain Keys Identified Message (DKIM) and Sender Policy Framework (SPF), to verify if a message genuinely has permission to use the email domain. Domain owners can apply policies to block emails that fail to pass outright, or quarantine them. Organisations using DMARC can also receive updates when emails using their domain fail to pass authentication, alerting them to ongoing attempts to impersonate them.

The NHS mandated the use of DMARC among other email security solutions in January 2017, with a review in July asserting that organisations needed to meet the secure standard as soon as possible. However, after examining 5,000 NHS email domains in November 2017, we found that just 1 per cent were currently using DMARC, and only five per cent of UK healthcare organisations had any DMARC policy in place.

However, although DMARC is a powerful tool for dealing with untargeted attacks such as large-scale phishing attacks, it only addresses around six per cent of targeted email attacks. Targeted email attacks are not only different from large-scale phishing attacks in terms of the impersonation technologies the criminals use, but also in terms of the content of the messages, and the goals of the attackers. Targeted attacks are most commonly aimed at key employees, with the goal of having them share massive amounts of sensitive data. By being more convincing, they are also associated with significantly higher success rates for the criminals. While the number of targeted attacks is much smaller, each one can have a huge impact as they are far more effective. Since email spoofing is commonly not the impersonation approach of choice, DMARC is also not the most suitable countermeasure. Instead, organisations will need to take on an email security solution that is capable of detecting signs of deception such as a mismatch between the sender name and the actual sender identity in order to address this threat.

Healthcare organisations must begin their email security journey now if they are to keep the private medical data they are entrusted with safe from criminals. While attackers are still able to freely impersonate healthcare domains with minimal effort, patients and employees alike are under threat from deceptive attacks that abuse their trust. This problem is urgent to address, as data that is leaked can never be unleaked, and healthcare providers have access to some of the most sensitive data there is.

By Markus Jakobsson, Chief Scientist at Agari

Could how happy you are as an adult depend on what school you went to, and what teacher you had?

Posted by on Jan 22, 2018 in Blog, Public Health | 0 comments

Extract from our guest blog
…I and my colleagues looked at the evidence from survey data on over 100,000 individuals in Australia, Germany, the UK and the US to discover what the origins of happiness might be.

What did we find?

  • Schools and teachers matter: Schools and individual teachers have a huge effect on the happiness of their children. Indeed, the school that children attend affects their happiness nearly as much as it affects their academic performance.
    What’s more, if we wish to predict which children will lead satisfying adult lives, the best indicator is their emotional health at age 16. This is more important than their academic qualifications right up to the age of 25 – and more important than their behaviour in childhood.
  • Children’s emotional health is vital: The best predictor of an adult’s life satisfaction is their emotional health as a child.
  • Relationships count: Most human misery is due not to economic factors but to failed relationships and physical and mental illness. Even in poor countries, mental illness accounts for more misery than physical illness does…

Read more>>


Posted by on Jan 17, 2018 in Blog, Public Health | 0 comments

How to measure your wellbeing impact: new guidance

Today we share a new guide to help charities understand, measure, evaluate and analyse their wellbeing impact. Ingrid Abreu Scherer, Programme Manager at the Centre, explains why we need the guide, and how it can help you, even if you’re not a data scientist.


People are complicated, and measuring traditional outcomes can sometimes hide this complexity – and thereby hide the full impact of your activities.

At the Centre we study this complexity, and the different things that make up our wellbeing: the quality of our health, work, relationships; how happy, anxious or satisfied we feel; how confident, purposeful, or connected our lives are. It’s all interconnected, and changes many times over the course of our lives.

Wellbeing can be measured by looking at observable factors (like employment), as well as by looking at factors that are subjective to the person experiencing them, like how safe we feel.

Charities and social enterprises have an impact on wellbeing of the people and, in most cases, the communities they work with. Hopefully they improve wellbeing. But they may also make people’s wellbeing decrease, even while achieving their organisational mission.

For example – if a family is constantly being moved from one temporary housing to the next, they will at any point be considered to be ‘in housing’. However, the benefits of having a place to live may be undermined by the stress and uncertainty of constantly moving, by the inability of children to have stable schooling or friendships, and by the lack of connection to the local area. Just measuring a family’s housing situation is not going to give us a full picture of their wellbeing.

We know work is important for wellbeing, but if a new job leaves the newly-employed person feeling more isolated and unsafe, the unintended consequence is lower wellbeing. Having a job is good – but having a good quality job is better, as the graph below shows.

You probably already knew this. And if you work in a voluntary, community or charity organisation, you also probably design your services and approach around the complexities of people’s lives.

So why doesn’t the way we measure our impact, for the most part, take this complexity into account as well? Why do we still tend to focus on traditional outcomes, while so often missing out on evaluating vital wellbeing impacts?

We think there might be a number of reasons:

  • There’s not been, until now, a clear and simple way to understand, measure and analyse the wellbeing data
  • There’s a need to make a stronger case for valuing wellbeing impact
  • Some wellbeing impacts – like confidence or sense of belonging – are often taken for granted by voluntary and community groups, and not worth measuring
  • There’s a need for a reliable framework – based on evidence and robust methods – that the sector can use, and which is accepted by funders and commissioners
  • Funders and commissioners are not always asking for wellbeing impacts to be measured
  • Organisations may have been collecting the information in different ways, without knowing how to compare impact between projects – within the same rganization, within areas, or across sectors.

Whether you want to improve health, education or employment, measuring wellbeing can show you the wider impact you have on the people and communities you support.

How to Measure Wellbeing Impact will help you put together a simple questionnaire to measure the wellbeing of the people you work with – whether you write your own or use tried and tested questions.

It will help you understand how to compare your different projects, and see the impact you’re having overall. You can also find out how to compare your results against the national, regional or local averages to make the case for your service.

Ultimately, our hope is that measuring wellbeing will help you understand your projects better. By developing your own wellbeing survey, and linking your findings to data you already collect, you’ll understand your full impact on people’s wellbeing. You’ll also find out what works to improve wellbeing and why.

Beyond your organisation, wellbeing measures can help us create a bigger picture. If organisations use consistent measures and share their results with us, we can start to build a better, bigger picture of what works. And identify strengths, and where there’s room for improvement across the sector.

Unhealthy employees now cost British firms six working weeks a year in lost productivity

Posted by on Jan 15, 2018 in Blog, Public Health | 0 comments


  • Study shows employees lose an average of 30.4* working days each year due to sickness and underperformance in the office as a result of ill-health.
  • Productivity loss due to physical and mental health issues is costing the UK economy an estimated £77.5 billion a year**.

Research from the 2017 Britain’s Healthiest Workplace survey (BHW)***, a study of almost 32,000 workers across all UK industries, has revealed that employees lose, on average, the equivalent of 30.4 days of productive time each year as they take time off sick and underperform in the office as a result of ill-health (otherwise known as presenteeism). This is equivalent to each worker losing six working weeks of productive time annually. Importantly, while some sectors performed better than others, the results demonstrated high levels of productivity loss across all sectors and organisational sizes.

When translated into monetary terms, the combined economic impact of this ill-health related absence and presenteeism is £77.5 billion a year for the UK economy. Worryingly, employee work impairment and the associated productivity loss appears to be on a worsening trend, up from 27.5 days and £73 billion respectively in 2016.

Britain’s Healthiest Workplace, which was developed by VitalityHealth and is delivered in partnership with the University of Cambridge, RAND Europe and Mercer, also points to a growing presenteeism problem, with time missed by the average employee through absence reducing since 2016 (3.3 days to 2.7 days), while increases in presenteeism (24.2 days to 27.7 days) have more than offset the observed reduction in absence. This increase in presenteeism demonstrates the importance of having a holistic understanding of employees’ physical and mental health, both in and out of the workplace.

Shaun Subel, Director of Corporate Wellbeing Strategy at VitalityHealth, said: “The Britain’s Healthiest Workplace results illustrate the significance of the productivity challenge facing the UK, but importantly also point to an exciting alternative in how employers can approach this problem.

“For too long, the link between employee lifestyle choices, their physical and mental health, and their work performance has been ignored. Our data demonstrates a clear relationship – employees who make healthier lifestyle choices benefit from an additional 25 days of productive time each year compared to the least healthy employees, and also exhibit higher levels of work engagement and lower levels of stress. As a result, effective workplace health and wellbeing solutions can deliver tangible improvements in employee engagement and productivity, and make a significant impact on an organisation’s bottom line.”

Chris Bailey, Partner at Mercer Marsh Benefits, said: “Some employers still doubt the impact of presenteeism, dismiss the data, and fail to take action. It’s key to understand that people are not machines – we are not 100% task focused and performing at our best all of the time.

“It is not a case of having a presenteeism problem or not. All organisations will see a reduction in how productive their people are when they are experiencing physical or mental health issues. The data shows that those organisations who understand this and take steps to maximise their employees’ productive time at work, for example through supporting an active workforce, promoting good nutrition and enabling positive mental health, enjoy a competitive advantage.”

Crisis, crisis. crisis ………

Posted by on Jan 12, 2018 in Blog, NHS | 0 comments

Crisis, crisis. crisis ………

There are headlines in all the papers , on TV and social media about the difficulties in the NHS of coping with emergencies, ambulance services under strain , non emergency operations deferred to release hospital capacity – why is it so bad this year ?

Here are some reasons- there will be more .

Early January has always been a difficult time for hospitals to cope with emergency admissions. There have been 3 Bank Holidays , and the “slow ” days between Christmas and New Year when many routine services have been reduced- it is more difficult to discharge people who need community services or social care packages.  I remember the post Christmas period always being very tight for beds, because of the difficulty of discharging people home or accessing tests in a timely manner. But this year it is worse .

More people are attending A and E – is that because they cannot easily access other sources of help, such as general practice , or community mental health services ?

The number of older people and people with long term conditions is increasing, leading to increaseddemand.The number of admissions has gone up by 4.5% compared with last year.

Social care funding is tight, with local authority budgets having been cut by  up to 40%- leading to limited provision of care packages, increased eligibility criteria, and shortage of care home places as private providers withdraw from the market .

Busy A and E’s may delay accepting people from ambulances because of shortage of space- tying up ambulances in waiting at the entrance, rather than being available for call outs.

There is a skills shortage , particularly A and E medical staff and specialist nursing staff – reliance on locums is expensive and may lead to delayed decision making , as staff are less experienced  or may be working in an unfamiliar environment.

This year, there is virulent flu about, as well as a lot of respiratory infections . It is not a pandemic, but some people have become very ill, needing intensive care .

It’s easy to describe the problems  – what are the solutions, if any ? Because the situation is caused by a number of factors, there needs to be a variety of actions .

Hospitals have always used the beds ear marked for planned operations as overspill , to increase capacity . This has often meant people having their planned operations cancelled on the day , which is very distressing. The government solution is to avoid last minute cancellations by deferring non urgent ” operations for a month. This will release capacity – though stores up problems ahead trying to catch up- as well as causing distress to the poor person who has been deferred. To say nothing of the waste of capacity of the surgeons and theatre teams who have less to do .

If money was available, short term capacity could be purchased from the private sector- both hospitals and care homes .

We know that having  “clinical senior decision makers ” i.e. Consultants at the “front door ” means decisions are made more quickly – some admissions to hospital can be avoided , and other solutions found e.g. Urgent outpatients, community support , GP follow up.

The skills shortage in A and E  and the admitting wards will be addressed by longer term solutions – redeployment of numbers of staff in training to those emergency specialities ,  and a hard look at how many A and Es can be staffed . Individual hospitals could look at how staff are deployed – and move more staff to care for  the emergency patients .

Closer working between hospitals, social care and the voluntary sector may help with  discharges – this is about relationships, not structures, but adequate funding needs to be in place. Community health services – e.g. District nurses, also need to be adequately funded .

There needs to be a relentless drive in hospitals to make timely discharge of patients a priority . Although some of the block is caused by lack of provision in social care, some of it is caused by internal hospital processes . Patients not being reviewed at the weekends, no  discharge plan being made on admission, waiting for tests, slow decision making etc.

Theres no doubt that the NHS needs more money – as does social care . An emergency injection of cash now could mean more staff are pulled in to deal with the current situation and emergency capacity purchased .

We need longer term plans to increase workforce , and longer term plans for better working relationships and processes across the whole system. The current crisis in emergency care is not one of A and E departments but the whole system.

The politics of this will play out . The government does not want such headlines , so may be forced to release some more money. The danger is that this talk of crisis gives ammunition to those who claim the NHS cannot work , and who would prefer to move to an insurance system with private providers.

We need to call it how it is, but also remember that most patients  are receiving good care from hard working staff despite the circumstances . And to work towards longer term solutions , including lobbying for more resources to both local government and the NHS


Dr Linda Patterson


Posted by on Jan 12, 2018 in Blog, Public Health | 0 comments

Bowel scope screening uptake increased by more than a fifth (21.5%) when people were sent additional reminders with a leaflet that addressed common concerns, according to a new study funded by Cancer Research UK and St Mark’s Hospital.*

The NHS bowel scope screening programme is gradually being rolled out in England to men and women aged between 55 and 59, prior to the bowel screening programme offered at 60.** It is a one-off, preventative and diagnostic test where a tiny camera is inserted into the bowel allowing doctors to find and remove any small bowel growths, called polyps, which could eventually turn into cancer.

The reminder letters, sent one and two years after the initial invitation, allowed people to choose the time of their appointment and the gender of the doctor performing the test.

The researchers found that the main concerns about the test included embarrassment, pain and fear of harm to the bowel. The leaflet, created by the researchers from University College London (UCL) with help from the public, included patient testimonials and advice from a named and pictured local GP to address this.

An invitation with an NHS information booklet and an appointment time is sent to the NHS-registered population at 55 years old. It is up to the recipient to confirm and attend their appointment. At two weeks, there is a further reminder to confirm the appointment. Around 40% of people attend their appointments with this system.***

Dr Robert Kerrison, lead researcher from University College London said: “Despite bowel scope screening attendance being low where it has been rolled out so far, this research shows that more could be done to improve uptake. Providing information targeting the concerns of patients is one way to break down the barriers to bowel scope screening uptake.”

Dr Jodie Moffat, Cancer Research UK’s head of early diagnosis said: “Cancer screening offers a lot of potential for reducing the burden of cancer but there are harms as well as benefits, so it’s important that people make their own decision about whether to take part or not. Studies such as this help us learn about the best way to provide information in a way that resonates with people and ensures we can minimise any unnecessary barriers to people taking part. To fully realise the potential of cancer screening we need a system that adopts research findings into practice and has enough of the right workforce to deliver what’s needed.”

Bowel cancer is the 4th most common cancer in the UK and over half of bowel cancer cases are diagnosed at a late stage in England.****

The study is published today in the Annals of Behavioural Medicine

Posted by on Jan 11, 2018 in Blog, NHS, Public Health | 0 comments

Muddling along

“Top dementia research charity calls on pharma to stay the course” is an odd headline, but the failure of trials of the “promising” new drug idalpirdine underline how expensive and unprofitable research into disease modifying drugs for Alzheimer’s Disease has become.

The charity, Alzheimer’s Research UK, has called for a recommitment from pharmaceutical companies to continue efforts to fund research into dementia.

Recent news that Pfizer – one of the manufacturers of the symptom-modifying cholinesterase inhibitor drugs for Alzheimer’s disease – will refocus efforts away from dementia research is a reminder of one of the barriers that stands in the way of bringing about the first life-changing treatment for dementia.

Investment in research comes with risks, says ARUK, and a number of initiatives are now in place to allow companies to spread this risk and continue investing in dementia. This includes collaborative efforts such as the Dementia Discovery Fund (DDF), which Alzheimer’s Research UK has invested in alongside Pfizer. The DDF works internationally with universities, pharmaceutical industry and biotechnology companies to identify and fund innovative early stage drug discovery research.

Dr Matthew Norton, Director of Policy at Alzheimer’s Research UK, the UK’s leading dementia research charity, said:

“We must continue to encourage companies to invest in research in dementia and neuroscience. We still lack life-changing treatments for dementia and the continued investment of pharmaceutical companies, which bring resources and expertise in drug discovery and clinical trials, is vital to improve the outlook for the 46 million people living with dementia worldwide.

“Although neuroscience research is high risk in that failure for pharmaceutical companies comes at a high price, the potential benefits of success to the millions of people around the world living with dementia are too great to ignore.

“Dementia is caused by diseases, which means it can be treated through advances in research. The UK is now a world leader in dementia research, and we hope that pharmaceutical companies will look at the long-term potential when deciding whether to participate in this effort. It is vital that all of us – charities, government and industry alike – make long-term commitments to dementia research if we are to bring an end to the fear, harm and heartbreak of dementia.”

Of course dementia may be a consequence of a life-time of accumulating harms and injuries to the brain. If it is there may be no cure. . Big Pharma may have come to this conclusion first. This is a disappointment for researchers, who focus on the chemicals in the brain rather than the brain’s experiences of the world. And it is a disappointment for psychiatrists, who would like a pill for every ill. Notice how the researchers have stopped talking about a cure (because it is unrealistic) and now talk of life-changing treatments rather than disease-modifying drugs. The language of dementia treatments is changing, perhaps to better manage expectations of success


Smooth operator?

Jeremy Hunt has kept his job and some people are pleased! Here’s Bruce Potter, chairman of national law firm Blake Morgan: “There has been much criticism of the so called ‘night of the blunt knives’ but one episode – Mr Hunt’s alleged refusal to move from health and to be given social care – seems to me to be an outbreak of sanity. First, health needs consistency not change like other parts of government.  Politicians efforts to distance themselves from the fate of the NHS have failed and arguably Hunt’s minimally invasive approach has been shrewder than many realise (with a few glaring exceptions). Second, Hunt’s demand to be given social care as well as health represents an aligning of responsibilities and challenges that has a surprising logic that has been absent from much recent health policy.  So well done Mr Hunt, let’s see what you can do!”

News from Nowhere’s moles agree about the social care responsibility but are puzzled by the “minimally invasive” attribute, and hope for clarification. They have no doubts, on the other hand, about the Secretary of State’s mellifluous use of words. Here is in 2015 saying how the NHS has to cope with demographic change, rising demand and technological advances (NHSEngland’s holy trinity).

“Let’s look at those challenges. And I think we have good news and bad news. If I start with the bad news it is that we face a triple whammy of huge financial pressures because of the deficit that we know we have to tackle as a country, of the ageing population that will mean we have a million more over 70s by 2020, and also of rising consumer expectations, the incredible excitement that people feel when they read about immunotherapy in the newspapers that gives a heart attack to me and Simon Stevens but is very, very exciting for the country. The desire for 24/7 access to healthcare. These are expectations that we have to recognise in the NHS but all of these add to a massive pressure on the system”.


Care Opinion: a new approach to feedback for a new kind of NHS organisation

Posted by on Jan 10, 2018 in Blog, NHS | 0 comments




During 2018 the NHS in many parts of England will move towards ACO/ACS models of care. The approach will vary from place to place, and may also evolve over time as local collaborations change.

The King’s Fund points out:

There is no single model for an ACO and so local context is important in shaping the approach taken in different areas. In some places, it is likely that working towards integrating hospital, community, mental health and adult social care services will make sense, whereas in others there will be an appetite for more broadly-based partnerships. Elsewhere, horizontal integration, such as hospital chains and groups, may be the focus.

This context of emerging organisational forms, new networks of care and multi-agency collaboration requires a new, modern and flexible approach to gathering and learning from the experiences of those who use services. Care Opinion is a perfect fit for the new landscape of ACOs.

About Care Opinion

Care Opinion CIC is an award-winning, non-profit feedback platform for health and social care across the UK. Since 2005 we have pioneered a new approach to hearing and learning from people’s experiences of the health/care services they rely on.

Our mature and values-based service has gained a national and international reputation, and is now used in three countries. In the UK we work with 600 health and social care organisations, and are visited by 100,000 people each week.

Our mission is to provide an online platform so that:

  • people can share honest feedback easily and without fear
  • stories are directed to wherever they can help make a difference, and
  • everyone can see how and where services are listening and changing in response

Our values are innovation, transparency, inclusivity, positivity and humanity.

(More details: )

Listening to what an emerging ACO/ACS wants

New systems of care require new thinking on the possibilities and potential of feedback, going far beyond the limited value of the NHS Friends and Family test. Increasingly, people want to see an approach which:

  • is clearly aligned with NHS values
  • serves the needs of both patients and staff
  • enables authentic voices to be heard
  • is transparent and accountable
  • is as real-time as possible, to support rapid resolution/improvement
  • can work across multiple organisations
  • engages and motivates staff
  • is both effective and cost-effective
  • avoids onerous data entry, paperwork, or copying and pasting
  • makes a genuine difference to care, culture and morale

Our experience over more than a decade of research, development and learning is that Care Opinion meets all of these challenges.

Why Care Opinion is a good fit for the new ACO/ACS landscape

Care Opinion has a number of attributes which set it apart from traditional, organisation-centric approaches to feedback. These include:

Person-centred Care Opinion starts from what people want to say, not from what organisations want to ask. So you learn about things you didn’t realise were important. And a feedback donor need tell their story just once: we share it will all the relevant organisations. Feedback is person-centric, not organisation-centric.
Accessible Care Opinion is online and accessible to people with a range of sensory impairments. BSL videos are linked from every page, and we recently added our innovative “picture stories” feature to help people with cognitive impairments tell their stories too.
Integrated Care Opinion works across all the organisations in an ACO/ACS. It spans commissioners and providers, health and social care. You can include the healthwatch, PPGs and local patient voice groups too.
Flexible As the ACO/ACS evolves, Care Opinion evolves too. We remain endlessly flexible as the world changes.
Two-way Almost every current health/care feedback system is one-way: so there is no room for resolving concerns, clarifying issues or making connections. Care Opinion is safe, simple and two-way.
Transparent Every Care Opinion post is moderated by an expert human, prior to publication. Responses are published too. The transparency that results spreads trust, understanding and learning among staff and patients alike.
Built for learning and change Simply collecting data won’t improve services or change culture. Feedback has to be shared, understood and acted on to make a difference. At Care Opinion, encouragement for change and learning is built into the platform.
Fully supported Care Opinion is more than a feedback platform: it’s also a journey which requires vision, courage and persistence. We provide unlimited phone and email support to keep you on track.


How Care Opinion works, in a nutshell

Care Opinion is an online feedback platform, and can also accept feedback by post and phone.

  1. People post their stories on the site, saying what was good and what could have been better. Each story is linked to the services it relates to.
  2. Every story is moderated by Care Opinion, before publication.
  3. On publication, relevant staff across multiple organisations can be alerted. Staff can control their own alerts.
  4. Authorised staff can respond online, as often as needed to resolve an issue. The story author may also respond. Everyone learns from the exchange.
  5. Over time, trust is built and culture becomes more open to feedback and learning.

Here are examples of effective responding creating change and building trust:

In addition, Care Opinion includes built-in flexible tools for

  • Searching
  • Reporting
  • Alerting
  • Blogging
  • Data visualisation
  • Service page customisation

Flexible, right across the health economy

Care Opinion works right across the health economy in a flexible way to suit local circumstances. This means that we can involve and work with

  • ACOs of any shape
  • Commissioners (including local authorities)
  • Healthwatch
  • Local patient voice organisations
  • General practices, individually as well as in federations
  • Practice participation groups

James Munro, 4 January 2018

Find out more

This is just the start: we have much more we can share with you! To find out more:


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